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Diabetes mellitus & blood glucose monitoring
1. Pickaway-Ross Medical Careers IIPickaway-Ross Medical Careers II
Diabetes MellitusDiabetes Mellitus
Symptoms, Treatment, Crisis
&
Measuring Blood Glucose Levels
2. Key TermsKey Terms
Diabetes Mellitus (sugar diabetes) is a disease in
which the body cannot produce or use insulin
properly.
Insulin is a hormone produced by the pancreas that
allows the glucose in the blood stream to enter into
cells to be used as energy.
3. ObjectivesObjectives
Distinguish between the types of diabetes mellitus.
Identify signs and symptoms of diabetes mellitus.
Describe risk factors for diabetes mellitus.
Explain the complications of diabetes mellitus
Discuss treatment of diabetes mellitus.
Recognize the signs and symptoms hypo and
hyperglycemia
Identify nurse aide actions to treat hypo and
hyperglycemia .
Demonstrate blood glucose monitoring procedure.
Measure and document accurate blood glucose.
Employ standard of care for diabetic clients
4. Diabetes Mellitus: TypesDiabetes Mellitus: Types
Named according to age of onset & need for insulin
Type I
Usually occurs early in life (children, teens, & young
adults)
Rapid Onset
Pancreas produces little or no insulin
Insulin dependent
More severe
Higher risk of complications
•Live longer with disease
5. Diabetes Mellitus: TypesDiabetes Mellitus: Types
Type II (Non-insulin dependent)
Adult-onset; typically obese
Can occur at any age
Slow onset
Controlled with diet and/or oral medications that
stimulate the pancreas to secrete insulin
Can become insulin dependent (Type I)
Gestational Diabetes
Diabetes develops during pregnancy
Typically goes away after pregnancy
Higher risk for Type II later in life
6. Signs & SymptomsSigns & Symptoms
1. Excessive thirst (polydipsia)
2. Excessive urination (polyuria)
3. Increased frequency in eating (polyphagia)
4. Recent loss of weight (without trying/dieting)
5. Delayed healing in wounds
6.Dry, itchy skin
7.Losing feeling or tingling in the feet
8.Blurred vision
9.Fatigue
7. Risk FactorsRisk Factors
Family History of the disease
Type I
Whites
Type II
Older
Overweight
African-American
Native Americans
Hispanics
9. TreatmentTreatment
Goal: Control of diet, exercise and medication.
Type I
Daily insulin therapy
Healthy eating
Exercise
Type II
Healthy eating
Exercise
Oral medications
Compliance by the patient and regular glucose monitoring
help keep the balance of treatment.
10. InsulinInsulin
Given as a subcutaneous injection by RN,
allows the body to use glucose
Types of insulin - long lasting or short acting
Insulin injections are timed to peak during meal
time and after meals
A patient may receive several types of insulin
Blood sugars regulate the amount of insulin ordered
Normal blood sugar levels: 70 - 110 mg/dl
11. Hyperglycemia: High Blood SugarHyperglycemia: High Blood Sugar
Too much food, too little insulin, stress or illness
Undiagnosed Diabetes
Onset may be gradual
Symptoms
1. Extreme thirst/dry mouth
2. Frequent urination
3. Dry skin
4. Hunger
5. Blurred vision
6. Drowsiness
7. Nausea
Can progress to DIABETIC COMA
12. Hyperglycemia: Diabetic ComaHyperglycemia: Diabetic Coma
Ketoacidosis (DKA)
Blood sugar - 250 mg/dl or above
Symptoms
1. Extreme dry mouth/thirst
2. Sweet or fruity odor to the breath (Juicy Fruit)
3. Nausea and/or vomiting
4. Weakness or dizziness
5. Confusion
6. Rapid, deep respirations
7. Drowsiness
8. Dry, flushed skin
Eventually lose consciousness/die without tx
13. Hyperglycemia: Diabetic ComaHyperglycemia: Diabetic Coma
Treatment
Place in a position of comfort
Monitor respirations
Need immediate medical treatment
•Fluid Replacement
•Electrolyte Replacement
•Insulin Therapy
16. Hypoglycemia – Insulin ShockHypoglycemia – Insulin Shock
Treatment
Restore blood sugar levels to normal ASAP
Conscious
•Drink fruit juice or sugared (not diet) soda
•Eat sugar in form of candy, cubes or tablets
Unconscious
•Requires immediate emergency care
•Glucagon injection
1.
