Diabetes in the Work Place Presented by Marie Byrd, RN, MSN, CCRN Inpatient Diabetes Coordinator Cone Health

Objectives  Outline basic pathophysiology of normal glucose metabolism  Define diabetes and explain classifications of diabetes  Discuss glucose metabolism with diabetes  Identify risk factors for developing diabetes  Review acute and chronic complications of uncontrolled diabetes  Identify diabetes educational resources  Identify 2 symptoms of hypoglycemia and hyperglycemia  Be able to identify goals for Hgb A1C and fasting blood sugars  Understand how food choices can affect blood sugar levels and name 3 food groups that contain high carbohydrate foods

Knowledge Assessment  Who has diabetes or has a family member with diabetes?  Who feels they are knowledgeable on diabetes and what needs to be done to control diabetes on a daily basis?  Who knows what to do for someone experiencing symptoms of low blood sugar?

In people without diabetes, glucose stays in a healthy range mg/dl because; Normal Blood Glucose Control Insulin is released at the right times and in the right amounts Insulin helps glucose enter cells

The digestive system breaks down carbohydrates from food into glucose. Some of that glucose is stored in the liver and muscles, but most of it enters the bloodstream and travels to cells to be used as energy. Stomach Blood stream Glucose

When insulin reaches a cell, it allows glucose to enter into that cell. *Think of insulin as a key that allows glucose to enter the cell. Glucose needs help from insulin to enter most cells. Insulin is produced by the pancreas. Pancreas Cell Insulin  ENERGY

What is diabetes? Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia (high blood sugar) resulting from defects in insulin secretion, insulin action, or both* *American Diabetes Association. (2008). Diagnosis and classification of diabetes mellitus. Diabetes Care, 31(1), S55-S60.

Burden of Diabetes in the United States Diabetes  29.1 million people or 9.3% of the population have diabetes  8.1 million people or 27.8% of people with diabetes are undiagnosed  Leading cause of: new blindness among adults kidney failure non-traumatic lower-limb amputations  Increases the risk of heart attack and stroke by 2-4 fold  7 th leading cause of death  Mortality rates 2-4 times greater than non-diabetic people of the same age Source: Centers for Disease Control and Prevention 2014 National Diabetes Statistics Report Diabetes 101: American Diabetes Association

Diagnostic Criteria for Diabetes Prediabetes: A1C of 5.7 to 6.4 A1C > 6.5 OR Fasting plasma glucose (FPG) >126 mg/dl OR Two-hour plasma glucose >200 mg/dl during an Oral Glucose Tolerance Test OR A random plasma glucose >200 mg/dl with symptoms of hyperglycemia ADA. I. Classification and Diagnosis. Diabetes Care 2013;36(suppl 1):S13. Table 2.

Hemoglobin A1C (HGB A1C)  HgbA1c reflects long-term blood glucose control and provides an average blood glucose for the past 2-3 months  Goal HgbA1c: <7.0%  Diagnosis of diabetes= HgbA1c of 6.5% or greater

Types of Diabetes Type 1 Diabetes  % of all diabetes  due to beta cell destruction; usually develops prior to age 30  Absolute insulin deficiency as the body does not make any insulin Type 2 Diabetes  90-95% of all diabetes  Result of insulin resistance and decreased insulin secretion  Risk of developing Type 2 diabetes increases with family history, age, obesity, lack of exercise, gestational diabetes, ethnicity African American, Asian, Hispanic) Gestational Diabetes  Diabetes during pregnancy  Result of the hormonal changes in the placenta that influence the blood glucose levels of the mother

Glucose Metabolism With Diabetes  You may not make any insulin at all (Type 1)  You may not make enough insulin (Type 2)  Your cells may not respond the right way to insulin in the blood (Type 2)  Which means glucose has trouble entering the cells and if it cannot enter the cells it leads to a harmful levels in the blood stream

Risk Factors for Developing Diabetes Risk factors for type 1 diabetes are still being researched but currently:  Having a family member with type 1 diabetes slightly increases the risk of developing the disease  Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes Several risk factors have been associated with type 2 diabetes and include:  Non-modifiable risk factors:  Family history of diabetes  Being over 45 years of age  Ethnicity  History of gestational diabetes  Modifiable risk factors:  Overweight  Unhealthy diet  Physical inactivity  High blood pressure  Poor nutrition during pregnancy International Diabetes Federation. (2014). Risk Factors. Retrieved from

1. Diabetes mellitus is defined as: a) Too much sugar or glucose in the blood stream b) Too much insulin in the blood stream c) Being overweight 2. What is the most common form of diabetes? a) Type 1 diabetes b) Type 2 diabetes 3. Which classification of diabetes consist of individuals that make no insulin? a) Type 1 diabetics b) Type 2 diabetics

Initial Diabetes Symptoms The following symptoms of diabetes are typical. However, some people with type 2 diabetes have symptoms so mild that they go unnoticed. Common symptoms of diabetes:  Urinating often  Feeling very thirsty  Feeling very hungry - even though you are eating  Extreme fatigue  Blurry vision  Cuts/bruises that are slow to heal  Weight loss - even though you are eating more (type 1)  Tingling, pain, or numbness in the hands/feet (type 2)  Early detection and treatment of diabetes can decrease the risk of developing the complications and harmful effects of diabetes such as damage to the eyes, heart, blood vessels, nervous system, teeth and gums, feet and skin, or kidneys. American Diabetes Association. (2015). Diabetes symptoms. Retrieved from:

