Diabetes is a very common health condition in North America. There are two types of Diabetes, Type 1 and Type 2. Most common type of Diabetes is Type 2 and it is usually a consequence of poor lifestyle habits and diet. Diabetes is when the pancreas organ in the body stops producing enough of the hormone insulin which results in excess sugar (glucose) in the bloodstream rather then in the cell.
A consequence of excess glucose in the bloodstream leads to long term health consequences, and it is linked to heart disease, heart attack, stroke, eye damage (retinopathy), kidney disease, nerve pain (neuropathy). Unfortunately, once a person is diagnosed with diabetes, they will have diabetes for the rest of their life. However, it is possible for diabetics to effectively control their diabetes with proper diet and exercise.
Caring for patients with Diabetes:
This will involve blood sugar monitoring, anti-diabetic medication administration, and being aware of the signs and symptoms of low and high blood sugar.
Blood sugar monitoring:
It is important to ensure your patient’s blood sugar is within normal limits. Not all diabetic patients will require blood sugar monitoring, if your patient does require it you will receive additional training to competently obtain blood sugar readings.
Normal blood sugar range is between 4 to 6 mmol, but diabetics may have slightly higher then normal blood sugar ranging from 6-10 mmol.
Above 11 mmol is high, but it is a medical emergency if your patients blood sugar is above 25mmol. High blood sugar is called Hyperglycemia, and signs and symptom include: excessive urinating, excessive thirst and hunger, flushed red skin, fast deep breathing, “fruity” smell on their breath, confusion and coma. Higher than normal blood sugar readings are usually a result of excessive food/drink intake and/or missed anti-diabetic medication.
The opposite complication of high blood sugar is low blood sugar (below 4 mmol) which is called Hypoglycemia. Review the chapter on hypoglycemia to learn more about the symptoms and management of hypoglycemia.
Contact your supervisor if you have any concerns with your patient’s blood sugar level, or call 911 if the patient is unresponsive.
Anti-Diabetic Medications
Anti-diabetic medications are important to be administered as directed.
Some patients will require Insulin which is a High-Alert medication that is given as an injection. This medication has the potential to cause serious harm if given in the wrong dose, which is why it is a High Alert Medication. Therefore, if your patient requires Insulin administration you will receive additional training and education so that you can confidently administer insulin.
Anti-diabetic medications should be given with meals to prevent the patient from becoming hypoglycemic (low blood sugar). If your patient does not feel like eating at the time the anti-diabetic medication is due, encourage them to eat, or else do not give them the medication until they do eat.
Common anti-diabetic medications are: Metformin, Glyburide, Glipizide, Acarbose, Actos
Foot care/ foot/leg amputation
A common complication from poorly controlled diabetes is slow wound healing, primarily in the feet. Due to the loss of sensation in the feet from diabetes, these patients can easily develop wounds in their feet that go unnoticed.
As a result, the wound can turn into a diabetic ulcer that will require special wound care/dressings to assist in the healing and closure of the wound.
If left untreated, these patients usually undergo amputation of the foot. With foot amputation, the patient will have mobility challenges. Most amputees will receive prosthetics (extremity moulds) to help with mobility.
Foot amputations can cause severe pain in the affected extremity, it is known as Phantom pain or nerve pain. Most patients will receive strong pain medications as needed to help ease this pain such as Hydromorphone, Morphine or Tylenol # 3. Your responsibility will be to provide basic foot care to these diabetic patients:
a) Inspect both sides of their feet daily and look for any cuts, scratches or open wounds. If you notice a wound that is taking a long time to heal, inform your supervisor so that a care plan can be developed.
b) Gently wash their feet and pay dry. Apply a small amount of lotion if dry.
c) Always ensure these patients have socks and shoes on as they are at increased risk of injury to their feet due to the gradual loss of sensation in their feet.
d) Check routinely for loss of sensation or complaints of numbness. These are signs of neuropathic changes in the extremity and should be brought to their doctors’ attention. For more information, call me today!
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