1. Diabetes CMT Training The Center for Life Enrichment
Resource: MTTP Student Manual

2. What is Diabetes?
Diabetes is a disorder in which the body does not properly utilize or release insulin which results in abnormally high levels of serum (blood) glucose

3. The Normal Process of Digestion
In the normal process of digestion, consumed sugars and starches (carbohydrates) and other foods are changed into a form of sugar called glucose
Glucose is distributed throughout the body and is used as the energy source for the body’s cells
The rise in blood sugar associated with eating triggers the pancreas to secrete the hormone called insulin

4. Why is Insulin Important?
Insulin is required to allow the blood glucose to leave the bloodstream and either enter the body’s cells where it is used for energy or enter the liver where it is stored for future use
In diabetes, either the body does not properly use the insulin that is secreted by the pancreas or the pancreas secretes too little or no insulin

5. The End Result
If the body does not properly use the insulin that is secreted by the pancreas or the pancreas secretes too little or no insulin, the glucose collects in the blood
These high levels of blood glucose, over time, cause complications such as:
Damage to the retinas of the eyes (Diabetic Retinopathy)
Nerve damage (Neuropathy)
Kidney failure
Blood vessel damage (increasing the incidence of heart attack & stroke)
Reduced circulation (increasing the risk of infection and the potential for amputation)
Impotence
Complications of pregnancy

6. Two Types of Diabetes Type I Diabetes Type II Diabetes
The pancreas secretes too little or no insulin
The person must receive insulin injections to allow the blood glucose to be utilized and/or stored properly
The insulin that is produced by the pancreas cannot be utilized effectively
Diet & exercise are employed as the first line of treatment
If diet & exercise are not sufficient, oral agents or insulin may be required

7. Why Does Diabetes Occur?
The exact cause of diabetes is not known

8. Why Does Diabetes Occur? Continued…
Type I Diabetes
Type II Diabetes
Scientists believe that a genetic predisposition coupled with environmental factors cause the immune system to attack the pancreas and destroy the cells that produce insulin
Most people who have Type I Diabetes develop the disease before the age of 30
Though the pancreas continues to produce insulin, the insulin is ineffective
Identified risk factors for Type II Diabetes:
Obesity (excessive fat prevents insulin from working properly)
Specific racial/cultural groups (African Americans and Hispanics have a higher incidence)
Family History
Diet, exercise, and oral medications are used for treatment

9. Signs & Symptoms of Type I Diabetes
Oftentimes, signs and symptoms of Type I Diabetes occur suddenly and include:
Frequent urination (polyuria)
Increased thirst (polydipsia)
Rapid weight loss (often in the presence of increased appetite – polyphagia)
Irritability
Nausea & vomiting

10. Signs & Symptoms of Type II Diabetes
The signs & symptoms of Type II Diabetes are usually more gradual in onset
In addition to the signs & symptoms mentioned on the previous slide, the signs & symptoms of Type II Diabetes may include:
Hard to heal infections (especially of the skin, gums, or bladder)
Vision changes
Tingling or numbness of the distal extremities
Itching
Tiredness

11. The Importance of Routine Exams
Regular medical check-ups which include laboratory monitoring are critical in detecting abnormally high blood glucose levels
Physical exams are encouraged annually by TCLE

12. Treatment
The goal of medication therapy for both Type I and Type II Diabetes is to maintain the blood sugar levels within normal range
Acceptable normal standards are from 70 to 110 mg/dl

13. Treatment – Type I Diabetes
In Type I Diabetes, the treatment is to provide insulin directly to the body
Insulin is injected under the skin into the fat layer of the body
The fatty tissue of the upper arm, thigh, and abdomen are the usual sites for administration
CMTs required to administer insulin receive special training from the RN CM/DN before they are authorized to administer insulin
Small syringes with very thin needles, insulin pens, or insulin pumps may be used
CMTs are not allowed to calculate the insulin dose. CMTs may be delegated the task of measuring insulin/filling the insulin syringe at the discretion of the RN CM/DN

