Diabetes MellitusDiabetes Mellitus (DM): a disease where the

body cannot use glucose normally to meet the energy needs of the body

In people over 65, 1 in 20 require treatmentInsulin is produced in the pancreas. During this

disease process, usually the beta cells of the pancreas cease to function properly.

Two Main Types of Diabetes: Insulin-dependent diabetes mellitus (IDDM) (Type

1) Non-insulin-dependent diabetes mellitus

(NIDDM) (Type 2)

Diabetes MellitusIDDM: In this disease, the beta cells of the pancreas

are damaged and can not produce or don’t produce enough insulin

Insulin is required for the metabolism of glucose

With no insulin, the glucose can not be absorbed by the cells for energy, and accumulates in the bloodstream.

Most often seen in younger people

Diabetes MellitusNIDDM:In this disease, insufficient insulin is

produced or the body ignores the insulinThis results in glucose not being absorbed by

the cells and the glucose accumulating in the blood stream.

Also known as old-age diabetesThis form is more stable than IDDM with

fewer incidents of diabetic coma or insulin shock

Diabetes MellitusSigns and Symptoms:IDDM: Abrupt onsetPolydipsia- excessive thirstPolyuria- excessive urinationPolyphagia- excessive hungerGlycosuria-sugar in the urineHyperglycemia- excessive sugar in the

bloodstream

Diabetes MellitusNIDDM:Patient is usually over weight with a sore or

infection and possibly constant fatigueFatigues easilySkin infections/ slow to healItchingBurning on urinationPain in fingers and toesVision changes

Diabetes MellitusComplications of DM:Renal FailureVision ChangesCardiovascular DamageHyperglycemiaHypoglycemia

Diabetes MellitusRenal Disease:A build up of glucose in the bloodstream

damages all vessels and organs. The crytals are very damagingNote increased itching due to the inability of

the kidneys to remove toxins from the bloodstream

Burning up urination is noted due to the glucose build up in the urine being caustic to the internal organs.

Diabetes MellitusVision ChangesCommon in long term diabetesGlaucoma-increased intraocular pressure

resulting in atrophy of the optic nerveCataracts- an opacity of the lens of the eye usually

occurring as a result of aging, trauma, endocrine or metabolic disease

Retinitis proliferans- inflammation of the retina marked by masses of connective tissue that project from the retina into the vitreous

Blindness-caused by diseases of the lens, the retina or the eye structures; diseases of the optic nerve; or lesions of the visual cortex or pathways of the brain

Diabetes MellitusCardiovascular Damage:Heart AttacksStrokesPeripheral Vascular Disease (PVD)AmputationVascular changes can interfere with the

normal circulation to the legs and feetDamage may be so extensive that the tissues

of the toes, feet, and legs may dieGangrene followed by amputation is common

Diabetes MellitusHyperglycemia- occurs when too little insulin is

available for metabolic needsSugar and acid compounds (ketones) build up in

the blood Known as diabetic ketoacidosis (DKA)Can lead to deathSugar and Ketones can spill over into the urine

First Symptoms:HeadacheConfusionDrowsinessIrritable

Diabetes MellitusTreatment of Hyperglycemia:Immediate tx is insulin and fluids given

intravenously by the nurseReport to the nurse immediately if you notice:Increased thirstComplaints of vision changesComplaints of nausea or vomitingA sweet odor to the breathDry, flushed skin

Diabetes MellitusHypoglycemia-low blood sugar Can be a result of an overdose of insulin

known as Insulin reaction or Insulin ShockCan also be a result of :Not eating enough at the right timeUnusual activitiesVomitingDiarrheaInteraction of medications

Diabetes MellitusSigns and Symptoms:HungerSweatingDizzinessConfusionErratic BehaviorPale moist skinStaggering gaitDrowsiness

Diabetes MellitusTreatment is:Sugar in some formA food containing sugar if the resident is

consciousAn Injection of glucagon if the patient is

unconsciousOrange Juice or other easily absorbed source

of sugar should be kept accessible for emergencies

Finger Stick Blood SugarFingerstick Blood Sugar (FSBS):Used by those with DM to monitor sugar

levels in the bloodUsed to determine dosage requirements of

antidiabetic medicationsResidents who experience emotional stress or

have an infection of any kind are at greater risk for imbalance

Finger Stick Blood SugarFSBS:Is checked by collecting a sample of capillary

blood with a lancetTransferring the blood sample to a regent

stripReading the visual results

Finger Stick Blood SugarThere are many different types of glucometers

(meters used to measure the glucose) availableGlucometers use a test strip in place of the

reagent stripGlucometers will usually give a digital readout

of the glucose levelEach glucometer and its test strips are

different, you will need to know how to properly operate your device before approaching the patient for a sample

Finger Stick Blood SugarFSBS:The MD will order specific times for blood sugar

testing usually before mealsThe MD may also order Two-hour post-prandial

blood sugars (PPBS)- this sample is to be collected exactly two hours after the patient finishes eating

After meals, the blood sugar should be elevated but within two hours after eating, should return to normal

The RN can also instruct you to get a FSBS now, if a patient is displaying S/S of a diabetic upset

Finger Stick Blood SugarNormal Blood Levels:These can vary from facility to facilityThe normal range is usually between 65 and 120Normal value being 70-110Notify the RN immediately if you obtain a value

higher or lower than the normal rangeMost glucometers have a small range. If the value

obtained is below 40 the meter will read “low” and if the value obtained is higher than 500, the meter will read “high”. Report to the RN immediately.

Finger Stick Blood SugarGlucometers:Must be calibrated daily or per facility policyCalibration is done to ensure meter accuracyCalibrating is completed by running a test

using a special test strip or by using a liquid control solution

The results must be within a specified range and must be documented on a log

Do not use a meter until it has been calibrated

Finger Stick Blood SugarProcedure:Equipment:Observe Standard PrecautionsAlcohol swabLancetGlucometerTest Strips for that specific glucometerSharps container

Finger Stick Blood SugarProcedure:Explain the procedure to your patientWipe the patient’s finger with the alcohol

wipe and allow to dryPierce the side of the middle or ring finger

using the lancetPlace the lancet in the sharps containerSqueeze the sides of the finger gently to

obtain a drop of blood

Finger Stick Blood SugarHold the puncture site directly over the reagent

strip and place a hanging drop of blood onto the reagent pad.

Insert the strip into the meter if this was not done previously

Wipe the finger with the alcohol swab and allow to dry.

Apply pressure until bleeding stopsApply bandage if necessaryThe meter should beep with completed with

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