What is diabetes?

Shahida Perveen Registered nurse Cardiac Rehab. Deptt. Diploma in Diabetic education from BIDE

What is diabetes?

Diabetes

is a long term disorder characterized by a raised level of glucose or sugar in the blood.

What is diabetes?

Where Does Glucose Comes From???

Your body uses glucose (a type of sugar) for energy. Glucose comes from food particularly starchy and sugary food (called carbohydrates) Digestion break down the carbohydrates into your food into glucose which goes into your body.

What is diabetes?

Carbohydrate Digestion Glucose

(energy) Some foods provide glucose, very quickly e.g. Jams, sweets and fruit juices. Other foods provide glucose slowly e.g. potatoes, bread and rice.

What is diabetes?

Why your blood glucose level is high?

The pancreas (a gland in the body near your stomach) makes a hormone called insulin. Insulin is very important , it helps glucose move from blood into cells where its used for energy. Its deficiency causes high glucose level in the body.

What is diabetes?

Types of Diabetes: Type I Type 2 Type 2 Diabetes: Is the most common type of diabetes. Develops gradually. Is found mainly in people aged over 40 Risk factors include: - Age - Obesity - Having a blood relative with diabetes.

What is diabetes?

Sign and Symptoms Of Diabetes:

Thirst and Dry mouth Passing a lot of Urine Tiredness Blurred Vision

What is diabetes?

Dont worry Healthy living and taking your medicine will make you feel better

Management Goal Target for Glucose Control

Ideal Range
70- 105 mg/dl Fasting Post Prandial Bedtime 80-120 mg/dl 100-140 mg/dl 80-140mg/dl 100- 140 mg/dl

Acceptable Range
80-120 mg/dl

Hyperglycemia

Sign and Symptoms:

Tiredness Thirst Blurred Vision Passing a lot of Urine

Causes Of Hyperglycemia

Not taking your tablets Too much of the wrong kind of Food Not enough Exercise Sickness Stress Weight gain

What Should I do?

Dont Panic. Its normal for your blood glucose level to go up and down in a day. Always take your tablets. If you have high blood glucose levels for a few days in a rows or you feel unwell, see your GP or Diabetes Specialist Nurse.

Hypoglycemia

Hypoglycemia is low blood glucose level. Sign and Symptoms:

Dizziness Sweaty Hunger Cold Faint Tired Confusion Having Pounding heart beat

Causes Of Hypoglycemia
Some tablets can make your glucose too low in certain situation for e.g

Not eating enough food

Exercise without eating Dinking alcohol

What Should You Do?

Eat or drink something immediately containing sugar e.g. glucose tablets or sugary drink (but not a diet drink) For Example: 2 or 3 glucose tablets cup(4 onz) of any fruit juice or regular soft drink. 1 cup (8 onz) milk. 5 or 6 pieces of hard candy. 1 or 2 teaspoon of sugar or honey in half glass of water.

Check & Identify Your Feet

Examine your feet daily Wash your feet in warm water every day Sit less and walk around Keep your feet away from heater Do not treat you feet yourself consult your physician

Diabetic Foot Care

Foot examination

Examine your feet daily and also after any trauma, no matter how minor, to your feet. Report any abnormalities to your physician.

Diabetic Foot Care

Apply Moisturizer:

Use a water-based moisturizer every day (but not between your toes) to prevent dry skin and cracking. Wear cotton or wool socks. Avoid elastic socks and hosiery because they may impair circulation.

Diabetic Foot Care

Toenail trimming:
Always cut your nails with a safety clipper, never a scissors. Cut them straight across and leave plenty of room out from the nailbed.

Diabetic Foot Care

Footwear:
Wear comfortable shoes or slippers to protect your feet all the time. To be sure your shoes fit properly. Avoid pointed shoes and peshawari sleepers.

Diabetic Foot Care

Smoking:
If you smoke any form of tobacco, quitting can be one of the best things you can do to prevent problems with your feet. Smoking accelerates damage to blood vessels, especially small blood vessels leading to poor circulation, which is a major risk factor for foot infections and ultimately amputations.

Diabetic Foot Care

Exercise:
Regular exercise will improve bone and joint health in your feet and legs, improve circulation to your legs, and will also help to stabilize your blood sugar levels

Self Monitoring Blood Glucose (SMBG)

Most of the time diabetic patients have no symptoms even his/her blood sugar level is very high/low, therefore regular self monitoring of glucose is the only way to inform you for the current level of glucose in you blood

Self Monitoring Blood Glucose (SMBG)

The ideal monitoring system would be

Simple, cheap, fault proof and reliable Painless and non invasive Give immediate and reliable information which cant be faked by patients Understood and useful by both patients and doctor Warn of impending hypoglycemia Provide an index of long term control

Check List

Always take your tablets Test your blood glucose regularly See your doctor regularly to check your diabetes and general health Have your eyes tested Eat a healthy diet Dont smoke Keep to sensible amounts of alcohol Keep fit Watch your weight Check your feet daily Wear comfortable shoes

Self Management And Its Importance

Better quality of life Control over own health rather than Dr. Feel better and healthier Cut down expenses Not loose time from work, better able to earn income and take care of family.

Objectives Of Management

Advice about potential risks of fasting. Providing guidelines for proper management of their diabetes.

Risks Associated with Fasting

Hypoglycemia Hyperglycemia Diabetic Ketoacidosis acidosis Dehydration and thrombosis

High Risk Group:

Patient with moderate hyperglycemia. Patients with renal insufficiency People living alone, treated with insulin or sulphonylurea Old age with ill health Drugs that may affect mentation. Patients with co morbid conditions that may present additional risks.

Start by identifying patients with Very high risks, high risks and moderate risks.

Very High Risks Group:

Severe hypoglycemia during three months prior to Ramadan. DKA within three months prior to Ramadan. HONK within three months prior to Ramadan. Type 1 diabetics. Patient with a history of recurrent hypoglycemia. Poor glycemic control. Acute illness. Pregnancy. Chronic dialysis. Patient who perform intense physical labor.

Moderate Risk Group:

Well controlled on short acting Insulin secretagogues such as Repaglinide or Nateglinide.

Education And Counseling

Educate the patient that they should be prepared to break their fast in case of an acute complication. Educate the patient and their family about signs and symptoms of Hypoglycemia and its management. Educate regarding blood sugar monitoring. Educate regarding meal planning. Educate regarding physical activity.

Nutrition

Increase fluid intake. Avoid food rich in fat and simple carbohydrates. Advise food with complex carbohydrates at Sehar. Take Sehar as late as possible.

Monitoring Sugar

2 Hours After Sehar 150-200 mg/dl At Zuhur 120-150 mg/dl Just before Aftaar 80-120 mg/dl After Aftaar: 100-140 mg/dl

Breaking the Fasting

Patient should end their fast if: Blood glucose is <60 mg/dl If the sugar is <70mg/dl in the first few hours after Sehar and the patient has taken insulin or sulphonylurea. If the blood sugars are > 300 mg/dl