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Caring for people with diabetes

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Overview of diabetes

Diabetes means that blood glucose inthe body (often called blood sugar) istoo high

Glucose comes from the food we eat Glucose is transported by the blood

stream to all the cells in the body.

G

G

G

G

G

G

GGG

Muscle

Bloodstream

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Overview of diabetes

Insulin helps the glucose fromfood get into your cells.

Insulin is a chemical (ahormone) made in a part of thebody called the pancreas.

PANCREAS

G

G

G

G

insulin

Muscle

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Overview of diabetes

If your body doesn't makeenough insulin or if theinsulin doesn't work the way

it should, glucose can't getinto cells.

Glucose stays in the blood.

Blood glucose levels get too

high, causing diabetes.Bloodstream

Muscle

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Complications of diabetes

Diabetes can cause increased risk of:

Heart Problems

Stroke

Eye sight problems

Kidney problems

Foot problems

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Treatment goals

Symptom free

Prevent short term complications

Prevent long term complications

Quality of life =Lifestyle focus

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Healthy eating

To help control blood glucose,blood fats and adequate bodyweight

Healthy Eating

Regular carbohydrate High in fibre

Low in fat (particularly saturatedfat)

Low in added sugar Adequate energy

/protein/fluids/vits and mins

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Exercise / activity

30 minutes moderate intensity most days preferablyall

Helps to: Increased insulin sensitivity

Decreased insulin requirements

Weight reduction

Lipid control

Blood pressure control

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Insulin and tablets

Type 2 diabetes treatment may be Healthy eating Healthy eating + tablets (several different types of

tablets may be on combination of tablets

Healthy eating + tablets + insulin Healthy eating and insulin

Type 1 diabetes always require insulin

May have long acting 1-2 times a day Short and long acting 1-4 times a day Continuous insulin pump

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What you need to know!

Blood glucose level that is considered low

Signs and symptoms

Causes

Plan of action to treat Strategies to prevent hypoglycaemia

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Hypoglycaemia

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Definition of hypoglycaemia

in people with diabetes who are treated withinsulin or oral hypoglycaemic agents

Hipoglikemi bila :

kadar glukosa darah < 60 mg/dL, ataukadar glukosa darah , 80 mg/dl dengan gejalaklinis

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Penyebab

DPMI Workforce Development The Alfred

Workforce Development Team June 2005

Makan kurang dari aturan

Berat badan turun

Sesudah olahraga

Sesudah melahirkan Sembuh dari sakit

Makan obat yang sifatnya serupa

Pemberian suntikan insulin yang tidak tepat

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Tanda klinis hipoglikemi

Stadium parasimpatik : lapar, mual, TD turun

Stadium gangguan otak ringan : lemah,lesu, sulitbicara, kesulitan menghitung sementara

Stadium simpatik : keringat dingin pada muka, bibiratau tangan gemetar

Stadium gangguan otak berat : tidak sadar denganatau tanpa kejang.

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Symptoms

excessive hunger

headache

profuse sweatingfeeling dizzy/shaking

pins and needles

around mouth

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Cognitive impairment

Symptoms of cognitive impairment

Lack of concentrationAltered vision

Peculiar behaviour

Loss of consciousness

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Nocturnal hypoglycemia

Symptoms may include:

Sweating

Vivid dreaming

Restlessness

Incontinence

Waking with a headache

High or low fasting levels

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Act quickly

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PENATALAKSANAAN HIPOGLIKEMIA

beri larutan gula

murni 20-30gram

Minum gula-gula

(bukan pemanis

pengganti gula atau

guladiet/gula diabetes

Obat DM stop

sementara

Pantau glukosa darah12 jam

Pertahankan GD-200

mg/dL (apabila

sebelumnya tdk sadar)

Cari penyebab

Suntik 50 cc Dx 40% (atau glukagon

0,5-1 mg iv/im,bila penyebab insulin)

Infus Dx 10% 6 jam/kolf

Pantau GD tiap jam

Belum sadar

GD masih < 100 mg/dLUlangi suntik 50 mL Dx 40%

Pantau GD tiap 1/2jam

Belum sadar

Ulangi suntik 50 mL Dx 40%

Pantau GD tiap 1/2jam

Belum sadar GD ~ 200 mg/dL

Suntik hidrokortison 100 mg per 4 jam selama12 jamatau

Deksamethason 10 mg iv bolus dilanjutkan 2 mg tiap 6

jam dan manitol iv 1 - 2 g/kg BB setiap 68 jam.

Caripenyebab kesadaran menurun.

SADAR TIDAK SADAR

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Never

Never give food to an unconscious

person

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Treatment if unconscious

Position in the left lateral position and withholdany food or fluids. Seek further medical help.

If glucagon is available it can be administered

subcutaneously, intramuscularly orintravenously.

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Tugas kita bukanlah untuk berhasil.Tugas kitaadalah untuk mencoba,

karena didalam mencobaitulah kita menemukan dan belajar

membangun kesempatan untuk berhasil

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Hyperglycaemia

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What you need to know!

