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Managing Diabetes For Nursing Students

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on 29 May 2014

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Transcript of Managing Diabetes For Nursing Students

Managing Diabetes For Nursing Students
Understanding Diabetes Management a Nursing Student's Guide
Chanel Zelaya, RN, MSN, FNP
Nursing Faculty Candidate
Presentation Objectives
At the end of the presentation the student will understand the:
1) definition of diabetes
2) difference between type 1 & type 2 Diabetes
3) risk factors for developing diabetes & recognizing prediabetes
4) guideline criteria for diabetes
5) management & treatment for diabetes
What is Diabetes?
Diabetes mellitus refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel. [*1]
If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the reasons may differ. Too much glucose can lead to serious health problems.
Type 1 Diabetes
A disease of insulin deficiency:
•Body does not make insulin
•Usually develops in children or young adults
•Normal Weight
•MUST take insulin daily to live
Type 2 Diabetes
A disease of Insulin Resistance (IR)
•Cells do not use insulin properly
•Not enough insulin being produced
•Develops in adulthood, but recently
more common in children due to obesity
•Seen in persons who are overweight
•Many different ways to treat, including diet and exercise, pills, or insulin
Type 2 Diabetes Key Concepts
•Insulin Resistance
•Reduced ability to make insulin
•Insulin not as effective, and does not allow glucose into cells, causing blood sugar levels to rise

Diabetes testing recommendations
Type 2 DM should be considered in all adults who are overweight (BMI _>25) and have additional risk factors:
1) physical inactivity
2) first degree relative with diabetes
3) members of high-risk ethnic groups (AA, Latino, Native American, Asian, Pacific Islander)
4)women who delivered an infant weighing > 9lb or were diagnosed with GDM
5)hypertension (_>140/90mm Hg or on therapy for hypertension)
6)HDL <35mm/dL or triglycerides >250mg/dL
7) women with polycystic ovarian syndrome
8) clinical conditions associated with insulin resistance
9) history of cardiovascular disease
In the absence of the above criteria, testing for prediabetes and diabetes should begin at age 45. If results are normal, testing should be repeated at least at 3 yr intervals, with consideration for more frequent testing. [*1]
Diabetes Risk Assessment Test
Could you have diabetes and not know it? One in four Americans with diabetes has it and doesn’t know it. [*1]
Diagnosing Diabetes
Diabetes is usually diagnosed based on plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-h plasma glucose (2-h PG) value after a 75-g oral glucose tolerance test (OGTT). Recently, an International Expert Committee added the A1C (threshold 6.5%) as a third option to diagnose diabetes.[*2]
First Step: The Initial Evaluation
A complete medical evaluation should be performed to classify the diabetes, detect the presence of diabetes complications, review previous treatment and risk factor control in patients with established diabetes, assist in formulating a management plan, and provide a basis for continuing care. [*3]
It's a Team Approach
People with diabetes should receive medical care from a team that may include physicians, nurse practitioners, physician’s assistants, nurses, dietitians, pharmacists, and mental health professionals all with expertise in diabetes. The care model should be a collaborative and integrated team approach.
Approach to Management of Hypergycemia
Approach to Management of Hyperglycemia
Figure 1: The approach should be used to determine appropriate efforts to achieve glycemic targets. Characteristics toward the left justify more stringent efforts to lower A1C, whereas those toward the right are compatible with less stringent efforts. Decisions should be made in conjunction with the patient, reflecting his or her preferences, beliefs, and values.
Treatment Therapy
Type 2 Diabetes Treatment Recommendations:
Metformin, is the preferred initial pharmacological agent for type 2 diabetes.
In newly diagnosed type 2 diabetic patients with markedly symptomatic and/or elevated blood glucose levels or A1C, consider insulin therapy, with or without additional agents, from the outset. [*3]
If noninsulin monotherapy at maximum tolerated dose does not achieve or maintain the A1C target over 3 months, add a second oral agent, a glucagon-like peptide 1 (GLP- 1) receptor agonist, or insulin. A patient-centered approach should be used to guide choice of pharmacological agents. [*3]
Due to the progressive nature of type 2 diabetes, insulin therapy is eventually indicated for many patients with type 2 diabetes. [*4]
Nutrition Therapy
It is recommended for all people with type 1 and type 2 diabetes as an effective component of the overall treatment plan. Individuals who have prediabetes or diabetes should receive individualized nutrition therapy as needed to achieve treatment goals, preferably provided by a registered dietitian. [*4]
Diabetes Self-Management Education & Support
People with diabetes should receive diabetes self-management support and education according to the National Standards for Diabetes Self- Management Education and Support when their diabetes is diagnosed and as needed thereafter. Effective self-management and quality of life are the key to adherence. [*3]
This education should address psychosocial issues, since emotional well-being is associated with positive diabetes outcomes. These programs are appropriate venues for people with prediabetes to receive education and support to develop and maintain behaviors that can prevent or delay the onset of diabetes. [*3]
Importance of Exercise
Adults with diabetes should be advised to perform at least 150 min/week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate), spread over at least 3 days/week with no more than 2 consecutive days without exercise. [*3]
Diabetic Foot Care
For all patients with diabetes, perform an annual comprehensive foot examination to identify risk factors predictive of ulcers and amputations. The foot examination should include inspection, assessment of foot pulses, and testing for loss of protective sensation (LOPS). [*3]
Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). Perform the A1C test quarterly in patients whose therapy has changed. [*4]
Target Goals to Prevent Further Complications
Case Study
1) American Diabetes Association. http://care.diabetesjournals.org/cgi/content/full/32/Supplement_1/s13/T3,Criteria for testing for pre-diabetes in asymptomatic adult individuals, accessed 4/26/14
3) American Diabetes Association. Standards of medical care in diabetes, 2012. Available at professional diabetes.org/CPR_Search.aspx. Accessed 4/26/14.
2) International expert report on the role of the A1c assay in the diagnosis of diabetes. Available at care.diabetesjournals.org/site/misc/ DC09-9033.pdf.Accessed 4/27/14
4) AACE Comprehensive Diabetes Management, Endocr Pract. 2013;19(Suppl 2) accessed 4/27/14.
Weight Loss
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