Diabetes. New Trends Presented by Barbara Obst RN MS August 2008

Transcription

1 Diabetes New Trends Presented by Barbara Obst RN MS August 2008

2 What is Diabetes Diabetes is a condition characterized by high levels of glucose. The glucose circulates in your blood and serves as the source of fuel. Glucose can not get inside cells by itself. Glucose needs insulin, to transport it from blood into cells. Diabetes occurs when the pancreas either can not produce any or not enough insulin. This causes a build up of glucose in the blood.

3 Type 1 Autoimmune conditions: the triggers are unknown but could be a virus that enters the body in response, the body not only attacks the virus but also the beta cells that produce insulin. Genetic Factors: there are genetic markers for Type 1 diabetes on the white blood cell that increases the possibility that autoimmunity will occur thus there is a genetic predisposition. 1 in 300 children under the age of 21 develop Type 1.

4 Management Insulin A calculated amount of insulin is given based on weight and insulin sensitivity. Most children receive 2 to 4 shots a day of either using long and short acting, or delivered via an insulin pump. Meal planning: having a plan for food consumption helps keep the blood glucose levels in the target range.

5 CARB COUNTING The main nutrient in food that affects blood glucose levels is carbohydrates. They come in two forms simple and complex. Sugars are simple such as soda candy, fruit. Starches are complex.rice, cereals, pasta, milk.

6 Carb Counting Carb Counting is the newest method for matching the insulin dose with the grams of carbohydrates eaten. 15grams equals 1 carb You might have an order that reads give 1 unit of insulin for every 5-20grams of CHO

7 Insulin Types Rapid Acting: LISPRO, Trade name Humalog it is man made insulin. Time of onset is 5-15 minutes Peak in ½ hour to 1.5 hours. Duration 3-4 hours.

8 Short Acting Regular Insulin made from pork, beef, human. Is fast acting and lasts a short time in the body. Time of onset is 30 minutes to an hour. Peak onset is 2-3 hours Hours of Duration is 3to 8 hours.

9 Immediate Acting NPH Provides a basal amount of insulin. Usually two shots are required. One in morning and one at night. Time of onset: 2-4 hours Peak Action Time: 6-10 hours Hours of duration: 10-18

10 Long Acting Lantus: has been marketed as only needing one shot, but trend is now to give two shots, one in morning and one at night because of Dawn Phenomen. Time of Onset: 2 hours It is Peakless 24 hour Duration.

11 Insulin Pump Uses a computer chip and a syringe reservoir, and is battery powered to deliver insulin continuously. The type of insulin is buffered regular insulin or Humulin BR. The pump delivers a basal rate and a a bolus dose.

12 A1c First the patient will be monitored for a pattern of what their blood sugars are. The A1c is a very important number. How A1c works: a small portion of the glucose that circulates throughout the child s blood after having been absorbed by their intestine also combines with the hemoglobin. It combines in direction proportion to the amount of glucose in the blood. Once this binding occurs, it remains for three months. You want a level below 8

13 Carbs and Insulin Your orders will probably look normal except for seeing carb counting, and giving coverage after the child eats. The child will check between meals sometimes, and usually right before the meal.

14 Blood Glucose Level Corrections Rule of 1800: is to calculate how many points the child s blood sugar will drop for each unit of fast acting insulin. Add up all the fast acting insulin the child takes in one day. This is Total Daily Dose or TDD. Divide 1800 by the TDD

15 Example of Rule of 1800 Total insulin is 30 units divide 1800 by 30 you get unit of fast acting insulin will lower the child s blood glucose by 60.

16 Rule of 500 This is the Rule to calculate the number of carbs that are covered by 1 unit of fast acting insulin. Add up all the fast acting insulin the child takes in one day. This is the TDD Divide 500 by the TDD This gives you the number of grams covered by 1 unit of fast acting insulin.

17 Example The childs TDD is 30. Divide 500 by 30. You get which is approximately grams of carbs per 1 unit of fast acting insulin. This would be important when figuring out what the child ate for meals.what the coverage would be.

18 What else to consider If the child is receiving therapy it is really important to look at the times of therapy and what the level of exercise is. The amount of exercise can effect how much insulin the child will need, or if the child will need a snack. Make sure that if the child is on carb counting that you actually know what the child ate. This can effect how much the child gets for coverage of the carbs. Just because the meal might say 5 carbs, if the child only ate 3 carbs and you covered for 5 the child might have a hypoglycemic reaction 1-2 hours after.

19 Site Care The site for the child with the diabetic pump is changed every 3 days. This is essential for continuation of good control. Depending on the age of the child a numbing cream might have to be used prior to insertion. So this process can take up to 45 minutes.

20 Site Care Check site for redness, swelling or leakage. Check site for lipohypertrophy, this is caused by insulin being given in the same area. Most schools do not require the nurse to replace the catheter. For Omni Pod, the pod includes the insertion needle.

21 Questions?