Caring for Children with Diabetes in Windsor

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Diabetes Review Judy Bornais RN, BScN, MSc, CDE


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


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


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


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


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


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


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


Life Expectancy Diabetes reduces survival by almost 12 years4


Diabetes is a Major Health Care Issue


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


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


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.


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.


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


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.


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)


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


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.


Targets Blood Sugar Ranges4


Targets Blood Sugar Ranges4


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


Signs and Symptoms of Hypoglycemiasweating shaking weakness hunger nausea irritability confusion


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%)


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


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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