What is hyperglycaemia

Causes

Describe the main principles of the treatment

Diabetic Ketoacidosis Hyperosmolar non ketotic coma

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Hyperglycaemia

Persistent BGL over 10 mmol/L

Signs and symptoms of hyperglycaemia Polyuria

Polydipsia Blurred vision

Weight loss

Infections, thrush

Tired

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Kadar glukosa darah sewaktu dan puasa sebagai patokan penyaringdan diagnosis DM (mg/dl)

DPMI Workforce Development The Alfred

Workforce Development Team June 2005

Bukan DM Belum pasti DMDM

Kadar glukosa Plasma Vena < 100 100 199 200

darah sewaktu Darah kapiler < 90 90 199 200

Kadar glukosa Plasma vena < 100 100 125 126darah puasa Darah kapiler < 90 90 99 100

( Konsensus Pengelolaan dan Pencegahan DM tipe 2 di Indonesia,PERKENI, 2006)

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Causes of Hyperglycaemia

Increased weight

Incorrect foods or amount of foods

Forgetting or insufficient medication lack of physical

activity Stress

Certain medications

Illness /infections

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Treatment

Relieve symptoms

Increase monitoring

Identify cause treat accordingly

Observe for signs of concurrent illness or infection

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Ketoasidosis

Merupakan defisiensi berat dan akut darisuatu perjalanan penyakit diabetes melitus.

Peningkatan produksi gula, oleh hati,penurunan penggunaan gula, peningkatanmobilisasi lemak, dan pembentukan keton.

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4 masalah metabolik

Hiperosmolar (hiperglikemi dan dehidrasi) Metabolik asidosis (akumulasi keton)

Hilangnya volume ekstraseluler (diuresis osmotik)

Ketidakseimbangan elektrolitmLaboratorium :

Kadar glukosa darah > 250 mg/dL

pH

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Tanda klinis :

Dehidrasi : haus, hangat,turgor menurun, membranmukosa kering, kelemahan, hipotensi, nadi cepatdan lemah

Metabolik asidosis : mual,muntah, nafas bauketon,letargi, koma

Kinis lain : nyeri perut, pernafasan Kussmaul(kompensasi mencegah penurunan pH)

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Tindakan cepat

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Resusitasi A, B, C

1. Airway : pastikan jalan nafas paten

2. Breathing : oksigen masker

3. Circulation : monitor fungsi jantung (TD, nadi)

jika shok berikan 10ml/kg normal saline iv.

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Penanganan

1. Rehidrasi : Pemberian cairan sebanyak 1 liter pada 30menit pertama kemudian 0,5 liter pada 30 menit kedua.Setelah itu cairan diberikan sesuai tingkat dehidrasi. Bilakadar glukosa darah < 200 mg/dl, NaCl 0,9% segera

diganti dengan dextrose 5%.2. Insulin: Insulin mulai diberikan pada jam ke-2, dalam

bentuk bolus (intravena) dosis 180 mU/Kg BB,dilanjutkan dengan drip insulin 90 mU/jam/kgBB dalam

NaCl 0,9%. Bila glukosa darah < 200 mg/dL, kecepatandikurangi menjadi 45 mU/jam/g BB. Bila glukosa darahstabil sekitar 200-300 mg/dL selama 12 jam, dilanjutkandengan drip insulin 1 2 unit/jam dan dilakukan slidingscale setiap 6 jam.

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Penanganan

3. Bikarbonas : Koreksi natrium bikarbonat dilakukanbila pH

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Penanganan

Tujuan : mengkoreksi kelainan patofisiologis yangmendasari :

Gangguan keseimbangan elektrolit

Kadar glukosa darah Gangguan asam basa

Mengobati faktor pencetus

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Diagnosa Keperawatan

1. Defisit volume cairan berhubungan dengandiuresis osmotic sekunder akibat hyperglikemi,kehilangan gastric berlebihan;diare, muntah

2.Nutrisi kurang dari kebutuhan tubuh berhubungandengan ketidak cukupan insulin, penurunanmasukan oral, status hypermetbolisme

3. Resiko tinggi infeksi/ sepsis berhubungan dengan

kadar glukosa tinggi, penurunan fungsi leukosit

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Tindakan Manajemen cairan/ elektrolit

1. Pantau TTV, kaji pulsasi, mukosa membran danturgor kulit

2. Monitor intake dan out put / jam

3. Pertahankan cairan peroral maupun intravena(NaCl 0,9%)

4. Lakukan pemasangan kateter (sesuai kondisi klien)

5. Kolaborasi pemberian kalium, bikarbonas

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Tindakan manajemen hiperglikemi

1. Auskultasi bising usus

2. Catat keluhan kembung, mual, muntah

3. Beri makanan cair yang mengandung nutrien dan

elektrolit jika memungkinkan4. Observasi tanda hipoglikemi

5. Lakukan pemeriksaan GDS/jam

6. Lakukan pemeriksaan GD,aseton, pH, HCO3

7. Pemberian terapi insulin

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Tindakan kontrol infeksi

1. Observasi tanda-tanda infeksi

2. Tingkatkan universalprecaution

3. Berikan posisi semi fowler

4. Auskultasi bunyi nafas5. Antibiotik

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Bila anda belum menemkan pekerjaanyang sesuai

dengan bakat anda, bakatilah apapun

pekerjaananda sekarang. Anda akan tampil

secemerlang

yang berbakat