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SYSTEMS PLUS COLLEGE FOUNDATION Balibago, Angeles City COLLEGE OF NURSING

Prepared by: Concepcion, Kimberly Trisha R. Herrera, Joash Julius S. Ligon, Rowena P. Manlincon, Arlyn G.

STATISTICS In the Philippines, It is estimated that there are about 3 million Filipinos who are diabetic, 50% are undiagnosed. Another 3 million Filipinos have impaired glucose tolerance which is a risk factor for future diabetes and cardiovascular disease. The prevalence of the disease in the Asia Pacific region has now reached epidemic proportions. (2013)

What is diabetes?
Diabetes is a condition that makes it difficult for the body to use the glucose (sugar) in the blood. The body normally produces a hormone called insulin. Insulin is produced by the pancreas. The pancreas is an organ found in the tummy area quite close to the stomach. Insulin allows the glucose in our food to be taken from the blood and used by the body for energy. STEM CELLS TO CURE TYPE 1 DIABETES MELLITUS
Stem cell research allows researchers to grow specific varieties of human cells in the lab and research how they behave and interact under different conditions. Stem cells open up a wide spectrum of diabetes research possibilities. Researchers took cells from human intestine cells and disabled a gene which enabled the cells to produce insulin. Stem cells for the treatment of diabetes are able to come from a variety of sources- Embryos, the placenta, umbilical cord, bone marrow, blood cells and teeth.

In the United States, a report says that 2 out 3 (66.6 %) adult Americans, and 15 % of the children, are overweight. In the United States alone, there are about 17 million diabetics. Five to 10 % have Type I (juvenile), and the rest, Type II (adult onset) diabetes. Before insulin was discovered in the early 1920s, type 1 diabetes had 100 % mortality. In the past 10 years, there has been a 33 % increased in the number of diabetic patients. (July 28, 2013)

POSSIBLE CAUSE OF DIABETES


Obesity (excessive weight) Age- as we get older we are more at risk of developing diabetes Heredity (passing of genes from parent to child) Race (ethnic origin) diabetes frequently occurs more in some ethnic groups. Bad eating habits Lack of physical activity

What are the Different types of Diabetes? Type I


Their pancreas has stopped producing insulin.

Type II
The pancreas is not producing enough insulin to meet the bodys needs; or the insulin that is produced is not working very well.

Gestational Diabetes
The extra demands of pregnancy mean that the mother does not have enough insulin to meet her bodys needs. It is vital for the babys health that the mother does not have high blood sugar levels It is vital for the babys health that the mother does not have high blood sugar levels. It is only occurring in pregnancy.

or use an insulin pump.

diet and exercise; diet, exercise and tablets; diet, exercise, tablets and insulin; diet, exercise and insulin.

mother may be given extra insulin as an injection. It is usually (but not always) resolving within 6 weeks of delivery.

The exact cause of this condition is still unknown. It usually occurs in people under 35 years of age, but there are exceptions to this.

Older people are more likely to develop type 2 diabetes, but there are exceptions to this.

What are the signs and symptoms of diabetes?


Extreme thirst Drowsiness Frequent urination Irritability Extreme hunger Nausea Blurred vision Poor wound healing

TREATMENT
People with this type of diabetes need to inject insulin may include By controlling the any of quantity and type of the the following Mothers food and drink. combinations: If this is not enough to treat the condition, the

What are the complications of diabetes?


If this abnormally high sugar level is not treated it can harm different parts of the body. The complications diabetes can cause include damage to:
the eyes (retinopathy); kidneys (nephropathy); Foot; heart; blood vessels(; and nerves (neuropathy).

TEST FOR TYPE 1 & 2 Glycated hemoglobin (A1C) test


A hemoglobin A1C (also known as glycated hemoglobin or HbA1c) test gives you a picture of your average blood sugar (glucose) for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes.

Complications in your baby for gestational diabetes


Excess growth Low blood sugar Respiratory distress syndrome Jaundice Type 2 diabetes later in life Death

Random blood sugar test


A blood sample will be taken at a random/any time. Regardless of when you last ate. Random blood sugar level of 200 mg/dL or 11.1 mmol/L or higher suggests diabetes

SCREENING and DIAGNOSTIC PROCEDURE FOR DIABETES


WHO SHOULD BE SCREEN FOR DIABETES

Fasting blood sugar test


A blood sample will be taken after an overnight fast. Prediabetes Diabetes 100 -125 mg/dL (5.6 - 6.9 126 mg/dL (7 mmol/L) or mmol/L) higher on two separate tests

Anyone with a body mass index higher than 25, regardless of age, who has additional risk factors, such as high blood pressure, a sedentary lifestyle, a history of polycystic ovary syndrome, having delivered a baby who weighed more than 9 pounds, a history of diabetes in pregnancy, high cholesterol levels, a history of heart disease, or having a close relative with diabetes.

