Learning objectives

Participants in this activity will be able to:
1. Explain what diabetes is and does.
2. Describe the four key elements of treatment for diabetes.
3. List the symptoms of low blood sugar and high blood sugar.
4. Know how to respond to a diabetic emergency.

What is Diabetes?

Diabetes is a disease that changes the way our bodies use food. It causes the level of sugar in the blood to be too high. The extra sugar harms the blood vessels and other organs in the body over time. Diabetes can cause great damage before any symptoms appear.

There are 2 main types of diabetes

Type I means that the pancreas is not producing insulin, or is producing very little. This type always requires shots of insulin injected into the body every day.
Type II means that the pancreas is producing insulin, but not enough, or that the body does not use its insulin effectively.

Nine out of ten cases of diabetes are Type II. It usually occurs in people over age 45 who are overweight. It can be treated by diet, exercise, and/or medications that are taken by mouth. Sometimes it also requires insulin injections.

Why is important to control diabetes?

The goal of treatment for diabetes is to keep the individual’s blood sugar as close to normal as possible for that person. Doing this will lower the person’s chances of getting:
- Stroke
- Heart disease
- Kidney failure
- Stomach disease
- High blood pressure
- Eye disease, loss of vision, or blindness
- Nerve damage, with pain or loss of feeling in hands, feet, legs, or other parts of the body A high level of sugar in the blood over a long period of time can cause these problems.

There are 4 parts to diabetic treatment

Diet, Exercise, Medicine, Monitoring
We will discuss each of these elements of treatment. Anyone who helps a diabetic person should be familiar with the medicine, exercise regimen, monitoring program, and diet that the individual is supposed to follow.

1. Diet
There is no one diabetic diet designed for every diabetic person, but there are guidelines to help diabetics with food choices. These guidelines are very similar to the kind of eating that is healthy for anyone. These are the main rules that should be followed:
1. Eat few sugary foods.
2. Eat less fat, especially saturated fat and cholesterol (butter, margarine, oils).
3. Eat a variety of fresh fruits, vegetables, lean meats, and fish.
4. Eat just enough calories to stay at a healthy weight.

Diabetics should eat the recommended number of servings from all the food groups on this pyramid every day, except for the fats, sweets, and alcohol. No one needs sweets or alcohol for good nutrition (they can be an occasional treat), and we get plenty of fats from the other food groups. The exact number of servings a diabetic should have from each group depends on individual calorie and nutrition needs, weight goals, exercise level, and preferences.
Many people think that diabetics are not allowed to eat sugar of any kind. This is no longer required. Sugar is a carbohydrate, like bread or potatoes, and can be part of the diabetic’s food plan. However, most sugary foods provide calories without many vitamins or minerals, and they are often high in fat. It is better to eat more foods rich in nutrients, like vegetables and fruits, and very few fatty, sweet foods like ice cream and candy.

Dieticians sometimes teach diabetics and those who care for them to use Exchange Lists. These lists are a way to plan meals by putting foods in a category, such as a starch exchange or fruit exchange. Foods on a list can be substituted for each other and sometimes for foods on other exchange lists. The diabetic person eats only a certain number of each type of exchange every day, as ordered by a doctor or established by the dietician.

2. Exercise
Exercise usually lowers blood sugar and may help insulin work better. It helps control weight, it improves blood flow, and it strengthens the heart. People with diabetes should exercise at least three times a week. Before a diabetic starts a new exercise program, a doctor should approve what kind, how often, and how long the diabetic exercises. Elderly and disabled people need to exercise also and should be helped to find an exercise they can do.

It is important that a diabetic not develop low blood sugar while exercising. Since the body burns sugar during exercise, the diabetic should “fuel up” with a piece of fruit or half a sandwich within an hour before starting any exercise. It is also a good idea for the diabetic to check his or her blood sugar level before he or she starts exercising. If the blood sugar reading is less than 70, he or she should eat something and wait for the blood sugar level to come up over 70 before exercising.

