DIABETES MELLITUS

“Elevated blood glucose level resulting from defects in

insulin secretion, insulin action, or both.”
DIABETES AND ITS CLASSIFICATION
Type I diabetes: Insulin-dependant diabetes
(IDDM).

Type II diabetes: non Insulin-dependant

diabetes (NIDDM).

Gestational diabetes mellitus.

Diabetes mellitus associated with other

conditions or syndrome.
 Pharmacological
therapy Education

Nutritional
Monitoring
Therapy

Exercise
 INSULIN PREPARATIONS
Insulin Type Onset of action Peak of action Duration of
action

Lispro Rapid acting 5-15 minutes 1-2 hours 4-5 hours

(Humalog®)

NPH Intermediate 1-2 hours 5-7 hours 13-18 hours

acting
INSULIN USE
• demonstrates appropriate injection technique.
• Insulin should usually be injected before meals (about ½
hour for regular insulin, 5-15 minutes before Humalog or
Novo log)
• Inject in the abdomen, the upper arms, thigh.
• Always check blood sugar before injecting insulin.
• If blood glucose is low, eat first, recheck, then inject if sugar
has come up to normal.
 Self-Monitoring Blood Glucose (SMBG)

 Continuous Glucose Monitoring System (CGMS)

 Glycated Hemoglobin

 Urine Glucose Testing

 Testing for Ketones

 Can insulin cause problems?
• Apart from hypoglycemia insulin has very few side-effects.

• You may feel some lumpiness at the site of the injection but
regularly changing the area of skin that you inject will help to
prevent this.
Blood Glucose Testing
• How to use patient’s specific glucometer: demonstrate
competency in use.
• When to test? Useful times: before injecting insulin, 1st
thing in the morning, 1-2 hours after meals (Once per day
is usually enough for patients not on insulin unless
otherwise ordered by provider).
• Blood Glucose Testing What is a “good” glucose level: 1)
80-120 before meals, 2) 100-180 after meals. Visual.
The importance of exercise
• Exercise lowers your blood sugar for the whole day.
• Thirty minutes a day is great but EVERY LITTLE BIT HELPS. The
importance of exercise Ways to get some exercise include:
walking (inside or out), dancing, chair exercises, taking the
stairs 1-2 flights, parking far from store door, meeting a friend
for coffee and walking around the block before or after the
coffee. Ask patient for ideas
Diet: Food to limit
• Use food boxes to point out foods high in carbs but low in sugar. Let them know
that the body can’t tell rice from chocolate cake.
• Avoid sugar sodas, malts. Switch to diet soda or water with lemon & sugar
substitute.
• Limit fruit juice to 4 oz. (1/2 cup) at a time : juice has as much sugar as soda.
• Watch portions of Rice, Pasta, Breads
• Limit fat intake, switch to canola or olive oil, limit fried foods
• Limit consumption of red meat, more poultry but remove skin
Diet: Food to increase
• Eat more vegetables, half plate. Discuss what patients think of as
vegetables. Remind them that corn and beans are high in
carbohydrates (sugar)
• 3 fruits per day
• Snacks: sugar free Jell-O; tea/coffee with couple gingersnaps or
vanilla wafers, fruit, sugar-free low fat yogurt, ½ sugar free pudding
made with skim milk (Visual)