Acute Complications of Diabetes  Hypoglycemia-Low blood sugar < 70 mg/dL  Hyperglycemia-Blood sugar > 200 mg/dL  Hyperglycemic Crisis  Diabetic Ketoacidosis  Hyperosmolar Hyperglycemic  Steroid induced hyperglycemia

Signs & Symptoms of High Blood Sugar  Excessive thirst  Frequent urination  Hunger  Weakness  Fatigue  Weight loss  Blurry vision

Headache Sweatiness Impaired vision Ringing in ears Increased heart rate Hunger Tingling/numbness of the tongue Feeling sleepy Trembling Irritability Lack of coordination Personality change Passing out Seizures Signs & Symptoms of Low Blood Sugar

How to Treat a Low Blood Sugar  Use 15:15 rule – Treat with 15 grams of carbohydrates and recheck blood glucose in 15 minutes (typically brings blood glucose up 50 points)  Examples of 15 grams of carbohydrates:  4 oz. (1/2 cup) juice  4 oz. (1/2 cup) regular soda  8 oz. (1 cup) skim milk  3-4 glucose tablets  1 tube instant glucose  Do Not over treat!  If unable to take anything by mouth, may need Glucagon depending on level of severity.

1. Which of the following is a symptom of low blood sugar? a. Drinking a lot of fluids b. Excessive urination c. Tremors d. Weight loss 2. Which of the following is considered a low blood sugar? a. 78 mg/dl b. 62 mg/dl c. 80 mg/dl

Long Term Complications of Diabetes  “Diabetes can affect many parts of the body and is associated with serious complications, such as heart disease and stroke, blindness, kidney failure, and lower-limb amputation. Some complications, especially microvascular (e.g., eye, kidney, and nerve) disease, can be reduced with good glucose control. Also, early detection and treatment of complications can prevent progression, so monitoring with dilated eye exams, urine tests, and foot exams is essential. Because the risk of cardiovascular disease is increased in diabetes and prediabetes, blood pressure and lipid management, along with smoking cessation, are especially important. By working together, people with diagnosed diabetes, their support network, and their health care providers can reduce the occurrence of these and other complications” (CDC National Diabetes Statistics Report, 2014; states.pdf).

Chronic Complications of Diabetes  Heart & blood vessel damage (increase risk of heart attack and stroke)  Nerve damage (Neuropathy)  Kidney damage (Nephropathy)  Eye damage (Retinopathy)  Foot damage (ulceration and amputations)  Lower limb damage (Peripheral Vascular disease)  Mental health issues (Depression, Alzheimer's)  Periodontal disease

How is diabetes managed?  Meal plan  Physical activity  Blood glucose monitoring  Take diabetes medications  Maintain ABCs (A1C, blood pressure, cholesterol)  Follow up with Healthcare Provider regularly  Stress management

Type 2 diabetes progression and screening  In type 2 diabetes, the pancreas continues to secret insulin but the body cannot use insulin properly; this condition is called insulin resistance. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin.  Type 2 diabetes develops slowly over months and years, so screening programs for early detection and treatment are important in employee populations

Managing Type 2 Diabetes  Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan and a program of regular physical activity, losing excess weight, and taking medications (such as oral medications and insulin). Medications for each individual with diabetes will often change during the course of the disease.  Self-management education or training focuses on self-care behaviors, such as healthy eating, being active, adhering to medications, learning coping skills, and monitoring blood glucose.  Many people with diabetes also need to take medications to control their blood pressure and to control their cholesterol. CDC National Diabetes Statistics Report, 2014; its-burden-in-the-united-states.pdf

‘ABCDE’ of Diabetes  A-A1C  B-Blood Pressure  C-Cholesterol  D- Diet  E - Exercise

Survival Skills of Diabetes  Medication management- how and when to take  Nutritional management-Dietitian consult – what to eat and the role of carbohydrates on blood glucose management  Exercise- get active  Signs &Symptoms of hyperglycemia and hypoglycemia- what you may feel like if blood glucose is too low or too high and how to treat it  Blood glucose monitoring - how to obtain and what the measurement means  Sick Day guidelines  Healthy coping  Reducing risks and complications  Who and when to contact in case of emergency  Plan for self-management support

Questions Contact information: Marie Byrd Office number:

References  American Diabetes Association. (2013). Classification and Diagnosis. Diabetes Care 2013;36(suppl 1):S13. Table 2.  American Diabetes Association. (2015). Diabetes complications. Retrieved from:  American Diabetes Association. (2015). Diabetes symptoms. Retrieved from:  American Diabetes Association. (2008). Diagnosis and classification of diabetes mellitus. Diabetes Care, 31(1), S55-S60.  Centers for Disease Control and Prevention. (2014). National Diabetes Statistics Report. Retrieved from: of-diabetes-and-its-burden-in-the-united-states.pdf  Centers for Disease Control and Prevention. (2014). National Diabetes Statistics Report Diabetes 101: American Diabetes Association. Retrieved from:  International Diabetes Federation. (2014). Risk Factors. Retrieved from