Mini Med School: Diabetes

Objectives:
After you take this class, you will be able to:

1. Discuss diabetes and why some people develop it.


2. Detail ways in which the nursing assistant can help the patient control their diabetes.

What is Diabetes?

Many people all over the world have the disease called diabetes. Children and adults can have diabetes. This disease stops the body from changing the foods we eat into energy for the body.

Think about the human body as a car. Gas does not go into the engine of the car for fuel until the car key is turned on. Gas will only be pumped into the car's engine when you turn on the key in a car as you start it.

When food is eaten, it turns into sugar (glucose). This sugar is the "gas" for the body. Insulin is the "key" that pumps the sugar into the cells for energy. When this key is not present, the body runs out of energy because the body's "gas" is not being pumped to the cells. Insulin does not change sugar into body fuel when a person has diabetes.

It is normal for the sugar to go from the blood to the cells for energy. When the sugar goes to the cells, the sugar does not stay in the blood. People without diabetes keep a low level of sugar in the blood because it moves from the blood into the cells, as it should.

When a person has no insulin or not enough insulin, the sugar is not sent to the body cells from the blood. The sugar will then build up in the blood. The sugar level of the blood gets high for the diabetic patient. Too much sugar in the blood is called "high blood sugar". High blood sugar is a sign of diabetes.

Most young children with this disease do not produce any insulin at all. These children will have to take insulin shots for the rest of their life.

When a person gets diabetes as an adult or an older person, they usually continue to make some insulin, but not enough to move all the sugar into the cells. These older people may be able to take care of their disease with diabetes pills, exercise and a good diet. They may be able to control this disease without having to take insulin shots like the child has to.

Most children have the form of diabetes called Type 1 diabetes. People that get diabetes in later life usually have Type 2 diabetes. Type 1 diabetes is more severe than Type 2 diabetes.

People with diabetes can develop blindness, poor vision, kidney failure, heart disease, strokes (CVA) poor circulation and other problems, such as foot infections, unless the diabetes is treated and kept under good control.

Health care workers should help these patients to control their disease. We must help them to eat a proper diet, to exercise and to follow their doctor's order for medicine, blood sugar testing and other care, including foot care, skin care and personal hygiene.

What are the Signs of Diabetes?

Some people with diabetes may have no signs at all. Others do. Some of the most common signs of diabetes are:

• Feeling very hungry
  
• Feeling very thirsty
  
• Wanting to drink a lot of water
  
• A dry mouth
  
• The need to urinate often
  
• Vision that is blurry and poor
  
• Weight loss
  
• Feeling weak and tired
  
• A tingling and numb feeling in the feet and hands
  
• Sores and cuts that do not heal at all or that take a long time to heal
  
• Itchy skin in the groin or vaginal area of the body
  

How Do People Develop Diabetes?

No one knows for sure why or how people get diabetes, but there are some things that can increase the chance of getting it.

Some of these things are:

• Family history. If a parent, grandparent, sister or brother has diabetes, the chances of getting diabetes is greater than it would be if you did not have this disease in your family. Family history cannot be changed.
  
  
• Race. Asians, Hispanics, Native Americans and African Americans appear to get diabetes more than other groups of people. Race is another thing that cannot be changed.
  
  
• Age. The chances of getting diabetes increase as people get older. Age and getting older cannot be controlled.
  
  
• Being overweight. People that are overweight get this disease more than those people that are thin or with a healthy body weight. Most people that weigh too much can lose some weight when they eat a proper diet and they exercise every day. Being overweight can be changed. People that lose weight can lower their chance of getting diabetes.
  
  
• Having high blood pressure. People with high blood pressure get diabetes more than those with a normal blood pressure. Many people can lower their blood pressure with stress management, exercise, a good diet and sometimes medicine.
  
  
• Having high cholesterol and/or high triglycerides. Like high blood pressure, high cholesterol and high triglycerides increase the chances of a person getting diabetes. These high levels can also be changed with medicine, a good diet and exercise.
  
  
• Alcohol use and smoking cigarettes. The chance of getting diabetes increases if a person smokes cigarettes or abuses alcohol. If a person does not use alcohol and does not smoke cigarettes, they are not as likely to get diabetes. We should tell patients to try to stop smoking. We should also help them to stop or decrease their use of beer, wine and other drinks that have alcohol.
  
  
• Some viruses and other diseases. Some viruses and diseases place people at greater risk of developing diabetes. It is often not possible to avoid these diseases.
  
  

Nursing assistants and others who take care of people with diabetes should:

• Help patients exercise on a regular basis, especially if they weigh too much, have high blood pressure or high cholesterol.
  
  
• Assist their patients and residents to eat a good diet. Some may have a diet that is low in salt when they have high blood pressure.
  
  
• Help their patients to use stress management tools such as sitting quietly and relaxing, deep breathing, prayer and meditation. Stress increases blood sugar levels. If you would like to learn more about stress and stress management, take the NursingAssistantEducation.com course entitled “Stress Management”. This course will help you and your patients to learn more about stress and how we can cope with it and live a better life.
  
