DIABETIC EDUCATION MODULE ONE GENERAL OVERVIEW OF TREATMENT AND SAFETY

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1 DIABETIC EDUCATION MODULE ONE GENERAL OVERVIEW OF TREATMENT AND SAFETY First Edition September 17, 1997 Kevin King R.N., B.S., C.C.R.N. Gregg Kunder R.N., B.S.N., C.C.T.C CHS UCLA Medical Center Le Conte Avenue Los Angeles, California Phone (310) FAX (310)

2 First Edition September 17, 1997 Copyright (c) 1997 Dumont-UCLA Liver Transplant Center Division of Liver and Pancreas Transplantation UCLA Medical Center Department of Surgery This material may not be reproduced without the written permission of the. 1

3 General Overview Of Treatment and Safety Diabetes is characterized by the body s inability to properly use the energy from the food you eat. Our bodies use the food we eat to make the sugar we need for energy. Insulin helps transport sugar into the cells of the body. In people who have diabetes, this system does not work. Instead of the sugar being transported into the cell, it builds up in the bloodstream. Your blood sugar level can even rise when you haven t eaten, if too little insulin is available. When your body is lacking insulin, the body can make extra sugar through various forms of metabolism and release it into the bloodstream. This can happen when your body lacks insulin or when the insulin your body has is not doing its job properly. There are two main types of diabetes. The first type is called type 1. In type 1 diabetes the body makes little or no insulin. As mentioned earlier, because there is no insulin, sugar cannot enter the cells and be used for energy. As long as there is no insulin, the blood sugar remains high. People with this type of diabetes must take insulin shots to live. Type 1 diabetes is also known as insulin-dependent diabetes. The symptoms of type 1 appear almost always very suddenly. They include increased thirst, increased urination, increased hunger, sudden weight loss, and feelings of being tired. These symptoms maybe present also when your diabetes is out of control. The second type is called Type 2. In this type of diabetes, the body makes insulin, however it is either not enough or does not do its job. Sugar can only get into cells through the cell s special entrances. In type 2, there is a problem with these entrances as little or no sugar gets into the cells even though insulin is present. Patients with this type may not have to take insulin shots to stay alive. Often, these patients are able to take an oral agent to decrease their blood sugars. Therefore, it is often referred to as non-insulin dependent diabetes. The symptoms of type 2 include: feeling tired, frequent infections, slow-healing wounds, blurry eyesight, problems with sexual function, dry or itchy skin, increased hunger, increased urination, and increased thirst. As a Liver Transplant recipient, it is important for you to know that many of the medications you are taking can raise your blood sugars. These medications include Prednisone, Prograf, and Cyclosporine. Therefore, it is extremely important that you are aware of this potential side effect. As you probably know there is no cure for diabetes. Therefore, the goal of treatment is to control it, that is, to keep your blood sugars near normal levels. If high blood sugars levels are not controlled, it may lead to a dangerous condition known as diabetic ketoacidosis. If 2

4 this condition is not treated, it can lead to coma and death. The target range for your blood sugars is: before breakfast, lunch, or dinner before bedtime 3. less than 180 after meals 4. If you have heart disease or kidney disease your target range will be higher. Hypoglycemia Hypoglycemia or low blood sugar is caused by too little food, too much insulin, diabetes medicine, or additional exercise. It may occur suddenly and may progress to insulin shock. A blood sugar level below 70mg/dl characterizes hypoglycemia or low blood sugar. The symptoms include shaking, fast heartbeat, sweating, anxiety, dizziness, hunger, impaired vision, weakness, fatigue, headache, and irritability. If your feel like your blood sugar is low, test your blood sugar. If you are unable to test your sugar, you may take one of the following: 1. ½ cup of juice 2. 1 cup of milk 3. 1 tablespoon of sugar in one ounce of water glucose tablets 5. If the patient is unconscious, you should dial dialing 911 and activate the emergency medical system. You or your caregiver will notify the case manager or coordinator on-call for all instances of hypoglycemia. 6. You should check your blood sugar thirty minutes after eating for any episode of hypoglycemia 7. Eat a snack or meal consisting of Carbohydrates, Proteins, and Fats within thirty minutes of a hypoglycemic episode. 8. For any episode of hypoglycemia occurring in the middle of the night, you should eat a bedtime snack. Hyperglycemia Hyperglycemia or high blood sugar is caused by too much food, too little insulin, illness, or stress. It is a gradual onset, which may progress to a diabetic coma. Hyperglycemia is considered to be any blood sugar above 160mg/dl. The symptoms of hyperglycemia include extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness, and 3

