okay in this video we are going to talk
about diabetes mellitus
and this is a super important topic if
you're in nursing school you will
definitely be asked lots of questions
about diabetes on your nursing exams and
then as a practicing nurse you will be
taking care of
many patients with diabetes in all
likelihood
so diabetes has a lot of different
comorbidities that it causes
so individuals with diabetes are
hospitalized more
than other people so it's important to
understand this disease
inside and out so that you can properly
care for your patients and
educate them so in this video we are
going to talk about the pathophysiology
of diabetes
we're going to talk about risk factors
as well as signs and symptoms
labs and diagnosis of diabetes as well
as
foot care and illness care diabetes
causes
chronic hyperglycemia so increased blood
glucose levels
due to insufficient insulin production
by the pancreas
and or insulin resistance of the cells
in the body so insulin is kind of like
an
escort and it helps to bring glucose
from the bloodstream
into the cells so if there's not enough
insulin
then glucose can't get it to the cells
and it builds up
in the bloodstream so there are three
types of diabetes
type 1 type 2 and gestational diabetes
with type 1 we have destruction of the
beta cells
in the pancreas due to an autoimmune
dysfunction and this leads to a lack of
insulin secretion
by the pancreas so patients with type 1
diabetes
they are insulin dependent they will
require
insulin for the rest of their lives in
order for that
glucose to get from the bloodstream into
the cells
then we have type 2 diabetes this is
where we have progressive
insulin resistance and decreased insulin
production
from the pancreas and this typically
occurs later in life but not always so
we
definitely are seeing increased
incidences of
juvenile diabetes risk factors
associated with
type 2 diabetes includes obesity
inactivity hypertension hyperlipidemia
smoking genetics and race
so patients that are african-american
hispanic
or american indian they are definitely
at higher risk
for diabetes the third type of diabetes
is
gestational diabetes so this is where
the placental hormones
counteract insulin and this results in
glucose intolerance during pregnancy
all right now let's talk about the signs
and symptoms of
diabetes which are basically the signs
and symptoms of hyperglycemia
there's a lot to remember they're all
here on the back of card 44.
let's first talk about the three ps
polydipsia
polyphagia and polyurea poly means like
a lot
or many so with diabetes you're going to
have a lot of thirst
a lot of hunger and a lot of urine
other symptoms include weight loss warm
and dry skin
so the way i remember the skin symptom
is warm and dry
sugars high cold and clammy need some
candy
so we'll talk about that cold and clammy
skin when we cover
hypoglycemia but for hyper
glycemia the skin will be warm and dry
other symptoms include dehydration which
you may see
weak pulses and decreased skin turgor in
the patient with dehydration
fruity breath kuzmal respirations
so with kuzmal respirations we have
increased rate
and depth of respirations other signs
and symptoms include nausea and vomiting
weakness and lethargy so in terms of
diagnosis of diabetes if the patient has
two or more of the following labs on
separate days
then that is indicative of diabetes so
these labs include a casual blood
glucose
over 200 a fasting blood glucose over
126 glucose over 200
with an oral glucose tolerance test
or an hgb a1c over
6.5 so again
if they have two or more of those over
separate days
then they would be diagnosed with
diabetes in terms of treatment
insulin is definitely an important one
to remember
if your patient is type 1 that is all
they're going to be getting
right they're insulin dependent type 1
diabetic patients
cannot take oral diabetic
medications they require insulin
if your patient is type 2 they can take
insulin
but they can also receive oral
anti-diabetic medications so um
when we are treating diabetes our goal
is to try to get that hgb a1c
under seven percent so that hgb a1c
result really tells us a lot about
the patient's blood glucose levels over
the past
two three months as opposed to just
doing like a spot check on the blood
glucose it just tells you
how that glucose is doing right then and
there that hgba1c
is a more indicative result on how the
patient has been managing their diabetes
over the last several months so that's
going to be
an important one to watch for and our
goal is to get that under
seven percent all right so finally let's
talk about
foot care and illness care which are
some important teaching you'll need to
provide
your diabetic patient so with foot care
as a wound nurse i see lots and lots of
diabetic foot ulcers
that often lead to amputations it's a
huge complication of diabetes so we
need our diabetic patients to take care
of their feet
so some of the education you should
provide your diabetic patients
include that they need to inspect their
feet daily
using a mirror they should always check
their shoes for objects before putting
their feet in there
because that can cause damage they
should apply
moisturizer to their feet but not
between the toes because
putting it between the toes can result
in athlete's foot which is basically a
fungal infection
they should wear cotton socks as opposed
to
synthetic socks and they definitely need
to wear
closed-toe shoes so they should not go
barefoot
or wear open-toed shoes and their shoes
need to be
fitted properly ideally they would go
see their podiatrist
and get some special properly fitted
shoes to help protect their feet
they should cut their toenails straight
across they shouldn't round them on the
sides because that can cause
hang nails which can lead to really
complicated infections
they should also not use
over-the-counter products for like
corn or callus removal and then finally
they should not use
heating pads on their feet because
diabetic patients have
decreased sensation in their extremities
so if that heating pad is too hot it can
burn them and cause damage and they
won't even know
because they can't really feel it in
terms of illness care this
is definitely important so i share an
office with the diabetic educators at my
hospital and when patients get sick
they are much more likely to have
life-threatening complications
such as diabetic ketoacidosis or dka
so when your patient is sick they need
to monitor
their blood glucose levels more
frequently they should
not skip insulin when they're sick
and they also need to test their urine
for ketones because if there is
ketones in the urine that could indicate
that they have dka
also when the patient is sick it's
important to
prevent dehydration so they should drink
about three liters
of water per day to prevent that
dehydration
and then they should notify the provider
if their illness lasts for more than one
day
if they have a temperature over 38.6
degrees
celsius if their blood glucose levels
are over 250
or if their urine is positive for
ketones
okay so i know there's a lot of
information in this video i hope it's
helpful
in my next video we will go over
complications
and critical care topics related to
diabetes
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