Denise Coffey MSN, RN

 American Diabetes Association:  Nearly 26 million Americans have diabetes and an estimated 79 million U.S. adults have prediabetes‚ according to new estimates from the Centers for Disease Control and Prevention (CDC).  The National Diabetes Fact Sheet for 2011 says that diabetes affects 8.3 percent of all Americans and 11.3 percent among those aged 20 and older. An estimated 7 million Americans with diabetes do not know they have the disease!!

 Insulin: what is it’s function??  Glucose: what is it’s function??

 Type I –which is?  Type 2 –which is?  Gestational Diabetes (GDM)  Other specific conditions resulting in hyperglycemia

 Hyperglycemia: what would you expect to see?  Lab work  Where do we want to see our patient’s lab values at?

 Hypoglycemia: what are some signs and symptoms?  What are you going to do as the RN assigned to a patient experiencing hypoglycemia?

 Microvascular: you tell me!  Macrovascular: you tell me!

 3 P’s: polyuria, polydipsia, polyphagia  Describe other assessment findings you would need to be on the look out for.

Blood Glucose >110 Insulin Resistance Decreased Insulin Increased Free Fatty Acid Oxidative Stress

Oxidative Stress Nitric Oxide Endothelin-1 Angiotensin ll Vasoconstriction Nitric Oxide Angiotensin ll Activation of activator protein -l Inflammation hypertension Vascular smooth muscle cell growth Release of chemokines Release of cytokines Expression of cellular adhesion molecules Nitric oxide Tissue factor Plasminogen Activator Prostaccyclin Thrombosis Hyper coagulation Platelet Activation Decreased Fibrinolysis

Increase in: Ketones Free Fatty Acids Lactate Immune Dysfunction Reactive 02 Species Infection Dissemination Increase Transcription Factors Leads to Secondary Meadiators Cellular Injury Inflammation Tissue Damage Altered Tissue Healing Acidosis Thrombosis Global Infarction Ischemia

 Diet –what teaching would you provide to your patient?  Exercise  PO medications- what teaching would you provide to our patient  Insulin therapies

 Insulin pumps  Pancreas transplant

 Patient education:  What education would you need to make sure you patient receives?