Caring for Children with Diabetes in Windsor

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Diabetes Review Judy Bornais RN, BScN, MSc, CDE

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PrevalenceMore than 2 million Canadians have diabetes1 By 2010 that number is expected to rise to 3 million 1 31% rise in prevalence in Ontario since 1995 2 Estimated that 1 in 5 individual over 45 years of age have diabetes and 1 in 3 over the age of 75 3 Studies suggest that up to 30% of people with diabetes are undiagnosed6

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Did You Know?About half of all people diagnosed with diabetes have already had the disease for as long as 7 years1 20 - 30% of those individuals diagnosed already have developed complications 3

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Cardiovascular disease is 2-4 times more prevalent in patients with diabetes than in those without1 Cardiovascular disease accounts for at least 60% of the deaths in patients with diabetes2

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When a patient develops vascular complications like MI or stroke, the outcome is worse in the individual with diabetes3

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The Burden of Cardiovascular Disease in DiabetesMortality rate in patients with diabetes more than doubled versus those without diabetesBalkau B, et al. Lancet 1997

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Does the outcome depend on the Type of Diabetes?Two large studies, UKDPS and DCCT, indicate that both Type 1 and Type 2 can result in macro and microvascular complications such as: Coronary heart disease Stroke Peripheral vascular disease Nephropathy retinopathy Neuropathy

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Clinical Impact of Diabetes The leading cause of new cases of end stage renal disease (ESRD)A leading cause of cardiovascular events in adultsThe leading cause of non-traumatic lower extremity amputationsThe leading cause of new cases of blindness in working age adults

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Life Expectancy Diabetes reduces survival by almost 12 years4

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Diabetes is a Major Health Care Issue

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How does this impact you?Patients with diabetes, had higher rates of hospitalization than the general population with an excess risk of about 30% In Essex County, in 1999 there were 18, 982 cases of people who visited a health care provider for their diabetes7

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There is hope!Complications of diabetes can be delayed and in some cases avoided with tight: glycemic control lifestyle modification vascular protection Health care professionals role…and the battle begins

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Not so long ago in a galaxy remarkably like ours , the evil Diabetes Empire ruled over a terror-stricken population. Striking without warning Diabetes would leave suffering , mutilation and death in its’ wake. Diabetes had thus ruled unopposed for generations.

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A mere 80 years ago Rebel Fighters , Banting and Best devised a weapon to battle the Empire. The weapon was called “Insulin”. While powerful , insulin was difficult to deliver and tricky to use . Diabetes learned to exploit these weaknesses over the years. The war raged on.

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To win the battle we must…Understand Diabetes Management Diabetes management involves balancing food, medication, and activity to achieve blood glucose levels that are near the normal range Hormones, stress, illness, food - raises blood sugars Insulin, medications (type 2), exercise* – lowers blood sugars

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Types of Diabetes?You have a patient who takes Novolin 20/80 twice a day. What type of diabetes does your patient have? Individual can have either type 1 or type 2. Taking insulin does not classify the individual as having type 1diabetes.

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What happens in DiabetesType 1 Diabetes The pancreas no longer produces insulin. The person is totally dependant on exogenous insulin Type 2 Diabetes The pancreas is not making enough insulin and/or the body is resistant (no longer sensitive to insulin)

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Treatment for DiabetesType 1 Diabetes InsulinType 2 Diabetes diet and exercise oral hypoglycemics oral hypoglycemics and insulin insulin

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The Phantom Menace : Diabetes’ New Ally - Hypoglycemia Hypoglycemia a new threat in Glucose Wars. No easy way to predict or treat (no glucose tabs or glucagon). Low blood sugar perceived as greater threat than hyperglycemia by caregivers.

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Targets Blood Sugar Ranges4

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Targets Blood Sugar Ranges4

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HypoglycemiaBlood sugars less than 4.0 mmol/L What are the Signs & Symptoms of a low blood sugar?

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Signs and Symptoms of Hypoglycemiasweating shaking weakness hunger nausea irritability confusion

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Symptoms of Hypoglycemia5Neurogenic (autonomic) Sweating (47 – 84%) Trembling (32-78%) Palpitations (8-62%) Hunger (39-49%) Anxiety (10-44%) Nausea (5-20%) Tingling (10-39%) Neuroglycopenic Difficulty concentration (31-75%) Weakness (28-71%) Vision change (24-60%) Confusion (13-53%) Tiredness (38-46%) Difficulty speaking (7-41%) Dizziness (11-41%) Headache (24-36%)

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SEVERITY OF HYPOGLYCEMIA4MILD Autonomic symptoms are present Individual is able to self-treat MODERATE Autonomic and neuroglycopenic symptoms are present Individual is able to self-treat SEVERE Individual requires assistance of another person Unconsciousness may occur Plasma glucose is typically < 2.8 mmol/L

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How do you treat a low blood sugar?A) Chocolate bar? B) A hard candy? C) Juice? D) Glucose tabs?

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Last Updated: 8th March 2018

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