  

How do People Find Out that They Have Diabetes?

The doctor usually diagnoses diabetes when the patient tells the doctor that they have the signs of this disease. Most tell the doctor that they are very thirsty or that they often have to go to the bathroom very often to void or urinate.

When the doctor is told about these signs, lab blood tests are done. The doctor will then order lab tests to find out how much sugar, or glucose, is in the person’s blood. If the lab test shows that the sugar level is high, the person has diabetes.

The normal blood sugar from these tests should be from 70 to 115. If the blood sugar level is more than 126 when the person has not eaten any meals or food, the patient is told that they have diabetes.

How Should We Care for Diabetic Patients and Residents?

The best way for the patient to control their diabetes is to follow the five keys of success. Nursing assistants, home health aides, personal care aides and other health care workers must help the person with these keys to success. The five keys of success are:

• DIET
  
  
• EXERCISE
  
  
• KNOWING WHAT THE BLOOD SUGAR IS
  
  
• PERSONAL CARE
  
  
• MEDICINES WHEN ORDERED
  

DIET:

In the hospital, nursing home, assisted living homes and the patient’s home care, we must make sure that the diabetic patient or resident:

• Eats a good diet
  
• Eats meals at the about the same time every day
  
• Does NOT miss any of their meals
  
• Has a snack at night if the doctor wants them to
  
• Does NOT eat regular sweets, candy, cakes and cookies. Some doctors may allow the patient to have special sweets, candy, cakes or cookies with no sugar or only a little sugar.
  
  

EXERCISE:

Exercise makes us all of us feel healthy, happy and lively. It also helps us cope with stress. People with diabetes get the same results from exercise, but they also get another good benefit - Exercise lowers blood sugar.

Nursing assistants must do all they can do to make sure that the patient or resident:

· Exercises every day, as ordered by the doctor. Nursing assistants should encourage the person to at least walk on a regular basis when the doctor orders it. Exercise on a regular basis is a very important activity of daily living. Some people may only be able to walk. Others may be able to run or ride a bike. Simple arm and leg exercises while sitting in a chair are good for elderly people who are not able to walk. Even these simple exercises are helpful.

KNOWING WHAT THE BLOOD SUGAR IS

Many nursing assistants are trained to take the blood sugar levels of diabetic patients. Others are not. If you are trained in taking blood sugars, you must be sure that you have done it correctly and documented or reported it.

Some patients in their home or an assisted living home may be able take their own blood sugar level alone or with a little help from the nursing assistant, home health aide or personal care aide.

Diabetic patients should:

• Have their blood sugar level checked on a regular basis. Some people with diabetes have to check it two or three times a day. Others may only have to check it one time a day.
  
  
• Know the signs of high blood sugar. The signs of high blood sugar are the same as the signs of diabetes that are listed above.
  
  
• Know the signs of low blood sugar. People who have low blood sugar may sweat. They can also feel shaky, dizzy, tired or confused.
  

Too much food, candy, cakes and other sweats can cause high blood sugar. It can also occur when the person is sick, has an infection, is under stress or does not exercise, as they should. Low blood sugar can happen when the person does not eat enough food or is doing too much exercise.

Nursing assistants who take care of patients should know the signs of high blood sugar and low blood sugar. If a nursing assistant observes a patient with the signs of high or low blood sugar, it must be reported to the nurse immediately.

PERSONAL CARE

People with diabetes sometimes have poor blood flow to their feet. They are also more prone to get infections. Nursing assistants, home health aides and personal care aides must make sure that all patients, especially diabetic patients:

• Are clean and well groomed
  
• Have good skin care
  
• Have good foot care. They should also wear shoes that fit well.
  

We should look at the feet of diabetic patients every day. If there is any redness or sores, it should be reported to the nurse immediately. At times, a person other than a nursing assistant or a home health aide must cut the toe nails of a person with diabetes. Check with the charge nurse before you cut the toe nails of a person with diabetes.

TAKING ORDERED MEDICATIONS

Diabetic patients and residents often take a diabetes medicine to keep their blood sugar down. If you work in an assisted living home or in the person's own home, you should remind them to take their medicine as the doctor has ordered.

Summary

Diabetes is a very common chronic disease that affects many people. Health care workers who take care of people with diabetes should know about this disease and ways that they can best take care of them.

A person with diabetes can live a long and healthy life when this disease is controlled.

References

Hockenberry, Marilyn J. and David Wilson. (2010).Wong's Essentials of Pediatric Nursing. 8th Edition. Elsevier Mosby.

Nettina, Sandra M. (2009). The Lippincott Manual of Nursing Practice. 7th Ed. Lippincott, Williams and Wilkins.

Kee, Joyce LeFever and Evelyn Hayes. (2009). Pharmacology: A Nursing Process Approach 6th Edition. Saunders Elsevier.

Monahan, Frances Donovan and Wilma J. Phipps (2007). Phipps’ Medical-Surgical Nursing: Health and Illness Perspectives. 8th Edition. Elsevier Mosby.

Copyright © 2010 Alene Burke