2. GLUCOSE REGULATION KRISTIN DEJONGE FERRIS STATE UNIVERSITY MSN PROGRAM

3. OBJECTIVES 1.Demonstrate application of pharmacology, pharmacotherapeutic, assessment, and pathophysiologic principles related to glucose regulation. 2.Discuss factors that influence glucose regulation and integrate current evidence-based knowledge. 3.Apply Virginia Henderson’s Unique Functions Theory. 4.Reflect on potential teaching tools for nursing education.

4. OVERVIEW: GLUCOSE REGULATION Definition Scope and Categories Risk Factors (Giddens, 2012)

5. PATHOPHYSIOLOGY Endocrine system Insulin (pancreas) Glucagon (pancreas) Secondary Processes Cortisol Epinephrine Hyperinsulinemia (Giddens, 2012) (McCance & Huether, 2014)

6. HYPERGLYCEMIA (McCance & Huether, 2014)

7. HYPERGLYCEMIA: CLINICAL MANIFESTATIONS Type 1 Diabetes (Insulin deficient) Autoimmune deficiency Secondary to other disease Type 2 Diabetes (Insulin resistant) Environmental & genetic components Metabolic syndrome Gestational diabetes (glucose intolerance) Physiologic complications: Blood vessels: vessel membrane changes, hypertension, PVD, cardiovascular disease (McCance & Huether, 2014)

8. HYPOGLYCEMIA Exogenous factors Medications or exercise Endogenous factor Pancreatic tumor Functional factors Liver disease Symptoms: tachycardia, palpitations, diaphoresis, tremors, confusion, visual changes, and seizures. Brittle Diabetes (Giddens, 2012) (McCance & Huether, 2014)

9. ASSESSMENT SKILLS Skin: Acanthosis nigricans Vascular changes Central Obesity Vision Diagnostic tools: Fasting BG Hemoglobin A1c Glutamic acid decarboxylase Associated problems Symptomatic history (Ball, Dains, Flynn, Solomon, & Stewart, 2015) (Giddens, 2012) (McCance & Huether, 2014)

10. RESEARCH STUDY Systematic review using a priori research protocol to review the effectiveness of lifestyle interventions on high risk individuals & individuals already dx with type 2 diabetes Lifestyle interventions effectively decrease risk for diabetes Lifestyle interventions did NOT decrease cardiovascular outcomes for those with Type 2 diabetes Schellenberg, Dryden, Vandermeer, Ha, & Korownyk, 2013

11. PHARMACOLOGY & PHARMOCOTHERAPEUTICS Oral antidiabetic agents Short duration; rapid acting Short duration; slower acting Intermediate duration Long duration InsulinGlucoseGlucagon (Giddens, 2012) (Lehne, 2013)

12. PHARMACOLOGY & PHARMOCOTHERAPEUTICS (Giddens, 2012)

13. THEORY Virginia Henderson’s Unique Functions of Nurses Theory “the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery that the person would perform unaided given the necessary strength, will, or knowledge. And to do this in such a way as to help the individual gain independence as rapidly as possible” (Henderson, 1997, p. 22). (Henderson, 1997)

14. CONCEPT TEACHING TOOLS Case Studies Develop critical thinking Understand collaboration to meet needs A Conversation Map Create a group of patients who have diabetes Stimulate discussions on self-care and interventions (Sandstrom, 2006) (Strang, Bagnardi, & Williams, 2010)

15. CONCEPT TEACHING TOOLS Concept Map Understand connections & system relationships Varied learning styles, aid the visual learners

16. SELF REFLECTION

17. CONCLUSION

18. REFERENCES