17. Specimen Collection - PlanSpecimen Collection - Plan
Standard precautions
Required prerequisites for test i.e., fasting
Organization of equipment
18. Specimen Collection - ProcedureSpecimen Collection - Procedure
1. Correct patient
2. Explanation & teaching (patient & family)
- provide clear explanations
3. Prepare client and environment
4. Obtain specimen
Right patient
Right amount of specimen
Right time
19. General GuidelinesGeneral Guidelines
Understand that collection of specimen may cause
anxiety, embarrassment, or discomfort
Provide support for the patient
Children may benefit from support from parents
or care providers during specimen collection
Aseptic technique for collection of all specimens
Know facilities policies and procedures
Be aware of deviations from normal values that
may occur as a result of certain medications or
diet
20. Glucose TestingGlucose Testing
Glucose testing may be done by urine or blood
Blood testing more accurate & has replaced urine
Frequency- ordered by physician
1. Fasting
2. 30 minutes prior to meals (AC)
3. 2 hours after meals (PC)
4. Bedtime (HS)
21. Glucose TestingGlucose Testing
Blood Tests:
1. Venipuncture
2. Capillary blood by skin puncture
Capillary blood is desirable:
When venipuncture cannot be performed
When reducing the frequency of needle sticks
in desired & less painful
22. Measuring Blood GlucoseMeasuring Blood Glucose
The ease of a skin puncture makes the procedure
possible for patients to perform at home
Skin puncture performed by a hand held lancet or
an automatic lancet device
Self-testing can be performed by two methods:
1. Reading a reagent strip
2. Use of a reflectance meter (Accucheck)
Both methods require a large drop of blood
Follow manufacturer’s instructions
23. Finger Stick SitesFinger Stick Sites
Sites for skin punctures: finger tips, ear lobes,
and heels (infants)
Finger tips most common
Avoid sites that are swollen, bruised, cyanotic,
scarred, or calloused (poor blood flow)
Callouses are frequent on the thumb & index
finger
Preferred fingers - middle & ring finger
Use the side of finger
25. Performing Skin PuncturePerforming Skin Puncture
Standard precautions
Have patient wash hands & position comfortably
Assemble equipment & open lancet or lancet
device & alcohol wipes
Calibrate meter according to instructions
Donn clean gloves
Inspect patient’s fingers
Warm site if cold (rub or apply warm wash cloth)
26. Performing Skin PuncturePerforming Skin Puncture
Hold finger with thumb and forefinger in a
dependent position & massage gently toward
puncture site
Clean site with alcohol (allow site to dry)
Place lancet device against side of finger & push
release button (hold lancet perpendicular to
site & pierce site in one continuous movement)
27. Performing Skin PuncturePerforming Skin Puncture
Wipe away first drop of blood
First drop usually contains a large amount of
serous fluid
Lightly squeeze site to allow a large drop of blood
to form
28. Blood Glucose TestBlood Glucose Test
Reagent strip - Check strips for expired dates;
place large drop of blood on strip and time
according to instructions
Glucose meter:
Be sure meter is calibrated properly (coding)
Perform control testing according to policy
Place large drop of blood on reagent strip
Press meter timer (many machines have
automatic timers)
Apply pressure to site until bleeding stops
Discard lancet in sharps container
29. Urine Testing for GlucoseUrine Testing for Glucose
Easy to perform and painless
Double-voided specimen for best results
Certain medications can cause false positives i.e.,
tetracyclines, sulfonamides, ascorbic acid
Dip reagent strip (check for expired dates) into
urine. Compare to color chart, reading at
designated time
Follow manufacture instructions
30. DocumentationDocumentation
Report results to RN immediately
Document (diabetic flow record)
Time specimen was collected
Site used
Test results
Patient tolerance of procedure
Other observations or patient complaints
31. Care of Diabetic PatientsCare of Diabetic Patients
The Patient Care Assistant:
•Accurate recording of vital signs
•Blood tests performed as ordered
•Accurate bedside testing
•Dietary trays delivered on time
•Correct diet & correct food
•Accurate I&O
•Notify RN if patient does not eat, NPO for
tests, observation of signs & symptoms,
patient complaints, test results