NSG 2640

The Basics – Energy – to keep
you going
 The body can create fuel from 3 sources, glucose, fat
and protein.
 Glucose is the major source of energy for the brain and
nervous system.
 The brain needs a constant source of glucose to
function.
 Glucose is obtained through the diet
 Glucose levels are regulated by the liver and pancreas

The Liver
 The liver regulates blood glucose levels through 3
processes:
 Glycogen synthesis (glycogenesis)
 Glycogen breakdown (glycogenolysis)
 Synthesis of Glucose from noncarb sources
(glyconeogenesis)
 When blood glucose levels rise, glucose is removed
from the blood and converted to glycogen
 When blood glucose levels fall, the liver breaks down
glycogen and releases the glucose to the body

The Pancreas
 Hormonal control of blood glucose levels is regulated
by the pancreas. (insulin & glucagon)
 The islets of Langerhans are the part of the pancreas
that secretes glucose regulating hormones (insulin,
glucagon)
 Insulin lowers blood glucose levels by facilitating the
movement of glucose into body tissues
 Glucagon maintains blood glucose levels by increasing
the release of glucose from the liver, into the
bloodstream.

By the numbers

Diabetes
 When an imbalance of insulin availability and insulin
need results in a disorder of carbohydrate, fat and
protein metabolism
 Type 1 – most commonly an autoimmune disorder.
Immune system attacks the pancreas (beta cells) and it
can no longer produce insulin
 Type 2 – Insulin resistance and insulin deficiency
(impaired release of insulin)

Diabetes Type 1
 The pancreas no longer produces insulin (beta
cell destruction)
 Occurs most commonly in children – but can
occur at any age
 People with DM1 require insulin several times
throughout the day

Diabetes Type 2
 People with Type 2 DM produce insulin,
however the body cannot utilize the insulin
(insulin resistance).
 Genetic and Acquired factors influence the
development of DM type 2

Diabetes Type 2
 Risk Factors
 Age –
 11.3% of people over age 20
 26.9% of people 65+ years
 Genetics – Risk of developing DM:
 15% if one parent is diabetic
 75% if both parents are diabetic
 Lifestyle – Poor diet
 Excess Weight
 Low Activity level

Gestational diabetes
 Refers to glucose intolerance that develops during
pregnancy.
 Occurs in 2-14% of pregnancies
 Gestational diabetes makes the pregnancy “high risk”
 Women who develop gestational diabetes have an
increased risk of developing type 2 diabetes within 10
years

Chronic Conditions
 Peripheral Neuropathies
 Microvascular Complications
 Nephropathies
 Retinopathies
 Foot Ulcers
 Infections

Dietary Management
 For the Type 1 diabetic managing his/her diet
important factors are to
 *eat consistent amounts/types of food at routine
times
 *monitor blood glucose levels
 *use insulin as prescribed to prevent elevated blood
glucose levels
 For the Type 2 diabetic managing his/her diet
includes
 losing weight which improves diabetic control.
 Ensuring food intake meets goals for maintaining
blood glucose levels.

Carb Counting

Exercise
 Exercise is not just good for the cardiovascular
system. In Type 2 diabetics decreased levels of
body fat allow for increased sensitivity to
insulin and improved blood glucose control.
 Type 1 diabetics need to be careful when
exercising. Exercise increases glucose uptake
into the muscles. If insulin levels are not
adjusted for exercise there is a high chance of
hypoglycemia resulting, even HOURS after
exercise ends

Equipment
 Glucometers

Medications
 Oral Meds
 People with type 2 diabetes experience
 Increased glucose production from the liver
 Decreased utilization of carbohydrates
 Impaired insulin secretion
 Decreased insulin stimulated glucose uptake in muscles
 Oral Antidiabetic Meds work on one or several of these
issues

Medications cont.
Insulin –All type 1 diabetics, and some type 2 diabetics
require insulin.
Insulin is categorized by time of onset and duration.
Insulin is given by the Subcut. or IV route
Insulin is given in set doses or based on a sliding scale

Medication cont.
 Insulin Pump

Insulin

Mixing Insulin