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Diabetes: Complications (Nursing)

by Rhonda Lawes

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      Slides 07-03 DiabeticMedications I Insulin and Glucose Control.pdf
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    00:01 Okay, now, here's a question for you.

    00:03 What do you think are the 2 main effects on the metabolism of glucose when insulin usage isn't effective? So just so that makes sense, what do you think happens to the metabolism of glucose when a human body can't utilize insulin to get glucose into the cell? Okay.

    00:29 So here's the results.

    00:31 You have an increase in glucose production.

    00:33 What? Yeah, seriously.

    00:34 These people already have elevated blood sugar, but because it can't be utilized, it increases its production and you can't utilize the blood sugar that's there or the additional blood sugar that's coming out.

    00:47 Yeah.

    00:47 Can you say "Train wreck?" So when you have insulin resistance and you're not able to utilize the glucose that you have, you are at an extreme high risk of the complications of diabetes.

    01:01 So, there's the magic red box that Lecturio always uses with the exclamation point to tell you this is why insulin resistance is a problem.

    01:10 If the patient can't use the glucose that's in their blood stream, they're robbing their body of energy, they're going to increase their glucose production, and their blood sugar's going to remain consistently high.

    01:22 Now, we're risking all the nasty complications of diabetes.

    01:28 Okay.

    01:29 So, I know there's a lot of complications here.

    01:32 And we usually just don't throw them all up on the screen, but I wanted you to get the effect -- Boom! Here it is.

    01:39 There's a ton of these complications, but I have a solution; strict blood glucose control.

    01:47 If you will help your patient learn what it takes to control the blood sugar in their body through activity, through diet, and through proper medication management, you're going to minimize the risk of them developing all those horrible complications.

    02:02 All right? So, now, let's go back and look at them at a reasonable pace, but I wanted you to get the idea, we have the answer.

    02:10 Whether they're type 1 or type 2, if we can work alongside with the patient without judgment or making them feel bad, we can help them find the most effective strategies to be more active, their cells to be more receptive to taking up insulin if they increase their physical activity, to monitoring their diet to a reasonable level.

    02:30 And following their medication treatment plans, we can minimize the risk of developing these complications.

    02:37 So, diabetic patients are at an increased risk for stroke.

    02:41 So, automatically, if I have diabetes, I know that my chance to get a stroke is higher.

    02:46 The poorer the control of my blood sugar, the higher my risk for stroke.

    02:51 Also, retinopathy.

    02:53 Patients with diabetes can lose their vision from retinopathy caused from elevated blood sugar.

    02:59 They're not only at risk for stroke, they're also at risk for cardiovascular disease and hypertension.

    03:06 Huh.

    03:07 And hypertension puts you at an increased risk for cardiovascular disease and stroke.

    03:11 So it's kind of like, "Wow.

    03:13 It all comes together in one, doesn't it?" Now, you have the macrovascular damage.

    03:19 That is when you are damaging the smallest vessels in your body, which makes it really hard for us to get good blood flow to your extremities, which is why diabetics who have very high blood sugars for a long period of time have horrible circulation in their extremities.

    03:34 They also often end up with an infection in their toe or in their foot.

    03:41 It's very difficult to get an antibiotic down there to that infection, and it is not unusual for these types of diabetic clients to have toes, feet, or legs amputated.

    03:52 You know, that's really unnecessary if we can help them understand how they can manage lifestyle and medications and avoid those types of complications.

    04:01 Also, we want to teach them to always look at their feet, so we can catch a wound early and intervene.

    04:07 Now, anyone with high blood pressure risks nephropathy, or problems with your kidneys, but diabetics are double whammy, man.

    04:14 They have the macrovascular damage and they have the issues with nephropathy, renal damage.

    04:20 So, eyes, kidneys, heart, brain.

    04:23 Those are some pretty important organs that take a hit from the complications of elevated blood sugar with diabetes.

    04:30 The other one's kind of personal, but it's a huge deal, obviously, that diabetes can cause erectile dysfunctions.

    04:38 Also, they don't heal well, okay? They have high lipids, high glucose, and it's almost like the have this -- this influx, it suppresses inflammation.

    04:47 So, when they get a regular cut, or they have to have surgery or they have a wound, it just doesn't heal as well as someone who didn't have diabetes.

    04:55 And last, we talked about that foot damage, but I want to bring it up again.

    04:59 Remember that poor circulation, they are very prone to the risk of losing toes, feet, or legs, and it just doesn't happen to the majority of patients that it does.

