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Diabetes in the Work Place
Presented by
Marie Byrd, RN, MSN, CCRN
Inpatient Diabetes Coordinator
Cone Health
Objectives Outline basic pathophysiology of normal glucose metabolism
Define diabetes and explain classifications of diabetes
Discuss glucose metabolism with diabetes
Identify risk factors for developing diabetes
Review acute and chronic complications of uncontrolled diabetes
Identify diabetes educational resources
Identify 2 symptoms of hypoglycemia and hyperglycemia
Be able to identify goals for Hgb A1C and fasting blood sugars
Understand how food choices can affect blood sugar levels and name 3 food
groups that contain high carbohydrate foods
Knowledge Assessment
Who has diabetes or has a family member with diabetes?
Who feels they are knowledgeable on diabetes and what needs to be done to control diabetes on a daily basis?
Who knows what to do for someone experiencing symptoms of low blood sugar?
In people without diabetes, glucose stays in a healthy range 70-130 mg/dl
because;
Normal Blood Glucose Control
Insulin is released at the right times and in the right amounts
Insulin helps glucose enter cells
The digestive system breaks down carbohydrates from
food into glucose.
Some of that glucose is stored in the liver and
muscles, but most of it enters the bloodstream and travels to cells to be used as energy.
Stomach
Blood stream
Glucose
When insulin reaches a cell, it allows glucose to
enter into that cell. *Think of insulin as a key that allows glucose to enter
the cell.
Glucose needs help from insulin to enter most cells. Insulin is produced
by the pancreas.
Pancreas
Cell
Insulin
ENERGY
What is diabetes?
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia (high blood sugar) resulting from defects in insulin
secretion, insulin action, or both**American Diabetes Association. (2008). Diagnosis and classification of diabetes mellitus. Diabetes Care, 31(1), S55-S60.
Burden of Diabetes in the United States
Diabetes 29.1 million people or 9.3% of the population have diabetes 8.1 million people or 27.8% of people with diabetes are
undiagnosed Leading cause of:
• new blindness among adults• kidney failure • non-traumatic lower-limb amputations
Increases the risk of heart attack and stroke by 2-4 fold 7th leading cause of death Mortality rates 2-4 times greater than non-diabetic people of the
same age
Source: Centers for Disease Control and Prevention2014 National Diabetes Statistics ReportDiabetes 101: American Diabetes Association
http://professional.diabetes.org
Diagnostic Criteria for Diabetes
Prediabetes: A1C of 5.7 to 6.4
A1C > 6.5
OR
Fasting plasma glucose (FPG)
>126 mg/dl
OR
Two-hour plasma glucose >200 mg/dl
during an Oral Glucose Tolerance Test
OR
A random plasma glucose >200 mg/dl
with symptoms of hyperglycemia
ADA. I. Classification and Diagnosis. Diabetes Care 2013;36(suppl 1):S13. Table 2.
Hemoglobin A1C (HGB A1C)
HgbA1c reflects long-term blood glucose control and provides an average blood glucose for the past 2-3 months
Goal HgbA1c: <7.0%
Diagnosis of diabetes= HgbA1c of 6.5% or
greater
Types of Diabetes
Type 1 Diabetes5 - 10% of all diabetes due to beta cell destruction; usually develops prior to age 30 Absolute insulin deficiency as the body does not make any
insulin
Type 2 Diabetes 90-95% of all diabetes Result of insulin resistance and decreased insulin secretion Risk of developing Type 2 diabetes increases with family
history, age, obesity, lack of exercise, gestational diabetes, ethnicity African American, Asian, Hispanic)
Gestational Diabetes Diabetes during pregnancy Result of the hormonal changes in the placenta that influence
the blood glucose levels of the mother
Glucose Metabolism With Diabetes You may not make any insulin at all (Type 1)
You may not make enough insulin (Type 2)
Your cells may not respond the right way to insulin in the blood (Type 2)
Which means glucose has trouble entering the cells and if it cannot enter the cells it leads to a harmful levels in the blood stream
Risk Factors for Developing DiabetesRisk factors for type 1 diabetes are still being researched but currently: Having a family member with type 1 diabetes slightly increases the risk of developing the
disease Environmental factors and exposure to some viral infections have also been linked to the risk
of developing type 1 diabetes
Several risk factors have been associated with type 2 diabetes and include: Non-modifiable risk factors: Family history of diabetes Being over 45 years of age Ethnicity History of gestational diabetes Modifiable risk factors: Overweight Unhealthy diet Physical inactivity High blood pressure Poor nutrition during pregnancy
International Diabetes Federation. (2014). Risk Factors. Retrieved from http://www.idf.org/about-diabetes/risk-factors
1. Diabetes mellitus is defined as:
a) Too much sugar or glucose in the blood stream
b) Too much insulin in the blood stream
c) Being overweight
2. What is the most common form of diabetes?
d) Type 1 diabetes
e) Type 2 diabetes
3. Which classification of diabetes consist of individuals that make no insulin?
f) Type 1 diabetics
g) Type 2 diabetics
Initial Diabetes SymptomsThe following symptoms of diabetes are typical. However, some people with type 2 diabetes have symptoms so mild that they go unnoticed.
Common symptoms of diabetes:
Urinating often
Feeling very thirsty
Feeling very hungry - even though you are eating
Extreme fatigue
Blurry vision
Cuts/bruises that are slow to heal
Weight loss - even though you are eating more (type 1)
Tingling, pain, or numbness in the hands/feet (type 2)
Early detection and treatment of diabetes can decrease the risk of developing the complications and harmful effects of diabetes such as damage to the eyes, heart, blood vessels, nervous system, teeth and gums, feet and skin, or kidneys.