5 nausea. If your blood sugar stays high for a long time, it can cause very serious health problems. Such as: Damage to blood vessels This damage can lead to poor blood flow to feet, legs, and skin. Thus, this damage will increase your risk for the following: Infections Heart problems Stroke Blindness Foot or leg amputation Kidney disease Damage to nerves This damage leads to the following: Infections (Damaged nerves don t sense pain. A cut or sore can get infected before you even notice it.) Sexual problems Stomach problems Coma A diabetic coma is known as diabetic ketoacidosis. It results from very high blood sugars. This is a life-threatening emergency. If untreated it can lead to death. If you feel your blood sugar is high, you should test your blood sugar. If your blood sugar level is over 200 for several tests you should contact your case manager or coordinator oncall. It is recommended that if you are diagnosed with diabetes that you always wear a medic alert bracelet. If you need help obtaining an application for a bracelet, let your case manager know. Insulin 4

6 Knowing the type of insulin you are using will tell you how fast it starts to work and how long it works. This is called action and activity. Regular insulin is a short acting insulin. It starts to work quickly and is finished working sooner than other types of insulin. Regular insulin starts to work in 30 minutes to 1 hour of administration. It peaks in 2-4 hours. It can last 6 to 8 hours. NPH insulin takes longer to work than Regular Insulin. It also keeps working longer than Regular Insulin. NPH starts to work in 4 to 6 hours. It peaks in 8-10 hours. It lasts 18 hours or longer. Humalog insulin is a rapid acting insulin. Humalog should only be given immediately before meals and only if you are able to eat a full meal. Humalog starts to work in 15 minutes, peaks in ½ to one hour and lasts about 2 to 4 hours. If you are taking Regular and NPH in the morning, when can you expect them to act? Your regular insulin will start to work in approximately 30 minutes to one hour. However, it should peak around lunchtime. Your morning NPH dose starts to work around 12 noon to 2 PM. It will peak around dinner or 6 PM. Therefore; the NPH should lower your blood sugar at dinnertime. If you are taking Regular and NPH in the evening, when can you expect them to act? As mentioned above the Regular starts to work in 30 minutes to one hour. It should peak around bedtime. Your NPH dose will start acting around bedtime but will not peak until breakfast the next morning. Knowing the action and activity of your insulin dose becomes very important especially when your insulin doses may need to be adjusted by your case manager in order to gain control of your blood sugar. Oral Agents There are many oral agents or medications used for the control of high blood sugars. These agents are used for people with type 2 diabetes. In other words, these drugs cause the cells in your pancreas to release insulin. Therefore, you must have some insulin in your body in order for these types of medications to work. 5

7 Glyburide This is an antidiabetic agent. It is an antidiabetic agent because it causes cells in the pancreas to release insulin. Therefore, insulin transports sugar into the cell and the blood sugar is lowered. Rezulin This is an antidiabetic agent. It is an antidiabetic agent because it improves insulin resistance. Rezulin is a relatively new drug. This particular drug stays in the body for 24 hours. It is taken with your largest meal of the day to decrease GI upset and provide better absorption. Therefore, your labs must be monitored very closely. If you are started on Rezulin, your dose of Regular and NPH insulin will be slowly decreased until your blood sugars reach an appropriate level. Blood Sugar Monitoring while on Oral Agents Your blood sugar monitoring requirement will be different when you are started on an oral agent. Once you start, you will be required to monitor your fasting blood sugar before breakfast and your blood sugar after your largest meal everyday. Once your blood sugars are stable, you will be monitoring your fasting blood sugar every Monday before breakfast. In addition, you will be monitoring your blood sugar on Wednesday and Friday after your largest meal. 6

8 Post Test 1. If I have diabetes, my blood sugar can still rise if I haven t eaten? True or False? 2. What substance transports sugar into the cell? 3. What are the two types of diabetes? 4. When should you test your blood sugar following treatment of an episode 5. hypoglycemia or low blood sugar? 6. What is the target range for my blood sugars? 7. What are the symptoms of low blood sugar? 7

9 8. What should I do if my blood sugar is below 70mg/dl? 9. What are the symptoms of hyperglycemia or high blood sugar? 10. What should I do if my blood sugar is above 200mg/dl? 11. What are five complications from high blood sugar or hyperglycemia? 12. Regular insulin is very long acting insulin? True or False? 13. If you took a morning shot of NPH insulin, when would you expect it to act? 14. If you took an evening shot of Regular insulin, when would you expect it to act? 15. What type of diabetics can use oral agents? 16. If I am started on an oral agent, I maybe required to monitor my blood sugars differently? True or False? 8

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