Nurses role in Managing diabetes

2. Muhammad Baqar
MSPH,BScN ,PBCHN,RN
NURSES ROLE IN
MANAGING DIABETES
CON, GMMMCH SUKKUR

3. Outlines
Define Diabetes Mellitus
Know the symptoms of Diabetes Mellitus
Understand diagnostic process of Diabetes Mellitus
Enumerate complication of Diabetes Mellitus
Understand facts and figures of Nursing workforce
Explain role and responsibilities of nurse to diabetes care
Understand five components of diabetes management.

4.  Is a group of metabolic diseases characterized by
elevated levels of glucose in the blood
(hyperglycemia) resulting from defects in insulin
secretion, insulin action, or both.
(American Diabetes Association [ADA] 2003)
Diabetes mellitus

6. Diagnostic Tests
Random blood sugar test.
200 milligrams per deciliter (mg/dL) — 11.1 millimoles
per liter (mmol/L) or higher suggests diabetes.
Fasting blood sugar test.
 level less than 100 mg/dL (5.6 mmol/L) is normal.
 level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is
considered pre-diabetes.
If it's 126 mg/dL (7mmol/L) or higher on two
separate tests, is diabetes.

7. Diagnostic Tests
Glycated hemoglobin (A1C) test.
Indicates average blood sugar level for the
past two to three months
level of 6.5 percent or higher on two
separate tests indicates that is diabetes
A1C between 5.7 and 6.4 percent indicates
prediabetes
Below 5.7 is considered normal.

8. Diagnostic Tests
Oral glucose tolerance test:
Level less than 140 mg/dL (7.8 mmol/L) is
normal
 More than 200 mg/dL (11.1 mmol/L) after
two hours indicates diabetes.
 Between 140 and 199 mg/dL (7.8 mmol/L
and 11.0 mmol/L) indicates pre-diabetes.

10. FACTS AND FIGURES NURSING
 Nurses account for 59% of health professionals.
The global nursing workforce is 27.9 million, of which 19.3 million
are professionals.
 Pakistan Nursing workforce is103777.
 The global shortage of nurses is estimated to be 5.9 million
 89% is in low and lower middle-income countries
 Nursing graduates need to increase by 8% a year to overcome
the predicted global shortfall by 2030.
 Approximately 90% of the nursing workforce is female

11. Nurse role in caring diabetes
patient
Educate about using behavior change and
health coaching techniques
 Screening, prevention and early detection of type 2
diabetes
 Promoting self-care
 An awareness of how mental health issues can
affect people with diabetes

12. Cont…
Assessing and meeting the patient’s
nutritional needs
 Urine & Blood glucose monitoring
 Oral therapies & Injectable therapies
 Identifying and treating hypoglycaemia
 Identifying and treating hyperglycaemia

13. Nursing Planning
Overall goals:
 Active patient participation
 No episodes of acute hyperglycemic
emergencies or hypoglycemia
 Maintain normal blood glucose levels
 Lifestyle adjustment with minimal stress

14. Diabetes Management
There are five components of diabetes management

15. Nutritional management
Nutrition, diet, and weight control are the
foundation of diabetes management.
Nutritional management Goals:
Providing all the essential food (eg, vitamins,minerals)
 Meeting energy needs
 Achieving and maintaining a reasonable
weight
 Preventing wide daily fluctuations in blood glucose
levels (close to normal )
Decreasing serum lipid levels.

17. Exercise
Benefits of Exercise
 Lowers blood glucose
 Decrease Cardiovascular risk factors.
 Psychological well being
 Improvement in insulin secretions.
 Decrease weight, decrease stress

18. Recommendations
Exercise at the same time each day.
Exercise the same amount of time each day.
Start slow and gradually increase exercise
If patient has diabetic complications, alter the
exercise type and amount as necessary.

19. Monitoring
Blood glucose monitoring is a cornerstone
in diabetes management.
Self-monitoring of blood glucose (SMBG) is
recommended by the ADA.
Many types of glucometers . Pick the one that best
suits the patient.
 Consider ease of use, skill level, cost of strips, visual
numbers etc….

20. Monitoring
 According to the ADA patients on insulin
should test at least four times a day, usually
before meals and at bedtime.
 Persons not receiving insulin and on orals
should test two-three times a day.
 Important to keep a Diabetic chart.

21. Drug Therapy: Oral Agents
Not insulin
Work to improve the mechanisms in which
insulin and glucose are produced and used
by the body.
Increase insulin production by pancreas
Reduce glucose production by liver
Enhance glucose transport into cell

22. Drug Therapy: Insulin
Types of insulin
Rapid-acting: Lispro
• Onset 10 – 15 min. Peak 1 hours. Effects last 2 hrs – 6 hrs
Short-acting: Regular
• Onset 30 min – 1 hr, Peak 2 – 3 hr, Effects last 4 – 6 hrs
Intermediate-acting: NPH or Lente
• Onset 2 – 4 hrs, Peak 6 – 12 hrs, Effects last 16 – 20 hrs
Long-acting: Ultralente, Lantus
• Onset 6-8hrs, Peak 12 – 16 hrs, Effects last 20 – 30 hrs

23. Injection Sites

24. Insulin Administration

25. Education
 Basic definition of diabetes (having a high blood
glucose level)
 Normal blood glucose ranges and target
blood glucose levels
 Effect of insulin and exercise (decrease
glucose)
 Effect of food and stress, including illness
and infections (increase glucose)
 Basic treatment approaches
 Administration of insulin or/and oral antidiabetes
medications

26. Education
Take insulin or oral antidiabetic agents as usual.
Diet information (food groups, timing of meals)
 Monitoring of blood glucose and ketones
Recognition, treatment, and prevention of acute
complications,(Hypoglycemia, Hyperglycemia)
Report nausea, vomiting, and diarrhea.
Where to buy and store insulin, syringes, and
glucose monitoring supplies
 When and how to reach the physician

27. Conclusion
Nurses play a key role in:
Diagnosing diabetes early to ensure timely
treatment.
Providing self-management training and
psychological support for people with diabetes to
help prevent complications.
Tackling the risk factors for type 2 diabetes to help
prevent the condition
Nurses can make the difference for people
affected by diabetes