American Diabetes Association. (2015). Diabetes symptoms. Retrieved from: http://www.diabetes.org/diabetes-basics/symptoms/
Acute Complications of Diabetes
Hypoglycemia-Low blood sugar < 70 mg/dL
Hyperglycemia-Blood sugar > 200 mg/dL
Hyperglycemic Crisis
Diabetic Ketoacidosis
Hyperosmolar Hyperglycemic
Steroid induced hyperglycemia
Signs & Symptoms of High Blood Sugar
Excessive thirst
Frequent urination
Hunger
Weakness
Fatigue
Weight loss
Blurry vision
• Headache
• Sweatiness
• Impaired vision
• Ringing in ears
• Increased heart rate
• Hunger
• Tingling/numbness of the tongue
• Feeling sleepy
• Trembling
• Irritability
• Lack of coordination
• Personality change
• Passing out
• Seizures
Signs & Symptoms of Low Blood Sugar
How to Treat a Low Blood Sugar
Use 15:15 rule – Treat with 15 grams of carbohydrates and recheck blood glucose in 15 minutes (typically brings blood glucose up 50 points)
Examples of 15 grams of carbohydrates:
4 oz. (1/2 cup) juice
4 oz. (1/2 cup) regular soda
8 oz. (1 cup) skim milk
3-4 glucose tablets
1 tube instant glucose
Do Not over treat!
If unable to take anything by mouth, may need Glucagon depending on level of severity.
1. Which of the following is a symptom of low blood sugar?
a. Drinking a lot of fluids
b. Excessive urination
c. Tremors
d. Weight loss
2. Which of the following is considered a low blood sugar?
a. 78 mg/dl
b. 62 mg/dl
c. 80 mg/dl
Long Term Complications of Diabetes
“Diabetes can affect many parts of the body and is associated with serious complications, such as heart disease and stroke, blindness, kidney failure, and lower-limb amputation. Some complications, especially microvascular (e.g., eye, kidney, and nerve) disease, can be reduced with good glucose control. Also, early detection and treatment of complications can prevent progression, so monitoring with dilated eye exams, urine tests, and foot exams is essential. Because the risk of cardiovascular disease is increased in diabetes and prediabetes, blood pressure and lipid management, along with smoking cessation, are especially important. By working together, people with diagnosed diabetes, their support network, and their health care providers can reduce the occurrence of these and other complications”(CDC National Diabetes Statistics Report, 2014; http://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf).
Chronic Complications of Diabetes
Heart & blood vessel damage (increase risk of heart attack and stroke)
Nerve damage (Neuropathy)
Kidney damage (Nephropathy)
Eye damage (Retinopathy)
Foot damage (ulceration and amputations)
Lower limb damage (Peripheral Vascular disease)
Mental health issues (Depression, Alzheimer's)
Periodontal disease
How is diabetes managed?
Meal plan
Physical activity
Blood glucose monitoring
Take diabetes medications
Maintain ABCs (A1C, blood pressure, cholesterol)
Follow up with Healthcare Provider regularly
Stress management
Type 2 diabetes progression and screening
In type 2 diabetes, the pancreas continues to secret insulin but the body cannot use insulin properly; this condition is called insulin resistance. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin.
Type 2 diabetes develops slowly over months and years, so screening programs for early detection and treatment are important in employee populations
Managing Type 2 Diabetes
Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan and a program of regular physical activity, losing excess weight, and taking medications (such as oral medications and insulin). Medications for each individual with diabetes will often change during the course of the disease.
Self-management education or training focuses on self-care behaviors, such as healthy eating, being active, adhering to medications, learning coping skills, and monitoring blood glucose.
Many people with diabetes also need to take medications to control their blood pressure and to control their cholesterol.
CDC National Diabetes Statistics Report, 2014; http://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf
‘ABCDE’ of Diabetes
A-A1C
B-Blood Pressure
C-Cholesterol
D- Diet
E - Exercise
Survival Skills of Diabetes Medication management- how and when to take
Nutritional management-Dietitian consult – what to eat and the role of carbohydrates on blood glucose management
Exercise- get active
Signs &Symptoms of hyperglycemia and hypoglycemia- what you may
feel like if blood glucose is too low or too high and how to treat it
Blood glucose monitoring - how to obtain and what the measurement
means
Sick Day guidelines
Healthy coping
Reducing risks and complications
Who and when to contact in case of emergency
Plan for self-management support
References American Diabetes Association. (2013). Classification and Diagnosis. Diabetes Care
2013;36(suppl 1):S13. Table 2.
American Diabetes Association. (2015). Diabetes complications. Retrieved from: http://www.diabetes.org/living-with-diabetes/complications/
American Diabetes Association. (2015). Diabetes symptoms. Retrieved from: http://www.diabetes.org/diabetes-basics/symptoms/
American Diabetes Association. (2008). Diagnosis and classification of diabetes mellitus. Diabetes Care, 31(1), S55-S60.
Centers for Disease Control and Prevention. (2014). National Diabetes Statistics Report. Retrieved from: http://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf
Centers for Disease Control and Prevention. (2014). National Diabetes Statistics Report Diabetes 101: American Diabetes Association. Retrieved from: http://professional.diabetes.org
International Diabetes Federation. (2014). Risk Factors. Retrieved from http://www.idf.org/about-diabetes/risk-factors