If a diabetic feels faint, sweaty, dizzy, or confused while doing any activity, he or she should stop and immediately drink fruit juice or a sweet (not diet) soft drink. He or she must respond quickly to this feeling, because it means his or her blood sugar level is too low.

3. Medication
Diabetics might receive insulin shots or they may take pills by mouth. Only a doctor can decide what medication and how much of it a diabetic should receive. It can be VERY dangerous to change a diabetic’s medication in any way unless it is ordered by a doctor. Diabetics must receive the exact amount of medicine their doctor has ordered, at the times the doctor has ordered. Timing of medicine and meals is important to prevent low blood sugar.

4. Monitoring
Close monitoring of a diabetic’s blood sugar level is one of the best ways for him or her to prevent long-term complications from the disease. Diabetics check their blood sugar by pricking a finger with a needle and testing a drop of blood with a special blood glucose meter. The meter, also called a monitor, gives a number that tells the level of glucose in the blood. These monitors must be kept clean and should be checked for accuracy periodically. Most diabetics need their blood sugar level tested at least once a day, usually in the morning before breakfast. Depending on the type of diabetes, the age of the person, and other factors, the individual may need his or her blood glucose tested as much as five times a day. Sometimes insulin dosages are adjusted depending on the blood sugar level. This chart from the National Diabetes Education Program shows the recommended blood sugar levels at different times of the day:

Before meals: 80-130

At bedtime: 100-150

A doctor must set the acceptable ranges for each person, and they might differ from the normal ranges given in the chart. When a blood glucose level falls outside the range set by the doctor, the doctor must be notified as soon as possible. If you are assisting a diabetic with monitoring his or her blood sugar, be sure you know the correct range for him or her. Another important part of monitoring is watching the feet and skin of a diabetic.
Diabetes can turn a small sore or wound into a very large problem. Sores, blisters, and wounds on a patient’s feet and skin must always be reported to your supervisor or a nurse.

Diabetic emergency and how to respond

Diabetes can cause both long-term and short-term problems. Blood sugar that is too low or extremely high can lead rapidly to unconsciousness and even death. You must know the symptoms of both conditions and know how to respond.

Hypoglycemia means that the level of sugar in the blood is too low (less than 70). Too much insulin or oral medication, too much exercise, not eating enough food, or drinking alcohol can cause it. Hypoglycemia can cause strokes and heart attacks in the elderly. This problem is also called insulin reaction or insulin shock.

Symptoms of low blood sugar: These symptoms occur suddenly and without warning:
• Shaky, nervous
• Sweaty and cold
• Pale, clammy skin
• Weak and tired, drowsy
• Sudden hunger
• Blurred or double vision
• Tingling of hands, lips or tongue
• Confusion
• Personality change
• Slurred speech
• Loss of consciousness
• Dizziness, or a staggering walk
• Nausea
• Headache
• Fast heartbeat
• Itching

Note: Elderly people and people with other diseases and disabilities can be especially sensitive to low blood sugar, and it can be very dangerous for them. Some people may have a reaction even when their blood sugar is not below 70. Any diabetic suddenly showing any of the signs listed above must receive immediate attention.

Treatment:
- The person should drink a sweet drink such as sweetened coffee or tea, orange juice, or soda.
- Or, the diabetic could eat sugar, corn syrup, or candy, or take glucose tablets.

Hyperglycemia means that the level of sugar in the blood is too high (above 180). It can be caused by infections, illness, stress, injury, not enough insulin, not enough exercise, or eating too much food. Very high levels of sugar can cause coma and death.

Symptoms of high blood sugar: These symptoms occur gradually and get worse over time:
• Extreme thirst and/or hunger
• Rapid weight loss
• Frequent urination
• Vision changes
• Dry skin and mouth
• Fatigue, drowsiness
• Nausea
• Fruity-smelling breath
• Very deep, gasping breathing
• Unconsciousness

Treatment:
The first seven symptoms in this list should be reported to your supervisor or a nurse as soon as possible. Fruity-smelling breath, deep gasping breathing, and unconsciousness are emergency symptoms that can lead quickly to death. Call 911 or access emergency medical care at once.

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