Anyone older than age 45 is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter.

Oral glucose tolerance test


A blood sample will be taken after you fast for at least eight hours or overnight. Then you'll drink a sugary solution, and your blood sugar level will be measured again after two hours. Normal: less than 140 mg/dL (7.8 mmol/L) Prediabetes: 140 to 199 mg/dL (7.8 to 11 mmol/L)

Self-monitoring of blood glucose


-Monitoring your own glucose (blood sugar) is done with a Glucose Meter. When you want to test for glucose with a glucose meter you need to place a small sample of your blood on a test strip. Your skin is pricked with a lancet - like a very fast pin-prick.

Instructions: a. Wash your hands with warm water and soap. Dry completely. You could also dab or wipe the area with alcohol and then dry completely. Use the lancet to prick your fingertip. Hold your hand down. Hold your finger at the same time until you see a small droplet of blood appear. Place the blood on the test strip. Follow the instructions for placing the test strip and using your meter. Keep a record of your result.

TEST FOR GESTATIONAL DIABETES


The test is generally given between the 24th and 28th week of pregnancy
b. c.

Initial glucose challenge test


You'll begin the glucose challenge test by drinking a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. Normal: below 130 to 140 mg/dL or 7.2 to 7.8 mmol/L Higher than normal: higher risk of gestational diabetes

d. e.

Follow-up glucose tolerance testing


You'll be asked to fast overnight and then have your fasting blood sugar level measured. Then you'll drink another sweet solution this one containing a higher concentration of glucose and your blood sugar level will be checked every hour for a period of three hours. If at least 2 of the blood sugar readings are higher than the normal values considered gestational diabetes

f.

TREATMENT FOR DIABETES


Insulin
Insulin is a hormone. It makes our body's cells absorb glucose from the blood. The glucose is stored in the liver and muscle as glycogen and stops the body from using fat as a source of energy. Human insulin with different durations of action (rapid-, short-, intermediate-, and long acting) It may be subcutaneous injection or insulin infusion pump Aspirate first the clear then the cloudy one. Insulin shots work fastest when given in the abdomen. Don't inject the insulin in exactly the same place each time, but move around the same area. Each mealtime injection of insulin should be given in the same general area for best results.

Insulin pump therapy Changed every 1 to 3 days Worn externally and injects insulin subcutaneous into the abdomen Infused in at low basal rate Must monitor glucose level 4 times a day

Oral Antidiabetes Drugs


It is for type 2 diabetes It includes Sulfonylureas, biguanides, meglitinides, incretin mimetics and amylinomimetics.

Transplantation
Pancreas transplant

Bariatric surgery
Although it is not
specifically considered a treatment for type 2 diabetes, people with type 2 diabetes who also have a body mass index higher than 35 may benefit from this type of surgery. People who've undergone gastric bypass have seen significant improvements in their blood sugar levels.

REHABILITATION FOR DIABETES


Diabetic patients undergoing rehabilitation require careful assessment, goal setting and good teamwork that will often involve multiple teams. For instance, some patients require a simpler regime to enable a family caregiver to administer regular medications. In other cases, improved control of blood glucose levels may assist with wound healing or pain control (high glucose levels lower pain thresholds). To provide patients with feedback on the effects of exercise therapy for diabetes, we use a multimeter incorporating a timer for the exercises (ViM Sports Memory, MicroStone Corporation), not a motion recorder attached to the lumber region. The numerical values associated with the exercises and activities during hospitalization are provided for patients on a computer screen.

