Diabetes

1. Diabetes • Tips on Educating people with Diabetes • By Judith Croasmun RN, BSN.

2. What is Diabetes? • Diabetes is a disease in which the body does not produce or properly use insulin. • Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. • The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play a major role.

3. Statistics: According to the American Diabetes Association • Out of the entire Unites States population(303 million) in 2007: • There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. • Diagnosed with Type I: 1.2-2.4 million people. • Diagnosed with Type II: 21.4-22.4 million people. • There are 5.7 million people undiagnosed (or nearly one quarter) and are unaware that they have the disease. • There are an additional 57 million people with pre-diabetes. • There are 1.6 million new cases diagnosed each year in adults over the age of 20.

4. Statistics Continued. • Diabetes and complications of diabetes is the 7th leading cause of death in the United States. • The risk of death among people with diabetes is about twice that of people without diabetes. • Heart disease is the leading cause of diabetes related deaths (68%); adults with diabetes have rates 2-4 times higher than those without diabetes. • Stroke: the risk of stroke is 2-4 times higher among people with diabetes. • Other complications are hypertension, blindness, kidney disease, nervous system diseases such as gastro-paresis, amputations, erectile dysfunction and pregnancy complications. • COSTS: Total costs (direct and indirect): $174 billion. • Direct costs are $116 billion. Indirect costs are $58 billion( disability, work loss, premature mortality).

5. Risk Factors Risk factors include: · Obesity · Lack of exercise · Family history of diabetes · Pre-diabetes · Ethnicity: African-American, Hispanic-American, Native American, Asian-American, and Pacific Islander · Gestational diabetes during Pregnancy or baby weighing more than 9 pounds · High triglycerides, high cholesterol, low HDL

6. A1C what does it mean? • The A1C is the average of the blood sugar over a 2-3 month time period. • Your blood cells have a memory. The A1C measures the amount of sugar that attaches to protein in the red blood cell. The average red blood cell only lives 3 months. Thus why the A1C measures are 2-3 month average of the pt glucose. O Red blood cell Glucose Protein

7. What should the A1C be? • The American Diabetes Association (ADA) recommends the A1C be under 6.4. • A Comparison of A1C as it correlates to the blood glucose level. • A1C Blood glucose • 4 % 65 • 5 % 100 • 6 % 135 • 7 % 170 • 8 % 205 • 9 % 240 • 10 % 275 • 11 % 310 • 12 % 345 • 13 % 380

8. Prevention • Glucose Control • Studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, every percentage point drop in A1C blood test results for example, from 8.0 to 7.0 percent can reduce the risk of microvascular complications eye, kidney, and nerve diseases by 40 percent. • In patients with type 1 diabetes, intensive insulin therapy has long-term beneficial effects on the risk of cardiovascular disease. • Blood Pressure Control • Blood pressure control reduces the risk of cardiovascular disease, heart disease, or stroke, among persons with diabetes by 33 to 50 percent, and the risk of microvascular complications, eye, kidney, and nerve diseases, by approximately 33 percent. Control of Blood Lipids Improved control of LDL cholesterol can reduce cardiovascular complications by 20 to 50 percent.

9. The Signs of Diabetes are: • eing very thirsty • Urinating often • Feeling very hungry or tired • Losing weight without trying • aving sores that heal slowly • aving dry, itchy skin • Losing the feeling in your feet or having tingling in your feet • aving blurry eyesight

10. Symptoms: Hypoglycemia can make you feel; Weak Confused Irritable Hungry Tired/fatigue Sweaty Headache. Shaky. Very low blood glucose can cause the patient could pass out or have a seizure. Hypoglycemia • Causes: • Taking too much diabetes medicine. • Missing a meal • Delaying a meal. • Exercising more than usual • Drinking alcoholic beverages. • Medicines taken for other health problems can cause blood glucose to drop.

11. Hypoglycemia Treatment • If you have any of these symptoms, check your blood glucose. If the level is 70 or below, have one of the following right away. Have one of these "quick fix" foods when your blood glucose is low. • 3 or 4 glucose tablets • 1 serving of glucose gel (equal to 15 grams of carbohydrate) • 1/2 cup (4 ounces) of any fruit juice • 1 cup (8 ounces) of milk • 1/2 cup (4 ounces) of a regular (not diet) soft drink • 5 or 6 pieces of hard candy • 1 tablespoon of sugar or honey

12. Symptoms Very thirsty Tired Blurry vision Frequent urination Nausea If your blood glucose is high much of the time, or if you have symptoms of high blood glucose, call your doctor. You may need a change in your diabetes medicines, or a change in your meal plan. Hyperglycemia: High blood glucose means you don’t have enough insulin in your body. • Causes • If your blood glucose stays over 180, it may be too high. • High blood glucose, or “hyperglycemia,” can happen if you miss taking your diabetes medicine. • Eat too much. • Don’t get enough exercise. • Medicines you take for other problems cause high blood glucose. • Infection, being sick • Stress

13. Hypoglycemia treatment • After 15 minutes, check your blood glucose again to make sure your level is 70 or above. • Repeat these steps as needed. Once your blood glucose is stable, if it will be at least an hour before your next meal, have a snack. • If you take diabetes medicines that can cause hypoglycemia, always carry food for emergencies. • It’s a good idea also to wear a medical identification bracelet or necklace.

