DIABETES

1
DIABETES

• Diabetes mellitus??metabolic disease
  characterized by hyperglycemia resulting from
  defects in insulin section, insulin action or
  bothlead to long-term damage, dysfunction and
  failure of various organs eyes, nerves, heart and
  blood vessels.
• There is IDD (type 1) NIDD (type 2)

2
SIGNS AND SYMPTOMS

• Because cells cant use the circulating blood
  glucose, as result of lack of insulin the nervous
  system signals the person to eat which promotes
  the rise of blood glucose levels as well as
  elevated circulating cholesterol
• Early signs and symptoms?dry mouth, thirsty,
  increased urination (at night), increased
  appetite, un-intended weight loss

3
SIGNS AND SYMPTOMS cont.

• ? no or low insulin in tissue, cant use glucose
  effectively, hyperglycemia? rapid onset of
  symptoms? increased osmotic renal load?
  production and excretion of large amounts of
  urine? loss of fluid? dehydration (dry mouth,
  electrolyte loss, cellular dehydration)

4
TREATMENT GOALS

• Non-pharmacologic therapy
• Monitor blood glucose levels (patient control
  disorder)
• Nutrition plan---encourage meal plan, avoid fad
  diets or prolonged fasting
• Physical activity aerobic exercise by walking,
  swimming, biking, --dont strain the body by
  weight lifting?optic capillary damage
• Pharmacologic therapy
• Medication regimen

5
TREATMENT cont.

• Type 2 treatment goals are nutrition? weight
  loss, meeting blood pressure, blood lipid, and
  blood glucose
• Exercise?reduce calories, loosing weight,
  increases the sensitivity of cell receptors to
  insulin and hence reduces insulin resistance
  (temporarily)

6
PHARMACIST INTERVENTION

• Identify gap, teach and monitor self-care
  measures
• Relieve and prevent diabetes related symptoms
• Maintain blood glucose levels (80-150 mg/dL)
• Achieve/maintain optimal weight
• Have patients become their own primary healthcare
  giver through intensive education
• Improve control and adherence to prescribed care
  plan over the long term

7
REFER

• Large Urine ketones
• Blood glucose 240 mg/dL
• Persistent nausea, vomiting, diarrhea etc.

8
SKIN CARE

• Bathe daily w/ mild soap
• Inspect skin daily
• Cleanse minor cuts/scratches w/soap and water
• Refer deep/serious cuts and burns

9
EYE CARE

• Get an annual dilated eye exam
• No topical ophthalmic preparations unless Rx
• Vision changes and eye irritations ? refer

10
FOOT CARE

• Inspect and clean feet daily
• Probe areas of feet to assess sensation
• Wear shoe that fit and comforable
• Change shoes and socks often
• Trim nails, dont walk barfoot
• Inspect shoes for foreign objects before
  inserting feet

11
GOOD SICK DAY COVERAGE

• Maintain usual/insulin oral agent schedule
• Increase non-caloric intake
• Monitor blood glucose and urine ketones
  frequently (q 2-4 hours)
• Know when to call, or take more insulin