EXERCISE
Benefits: Lower blood glucose Better weight control More strength, energy and flexibility Less need for insulin and other medications Lower cholesterol Reduced stress Feeling better about yourself. Before you start, get a checkup
Good forms of aerobic exercise may include: Walking Swimming Biking Dancing Be as consistent as possible. In general: The best time to exercise is about 1- 3 hours after a meal. Its considered best to build up at least 30 minutes on most preferably all days of the week. Its not best not to exercise when your insulin is peaking.

diabetes

PROMOTION AND PREVENTION

Be physically active: participate in at least 30 minutes of exercise every day Eat well: enjoy a variety of healthy food including at least 2 fruit and 5 vegetables a day, choose lean meats, reduced fat dairy products and eat wholegrain breads and cereals Maintain a healthy weight Limit alcohol intake Quit smoking

BEFORE EXERCISE
If you arent used to exercising, start slowly. Whatever your fitness level, remember to: Test your blood glucose level before exercising. (Ask your

health care provider what levels are safe for you. Do 5-10 minutes of warm-up activity, such as walking at your regular pace, followed by gentle stretching.

WHAT TYPE OF DIET SHOULD YOU EAT?


Healthy diets are: low in refined sugar; low in saturated fat; high in fiber, vitamins and minerals.

BEFORE EXERCISE
Its important to gradually increase the pace and intensity of your exercise. Ask your health care provider about what signs mean you should slow down. Its also important to: Carry diabetes identification Be prepared for low blood glucose. (Carry glucose tablets, juice or another fast-acting source of carbohydrate.

PRINCIPLES OF DIET MANAGEMENT


1 Have regular meal times and avoid skipping meals. 2. Have small and frequent meals. 3. Practice varied and balanced diet. 4. Distribute evenly the intake of complex carbohydrate between meals. 5. Ration the intake of fruit and milk. Milk : 1-2 serving per day Fruit: 1-2 serving per day Have your fruits and milk after each main meal. 6. Increase your dietary bre intake. 7. Eat less fat or oil. 8. Have regular exercise. 9. Avoid alcohol intake.
1.

AFTER EXERCISE
Take 5-10 minutes to cool down (walk slowly, then do gentle stretches). Then check your blood glucose level so you can learn how your body responds to exercise. Keep a logbook with notes about each days: Type and length of exercise Pre- and post-exercise glucose levels.

SPECIAL PRECAUTIONS
Drink plenty of water before, during and after exercise. Make sure footwear fits properly. Check your feet after exercising for redness, cuts, or sores. Avoid exercising when the weather is too hot, humid or cold. Learn what to eat or do if your blood glucose becomes too low or high. Know how to adjust your diet and insulin on days when you are more or less active than usual.

BASIC DIET GUIDELINES


1. Avoid simple carbohydrates - Sugar - Honey - Soft drink - Candy - Jam - Ice -cream - Sweetened condensed milk 2. Consume complex carbohydrates in moderation - Grain/cereals - Tuber - Bread - Biscuit - Pasta - Fruits 3. Eat freely the following items: - Spices - Water / Tea / Coffee (without sugar) - Green leafy vegetables

SHOULD YOU WORRY ABOUT YOUR CHOLESTEROL LEVEL?


It is important to control your cholesterol level. A high cholesterol level may speed up the hardening of the arteries and increase your risk of a heart attack. A healthy low-fat diet with plenty of high-fibre starch helps to control your cholesterol level.

HOW OFTEN SHOULD YOU HAVE YOUR EYES TESTED?


When you have diabetes you should have your eyes checked every year by the doctor - including a full examination of the back of the eye. This is different to a vision test for glasses.

FOOT CARE

Note: Anything wrong with toe or foot can become a major problem for someone with diabetes. People with diabetes are 15 times more likely to have a foot or lower leg amputation than someone without diabetes. Early treatment can reduce the risk of serious infection or amputation.

NICE TO KNOW FACTS


1. Diabetes is a silent epidemic and according to WHO there are 246 million people in the world living with diabetes. This is almost 6% of the world's adult population. 2. Diabetes in Asians is five times the rate of the white population 3. Diabetes causes 6 deaths every minute and one in 20 deaths in the world is due to the condition. Every year it is estimated that 3.2 million people in the world die due to the diabetes or its related causes. 4. Diabetes is an important 'silent killer disease' as there is usually no early symptom of the disease. The commonest early symptom is feeling thirsty 5. The major cause of increase in the incidence of diabetes is a sedentary lifestyle. Exercise and diet can either reduce or delay the incidence of diabetes by over 50%. 6. Diabetes is the number one cause of kidney failure in the world. Besides this every year it is responsible for 5% or 5 million blindness in adults and one million limb amputations. Diabetes is also an important cause of heart disease, stroke and cataract. 7. The current cost of treating diabetes and its complications in the world is estimated as US $ 215-375 billion. The disease is growing fastest in developing countries where there are more people in the lower and middle-income group.

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