14. Treatment – Type II Diabetes
When an individual is diagnosed with Type II Diabetes, dietary restrictions and an increase in exercise will be tried to lower blood sugar levels adequately
If diet and exercise are not effective, oral hypoglycemic agents will be utilized to lower blood sugar levels adequately
Oral hypoglycemic agents work by stimulating the pancreas to increase the production of insulin, by increasing the effectiveness of the insulin produced, or by increasing the body’s ability to utilize its own insulin
If the body does not respond to oral agents, insulin injections may be required

15. Unwanted/Side Effects of Medication
Unwanted/side effects of the medications used to treat diabetes and complications of the disease requiring emergency intervention include:
Hypoglycemia
Hyperglycemia
DKA (Diabetic Coma)

16. Hypoglycemia
Hypoglycemia (low blood sugar) occurs more commonly in individuals taking insulin
Often referred to as insulin shock or insulin reaction
Hypoglycemic reactions can occur suddenly

17. Signs & Symptoms of Hypoglycemia
Feeling shaky
Becoming sweaty
Feeling tired, weak, or nervous
Feeling hungry
Becoming irritable or confused
Developing a headache
Developing a rapid heart rate

18. Treatment of Hypoglycemia
It is critical that low blood sugar be treated immediately to avoid unconsciousness and brain damage
If the person is conscious, administer a quick acting sugar by mouth to keep the person from losing consciousness:
1/2 cup of sweetened fruit juice (OJ or Apple)
Hard candy
1/2 cup of regular soda
GlucoTabs
If the person is unconscious, injecting Glucagon will stimulate the release of the stored form of glucose, glucogen, from the liver
911 should be called and the person should be transported to the nearest emergency room for evaluation and stabilization
CMTs receive individualized training from the delegating nurse before being authorized to administer glucagon

19. Hyperglycemia
Hyperglycemia (high blood sugar) occurs when the individual’s blood sugar rises well above the normal range and stays there—240 mg/dl or higher
Hyperglycemia results from dietary indiscretions, too little medication, illnesses, and/or stress
Hyperglycemia often has a slower pattern of onset

20. Signs & Symptoms of Hyperglycemia
Thirstier than usual
Hungrier than usual
More frequent urination
Getting up at night to urinate
Dry, itchy skin
More tired than usual
Changes in vision
Infection
Cuts or sores that heal slower than normal

21. Treatment of Hyperglycemia
The best treatment is prevention
Eat according to the prescribed meal plan
Take medications as prescribed
Monitor blood sugar levels
Maintain a routine pattern of exercise
If hyperglycemia persists, call the delegating nurse/Health Care Professional

22. Diabetic Ketoacidosis (DKA)
DKA (diabetic coma) is a dangerous condition that is usually only seen in Type I diabetics
DKA occurs when an imbalance between insulin and blood sugar is so out of control that ketones are produced and accumulate in the blood
At high levels, ketones are poisonous to the body

23. Signs & Symptoms of DKA Dry mouth Excessive thirst Loss of appetite
Excessive urination
Dry/flushed skin
Labored breathing
Fruity smelling breath (acetone odor)
Vomiting
Abdominal pain
Unconsciousness
If an individual is suspected of having DKA, the delegating nurse should be contacted and 911 called

24. Your Responsibilities
It is important for the individual/care giver to:
Inform the delegating nurse of any changes in health
Know that the individual should wear a medic alert bracelet
Observe for signs and symptoms of hypoglycemia and hyperglycemia, and intervene appropriately
Follow the prescribed diet
Maintain a regular pattern of exercise
Know that the individual should avoid the use of alcohol
See a podiatrist regularly for foot care
Follow the Nursing Care Plan for foot care

25. Questions?
If you have any questions or concerns related to Diabetes and our participants, contact TCLE’s delegating nurse
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