Diabetes

Describe the difference between the cause of Type 1 and Type 2 diabetes

Type 1: ‘not producing insulin’

• As not producing insulin, glucose in blood cannot access cells causing increase in blood glucose

• Causing

  • Increase in urination due to increased BS

  • Blurred vision as glucose build up in eyes

  • Slow healing as glucose in blood feeding bacteria

  • Increase occurrence of thrush, UTIs

Type 2: ‘receptor sites mutates or blocked up by fatty deposits, cannot ‘unlock’ lock’

• Similar symptoms and also increasing blood glucose

• Not all blocked so some can go in

What are the functions of Insulin and Glucagon

What are treatments for Type 1 and 2 diabetes?

Type 1: Insulin pens/injectors

Type 2: Lifestyle, metformin/glycoside, Insulin pens/injectors

What are Blood Glucose Levels measured as and what are normal values for diabetic and non diabetics?

Measured as millimoles per litre (mmol/L).

Normal values:

• Non diabetic

  • 3.0 to 5.6 mmol/L

• Diabetic

  • 4.0 to 7.0 mmol/L before meal

  • 10 mmol/L one and half hours after meals

  • Around 8 mmol/L at bedtime

Describe Hypoglycaemia common causes, signs and symptoms, and management.

Common causes:

• OD insulin or oral hypoglycaemic agents

• Hepatic or Renal dysfunction

• Other illnesses including infection

• GI disturbances

• Inadequate food intake

• Increased physical activity

• Alcohol intake

• Pregnancy and breastfeeding

• Elderly

Signs and symptoms:

• Usually rapid onset

• Skin can appear pale and sweaty

• Normal or shallow respirations

• Rapid and full pulse

• Irritable, confused, uncoordinated, aggressive or anti-social behaviour

• Hunger, Headache, Dizziness, Seizures (in late stages)

Management:

Is dependent on severity

Mild (able to swallow, cooperative and alert)

• Encourage to eat fast acting carbohydrate (e.g. sugar water, sweets [not chocolate])

• Monitor till BM >4mmol/L

• Then encourage long acting carbohydrate (e.g. biscuits, toast, meal if due)

• Continually reassess

Moderate (may be combative or unable to swallow)

• As per Mild, however if not able to swallow or combative - escalate to senior clinician to administer glucose gel etc.

Severe (unconscious, fitting, severely combative or risk of choking/aspiration)

• Manage ABCs

• Escalate to senior clinician

Describe Hyperglycaemia common causes, signs and symptoms, and management

Common causes:

• Undiagnosed diabetes

• Illness

• Infection

• MI

• Medication including steroids

• Failure to administer diabetic medications

Signs and symptoms:

• Usually gradual progression (hours to days)

• Skin is dry

• Deep and sighing respiration (Kussmals respiration)

• Rapid and weak pulse (decompensating BP)

• Restless, drowsy or lethargic behaviour

• Sweet, fruity breath (Ketone breath)

• Abdominal pain

• Nausea

• Polyuria

• Polydipsia

• Polyphagia

• Rapid weight loss

Management:

• Correct ABC problems

• Measure and record BM

• ECG

• Administer O2 of hypoxaemic

• Pre-alert

Explain the process for measuring blood glucose

• Clean pat finger with alcohol swab

• Once finger dry, obtain blood sample suing capillary lancet

• Wipe away first drop of blood

• Obtain fresh test strip and insert black wide end into meter

• Wait for droplet to appear on screen

• Insert end of test strip to blood sample

• Wait approx 5 secs for rereading to appear

• Press ejector button over clinical waste bag