    05:09 If we can partner with them, and help them make the changes to keep them the safest, and live their best quality of life.

    05:16 So let's wrap up this section.

    05:18 Glucose is taken in through dietary carbohydrates.

    05:21 We talked about some awesome pizza.

    05:24 Then it's absorbed into the cells of skeletal muscle, and also stored in the liver.

    05:28 Those are the 2 main areas of storage.

    05:31 Insulin is secreted by the pancreas when the blood glucose levels rise.

    05:36 So when you eat that pizza, your blood glucose levels go up, the pancreas secretes the insulin.

    05:42 Remember what the insulin does, it binds to that receptor, opens the doorway to the glucose to go from the bloodstream into the cell.

    05:51 That's what insulin does.

    05:52 It's the facilitator, the helper to glucose, to get it into the cell.

    05:57 Type 1 diabetic patients have damaged beta cells in their pancreas.

    06:01 They can't secrete insulin.

    06:03 That's why they have to have insulin replacement.

    06:06 There are some oral medications that we can use for type 2 diabetics that stimulate the pancreas to put out more insulin.

    06:12 That's not going to be appropriate for a type 1 diabetic client because their pancreas just can't do it.

    06:19 Those cells have been damaged and are not able to secrete insulin.

    06:23 That's why most of the oral medications, oral anti-diabetic medications, will not work for that type 1 diabetic, but watch for the one that's showing some promise for type 1 diabetics around insulin and we can add this oral medication to make that even more effective.

    06:40 But even so, there's no replacement for insulin at this point.

    06:46 Type 2 diabetics are patients that often are insulin resistant.

    06:51 Remember that? "Resistance is futile." Yeah, it is futile because if you can't get that under control, they're going to have a lot of complications.

    07:00 So, a type 2 diabetic might be able to make insulin, but they just can't use it effectively to get that glucose into their cell to use it for energy.

    07:08 So all that does is wreak havoc on the rest of their body.

    07:12 Now, type 2 diabetes can be treated with oral anti-diabetics.

    07:16 Now, it may progress to the need to have insulin replacement, but initially, if we catch it early enough, we can do oral anti-diabetics and some lifestyle changes, and hopefully, get that under control and slow the progression of the disease.

    07:30 Now, several cardio risk factors are associated with diabetes, and there's potential for their eyes, kidneys, and their microvascular circulation to be damaged, okay? So, you're thinking eyes, kidneys, remember? Even your brain with a stroke, and then your circulation is definitely affected.

    07:47 So, the more controlled and consistent you can help keep their blood sugar closer to a normal blood sugar, and keep that sustained, the lower the risk factor of these extensive complications from diabetes that your patient will experience.

    08:02 So don't rush over that.

    08:04 You need to have a clear understanding of type 1 diabetes and type 2 diabetes, and also understand the difficulties in lifestyle changes.

    08:13 You need to be someone who's also making healthy choices in your diet and in your level of physical activity, so you can understand how difficult it is for your patient.

    08:24 Thank you for watching our video on diabetic medications.


    About the Lecture

    The lecture Diabetes: Complications (Nursing) by Rhonda Lawes is from the course Endocrine Medications (Nursing). It contains the following chapters:

    • Results of Ineffective Glucose Utilization
    • Complications of Diabetes
    • In a Nutshell

    Included Quiz Questions

    1. Increase in glucose production and decrease in glucose utilization
    2. Decrease in glucose production and increase in glucose utilization
    3. Increase in glucose production and increase in glucose utilization
    4. Decrease in glucose production and decrease in glucose utilization
    1. Closely monitor blood glucose and maintain strict glucose control.
    2. Closely monitor blood glucose and maintain glucose on the low side of normal to ensure no organ damage occurs.
    3. Closely monitor blood pressure because cardiovascular affects can be the most severe in this disease.
    4. Closely monitor feet and skin because wounds and infection are the most serious complication of this disease.
    1. Increased stroke risk, retinopathy, and delayed wound healing
    2. Urinary incontinence, hearing loss, and loss of balance
    3. Muscle spasms, heart attacks, and increased risk of cancer
    4. Headaches, dysphagia, and renal insufficiency
    1. Pancreas
    2. Small intestine
    3. Stomach
    4. Gallbladder

    Author of lecture Diabetes: Complications (Nursing)

     Rhonda Lawes

    Rhonda Lawes


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