14. Hyperglycemia Treatment • Drink more water. Water helps remove the excess glucose from your urine and helps you avoid dehydration. Speak to your Provider if you are a dialysis patient or have CHF. • Exercise more. Exercise will help to lower your blood glucose. Caution: If you have type 1 diabetes and your blood glucose is over 240 mg/dL, you need to check your urine for ketones. • When you have ketones, Do NOTexercise. If you have type 2 diabetes and your blood glucose is over 300 mg/dL, even without ketones, do NOT exercise. Change your eating habits. You may need to meet with the dietitian to change the amount and types of foods you are eating. If you have type 1 diabetes and your blood glucose is more than 250 mg/dL, your doctor may want you to test your urine or blood for ketones. Call your doctor if your blood glucose is consistently greater than 180 mg/dL 1-2 hours after a meal or if you have two consecutive readings greater than 300 mg/dL.

15. Educating People Who are Newly Diagnosed Diabetics in Family Practice • First: Find out what the patient knows about diabetes, ask if the patient has anyone in their family with diabetes ( rationale: allows them to voice any knowledge of the disease learned from family members). • Second: Find out if they have family members that can be a support system for them. Patients with newly diagnosed diabetes often have many pre-conceived notions on what happens to those who have diabetes including loss of limbs through amputations .

16. People with diabetes are go through many different feeling on having diabetes including Anger, fear, depression, grief. Loss of control. • Third. Get them, supplies and a monitor. Set up the machine with date and time and memory. Instruct them to bring the monitor to every visit to check their levels if they don’t record in a log. • Next make a verbal contract with the patient to make a commitment to check their glucose level twice a day for at least 2 weeks and to record the date, time, and the BS level in a journal. • Give pt written information on the signs and symptoms of both hyper and hypoglycemia and have them use it to educate the patients family on the signs and symptoms in the event the pt is glucose is out of whack and the pt is unaware of their levels or if they are not acting right confused , sleepy ect.

17. Foot Ulcers/Infections on the diabetic foot • Statistics • Foot problems affect 15-20% of all pt’s with diabetes. • Diabetes foot ulcers are the cause of 86,000 of lower extremity amputations. • Healthcare cost of the pt with diabetes exceed $1 Billion . • What tests should be done on the foot at every visit by the provider ? • Visual examination • Palpation • Monofilament test • Tuning fork test • Inspection of foot wear (Why? Because there is a decrease in sensation on foot and the patient may not realize they are forcing their feet in to shoes that may be to small)

18. Teach people with Diabetes how to care for their feet. Tell them to: • Check feet daily for cuts, sores, red spots, and infected toe nails. • Wash feet daily, and pat dry. Apply lotion to keep the skin soft. DO NOT apply lotion between the toes. • Always wear shoes and socks. • Have a family member with you when you purchase shoes. The person with diabetes often has decreased sensation in their feet and this can lead to buying shoes that are to tight. When examining the feet make sure to check for any areas that are red/marks made by a to tight shoe. • Never go bare foot outside. • Protect your feet from hot and cold. Do not use heating pads or hot water bottles on your feet.

19. What are factors that increase risk of amputation? • Loss of sensation • Erythema or hemorrhage under a callus. • Bony Deformity such as Charcot foot. • PAD • Hx of ulcers • Diabetes for more than 10 years. • Male gender • Poor glycemic control. • Cardiovascular dz. • Renal dz. • Retinal dz.

20. Will Medicare pay for diabetic shoes? • Medicare will cover the cost of one pair of therapeutic shoes (diabetic shoes) and inserts for people with diabetes if you have a medical need for them. The Medicare payment for therapeutic shoes is subject to the requirement that they are necessary and reasonable for protection of insensitive feet or neuropathy

21. Teaching pts to self inject insulin • Clean site with alcohol, and let dry. • Pinch up skin and inject at a 45 degree angle. If using a pen leave the needle in the sq tissue for at least 6 seconds. • Rotate injection sites with every injection. • Insulin works most effective in the abdomen. • When using a flex pen to inject insulin have the pt hold it like you would clinch a fist around it and the place the thumb on the top and press firmly on the button. • Teach the pt to tap on the syringe to get out air bubbles and to dial up 2 units of insulin to insure the pt get the accurate amount on medication and not air. If there is still air then tap again and perform another air shot with 2 more units. It can take up to 6 times to get a large air bubble out. • Change the needle daily. • Dispose of syringes and needles in a empty laundry bottle with a cap to ensure safety of family members.

22. Diabetes Resources • http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm • www.diabetes.org/pro