Diabetes CMT Training The Center for Life Enrichment Resource: MTTP Student Manual

What is Diabetes? Diabetes is a disorder in which the body does not properly utilize or release insulin which results in abnormally high levels of serum (blood) glucose

The Normal Process of Digestion In the normal process of digestion, consumed sugars and starches (carbohydrates) and other foods are changed into a form of sugar called glucose Glucose is distributed throughout the body and is used as the energy source for the body’s cells The rise in blood sugar associated with eating triggers the pancreas to secrete the hormone called insulin

Why is Insulin Important? Insulin is required to allow the blood glucose to leave the bloodstream and either enter the body’s cells where it is used for energy or enter the liver where it is stored for future use In diabetes, either the body does not properly use the insulin that is secreted by the pancreas or the pancreas secretes too little or no insulin

The End Result If the body does not properly use the insulin that is secreted by the pancreas or the pancreas secretes too little or no insulin, the glucose collects in the blood These high levels of blood glucose, over time, cause complications such as: Damage to the retinas of the eyes (Diabetic Retinopathy) Nerve damage (Neuropathy) Kidney failure Blood vessel damage (increasing the incidence of heart attack & stroke) Reduced circulation (increasing the risk of infection and the potential for amputation) Impotence Complications of pregnancy

Two Types of Diabetes Type I Diabetes Type II Diabetes The pancreas secretes too little or no insulin The person must receive insulin injections to allow the blood glucose to be utilized and/or stored properly The insulin that is produced by the pancreas cannot be utilized effectively Diet & exercise are employed as the first line of treatment If diet & exercise are not sufficient, oral agents or insulin may be required

Why Does Diabetes Occur? The exact cause of diabetes is not known

Why Does Diabetes Occur? Continued… Type I Diabetes Type II Diabetes Scientists believe that a genetic predisposition coupled with environmental factors cause the immune system to attack the pancreas and destroy the cells that produce insulin Most people who have Type I Diabetes develop the disease before the age of 30 Though the pancreas continues to produce insulin, the insulin is ineffective Identified risk factors for Type II Diabetes: Obesity (excessive fat prevents insulin from working properly) Specific racial/cultural groups (African Americans and Hispanics have a higher incidence) Family History Diet, exercise, and oral medications are used for treatment

Signs & Symptoms of Type I Diabetes Oftentimes, signs and symptoms of Type I Diabetes occur suddenly and include: Frequent urination (polyuria) Increased thirst (polydipsia) Rapid weight loss (often in the presence of increased appetite – polyphagia) Irritability Nausea & vomiting

Signs & Symptoms of Type II Diabetes The signs & symptoms of Type II Diabetes are usually more gradual in onset In addition to the signs & symptoms mentioned on the previous slide, the signs & symptoms of Type II Diabetes may include: Hard to heal infections (especially of the skin, gums, or bladder) Vision changes Tingling or numbness of the distal extremities Itching Tiredness

The Importance of Routine Exams Regular medical check-ups which include laboratory monitoring are critical in detecting abnormally high blood glucose levels Physical exams are encouraged annually by TCLE

Treatment The goal of medication therapy for both Type I and Type II Diabetes is to maintain the blood sugar levels within normal range Acceptable normal standards are from 70 to 110 mg/dl

Treatment – Type I Diabetes In Type I Diabetes, the treatment is to provide insulin directly to the body Insulin is injected under the skin into the fat layer of the body The fatty tissue of the upper arm, thigh, and abdomen are the usual sites for administration CMTs required to administer insulin receive special training from the RN CM/DN before they are authorized to administer insulin Small syringes with very thin needles, insulin pens, or insulin pumps may be used CMTs are not allowed to calculate the insulin dose. CMTs may be delegated the task of measuring insulin/filling the insulin syringe at the discretion of the RN CM/DN

Treatment – Type II Diabetes When an individual is diagnosed with Type II Diabetes, dietary restrictions and an increase in exercise will be tried to lower blood sugar levels adequately If diet and exercise are not effective, oral hypoglycemic agents will be utilized to lower blood sugar levels adequately Oral hypoglycemic agents work by stimulating the pancreas to increase the production of insulin, by increasing the effectiveness of the insulin produced, or by increasing the body’s ability to utilize its own insulin If the body does not respond to oral agents, insulin injections may be required

Unwanted/Side Effects of Medication Unwanted/side effects of the medications used to treat diabetes and complications of the disease requiring emergency intervention include: Hypoglycemia Hyperglycemia DKA (Diabetic Coma)

Hypoglycemia Hypoglycemia (low blood sugar) occurs more commonly in individuals taking insulin Often referred to as insulin shock or insulin reaction Hypoglycemic reactions can occur suddenly

Signs & Symptoms of Hypoglycemia Feeling shaky Becoming sweaty Feeling tired, weak, or nervous Feeling hungry Becoming irritable or confused Developing a headache Developing a rapid heart rate

Treatment of Hypoglycemia It is critical that low blood sugar be treated immediately to avoid unconsciousness and brain damage If the person is conscious, administer a quick acting sugar by mouth to keep the person from losing consciousness: 1/2 cup of sweetened fruit juice (OJ or Apple) Hard candy 1/2 cup of regular soda GlucoTabs If the person is unconscious, injecting Glucagon will stimulate the release of the stored form of glucose, glucogen, from the liver 911 should be called and the person should be transported to the nearest emergency room for evaluation and stabilization CMTs receive individualized training from the delegating nurse before being authorized to administer glucagon

Hyperglycemia Hyperglycemia (high blood sugar) occurs when the individual’s blood sugar rises well above the normal range and stays there—240 mg/dl or higher Hyperglycemia results from dietary indiscretions, too little medication, illnesses, and/or stress Hyperglycemia often has a slower pattern of onset

Signs & Symptoms of Hyperglycemia Thirstier than usual Hungrier than usual More frequent urination Getting up at night to urinate Dry, itchy skin More tired than usual Changes in vision Infection Cuts or sores that heal slower than normal

Treatment of Hyperglycemia The best treatment is prevention Eat according to the prescribed meal plan Take medications as prescribed Monitor blood sugar levels Maintain a routine pattern of exercise If hyperglycemia persists, call the delegating nurse/Health Care Professional

Diabetic Ketoacidosis (DKA) DKA (diabetic coma) is a dangerous condition that is usually only seen in Type I diabetics DKA occurs when an imbalance between insulin and blood sugar is so out of control that ketones are produced and accumulate in the blood At high levels, ketones are poisonous to the body

Signs & Symptoms of DKA Dry mouth Excessive thirst Loss of appetite Excessive urination Dry/flushed skin Labored breathing Fruity smelling breath (acetone odor) Vomiting Abdominal pain Unconsciousness If an individual is suspected of having DKA, the delegating nurse should be contacted and 911 called

Your Responsibilities It is important for the individual/care giver to: Inform the delegating nurse of any changes in health Know that the individual should wear a medic alert bracelet Observe for signs and symptoms of hypoglycemia and hyperglycemia, and intervene appropriately Follow the prescribed diet Maintain a regular pattern of exercise Know that the individual should avoid the use of alcohol See a podiatrist regularly for foot care Follow the Nursing Care Plan for foot care

Questions? If you have any questions or concerns related to Diabetes and our participants, contact TCLE’s delegating nurse 301-373-8100 *821