Pickaway-Ross Medical Careers II

Diabetes Mellitus
Symptoms, Treatment, Crisis
&
Measuring Blood Glucose Levels
Key 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.
Objectives
 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

Diabetes 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
Diabetes 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
Signs & 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
Risk Factors
Family History of the disease
Type I
Whites
Type II
 Older
Overweight
African-American
Native Americans
Hispanics
Complications
•Blindness
•Kidney damage/renal failure
•Nerve damage
•Damage to gums and teeth
•Heart & blood vessel disease from fatty deposits
•Foot & leg wounds & ulcers
•Infection & gangrene
•Amputation
Treatment
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.
Insulin
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
Hyperglycemia: 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
Hyperglycemia: 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
Hyperglycemia: Diabetic Coma
Treatment
Place in a position of comfort
Monitor respirations
Need immediate medical treatment
•Fluid Replacement
•Electrolyte Replacement
•Insulin Therapy
Hypoglycemia - Low Blood Sugar
Failure to eat proper amounts, vomiting after
taking insulin, or taking excess insulin
Sudden onset
Symptoms
1. Hunger
2. Fatigue; weakness
3. Trembling; shaking
4. Sweating
5. Headache
6. Dizziness; feeling faint
Can progress to INSULIN SHOCK
Hypoglycemia – Insulin Shock
Blood sugar - 60 mg/dl or below
Symptoms
1. Behavior change
2. Confusion
3. Clumsy and jerky
4. Restless, anxious
5. Palpitations
6. Rapid pulse
7. Low blood pressure
8. Convulsions
Eventually lose consciousness/brain damage/death
Hypoglycemia – 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.
Specimen Collection - Plan
Standard precautions
Required prerequisites for test i.e., fasting
Organization of equipment
Specimen 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
General 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
Glucose 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)
Glucose 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
Measuring 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
Finger 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
Finger Stick Sites
Performing 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)
Performing 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)
Performing 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
Blood 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
Urine 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
Documentation
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
Care 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