Diabetic_Care_Module_FINAL_FIXED2. Forpptx

Nursing care module for diabetic care

1. Diabetic Care Module Comprehensive Training Presentation (Introduction & Pathophysiology Sample)

2. What is Diabetes? Chronic metabolic disorder characterized by hyperglycemia Results from defects in insulin secretion, insulin action, or both

3. Types of Diabetes Type 1 Diabetes – autoimmune destruction of beta cells Type 2 Diabetes – insulin resistance + beta-cell dysfunction Gestational Diabetes – during pregnancy Other types – secondary to diseases/medications

4. Global Burden 537 million adults (20–79 yrs) living with diabetes worldwide (IDF 2021) Expected to rise to 643 million by 2030 Major cause of morbidity, mortality, and healthcare cost

5. Why Diabetic Care Matters Prevent acute complications (DKA, HHS, hypoglycemia) Reduce risk of chronic complications (CVD, kidney disease, blindness, amputations) Improve quality of life and longevity

6. Objectives of Module Understand pathophysiology, diagnosis, and management Emphasize lifestyle interventions and self-care Highlight acute and chronic complication management Empower healthcare teams and patients

7. Normal Glucose Metabolism Insulin regulates glucose uptake in muscle and adipose tissue Suppresses hepatic glucose production Maintains normal fasting and postprandial glucose levels

8. Pathophysiology of Type 1 Diabetes Autoimmune destruction of pancreatic beta cells Absolute insulin deficiency Often presents in childhood/adolescence

9. Pathophysiology of Type 2 Diabetes Combination of insulin resistance and impaired beta-cell function Progressive loss of insulin secretion over time Associated with obesity, sedentary lifestyle, genetics

10. From Prediabetes to Diabetes Insulin resistance develops early Beta-cell dysfunction worsens gradually Impaired glucose tolerance progresses to overt diabetes

11. Consequences of Hyperglycemia Acute: DKA, HHS Chronic: Microvascular (retinopathy, nephropathy, neuropathy) Chronic: Macrovascular (CVD, stroke, PAD)

12. Pathophysiology Flowchart Progression from genetic and environmental risk factors to diabetes complications.

13. Diagnostic Criteria Fasting Plasma Glucose (FPG) ≥ 126 mg/dL (7.0 mmol/L) 2-hour OGTT ≥ 200 mg/dL (11.1 mmol/L) HbA1c ≥ 6.5% Random plasma glucose ≥ 200 mg/dL with symptoms

14. Screening Guidelines Adults ≥ 45 years: test every 3 years Younger adults with risk factors: overweight, family history, hypertension, PCOS Gestational diabetes screening at 24–28 weeks

15. Monitoring Methods Self-Monitoring of Blood Glucose (SMBG) using glucometers Continuous Glucose Monitoring (CGM) for real-time trends HbA1c every 3–6 months Urine tests for protein/ketones when needed

16. Target Goals HbA1c: < 7% (individualized) Preprandial plasma glucose: 80–130 mg/dL Postprandial plasma glucose: < 180 mg/dL Blood pressure: < 130/80 mmHg

17. Diagnosis Algorithm Step 1: Screen risk factors / symptoms Step 2: Order FPG, OGTT, or HbA1c Step 3: Confirm abnormal test on repeat day Step 4: Diagnose diabetes or prediabetes Step 5: Initiate lifestyle/pharmacological care

18. Importance of Monitoring Detects disease early Prevents acute complications Slows chronic complications Guides therapy adjustment

19. HbA1c Diagnostic Ranges Normal: <5.7% Prediabetes: 5.7–6.4% Diabetes: ≥6.5%

20. Role of Diet Balanced meals with whole grains, vegetables, lean protein Limit refined carbs and sugary beverages Encourage portion control and mindful eating

21. Glycemic Index Low GI foods: legumes, oats, whole grains High GI foods: white bread, sugary snacks Prefer low-to-moderate GI meals to reduce glucose spikes

22. Physical Activity At least 150 min/week of moderate-intensity aerobic activity Strength training 2–3 times/week Reduce sedentary time (break sitting every 30 min)

23. Weight Management Aim for 5–10% weight loss in overweight patients Sustainable lifestyle changes over crash diets Behavioral counseling may help

24. Stress Management Stress increases cortisol → raises blood sugar Techniques: yoga, meditation, breathing exercises Support groups and counseling

25. Sleep & Circadian Rhythm Poor sleep linked to insulin resistance Target 7–8 hours of quality sleep Maintain regular sleep-wake schedule

26. Alcohol & Smoking Limit alcohol: ≤1 drink/day (women), ≤2 drinks/day (men) Avoid binge drinking → risk of hypoglycemia Smoking cessation is critical to reduce CV risk

27. Personalized Care Cultural dietary considerations Individualized exercise capacity Tailored goals for elderly or comorbid patients

28. Lifestyle Management Wheel Comprehensive approach to optimize glycemic control.

29. Pharmacological Management Overview Drug therapy complements lifestyle management Goal: achieve individualized glycemic targets Choice depends on age, comorbidities, cost, patient preference

30. Oral Agents: Metformin First-line therapy unless contraindicated Mechanism: reduces hepatic glucose production, improves sensitivity Side effects: GI upset, rare lactic acidosis Contraindicated in severe renal/hepatic impairment

31. Oral Agents: Sulfonylureas Examples: glibenclamide, glipizide Mechanism: increase insulin secretion Advantages: inexpensive, effective Risks: hypoglycemia, weight gain

32. Oral Agents: DPP-4 Inhibitors Examples: sitagliptin, saxagliptin Mechanism: increase incretin levels → more insulin, less glucagon Well tolerated, weight neutral Costlier option

33. Oral Agents: SGLT2 Inhibitors Examples: dapagliflozin, empagliflozin Mechanism: increase urinary glucose excretion Benefits: weight loss, ↓CV risk, ↓CKD progression Risks: genital infections, dehydration, ketoacidosis

34. Injectable Agents: GLP-1 RAs Examples: liraglutide, semaglutide Mechanism: enhance insulin, suppress glucagon, slow gastric emptying Benefits: weight loss, CV protection Side effects: nausea, GI upset, high cost

35. Insulin Therapy Indicated when oral therapy inadequate or in severe hyperglycemia Types: basal, prandial, premixed Requires patient education on injection, hypoglycemia prevention

36. Insulin Regimens Basal-only: once daily (NPH, glargine, detemir) Basal-bolus: basal + mealtime rapid-acting Premixed: fixed ratio of basal + bolus Choice depends on patient lifestyle and glucose pattern

37. Treatment Algorithm Step 1: Lifestyle + Metformin Step 2: Add 2nd agent (SGLT2i, DPP4i, SU, or GLP1-RA) Step 3: Triple therapy if needed Step 4: Insulin initiation when HbA1c uncontrolled

38. Key Considerations Individualize therapy by comorbidities (CVD, CKD, obesity) Balance efficacy, safety, cost, and adherence Educate patients on hypoglycemia recognition and sick-day rules

39. Acute Complications Overview Diabetes can cause sudden life-threatening events Most common: Hypoglycemia, DKA, HHS Prompt recognition and treatment is critical

40. Hypoglycemia Definition: blood glucose <70 mg/dL Symptoms: sweating, tremors, confusion, seizures Treatment: oral glucose, IV dextrose, glucagon if severe Prevention: patient education, medication adjustment

41. Diabetic Ketoacidosis (DKA) More common in Type 1 DM Causes: infection, missed insulin, MI Features: hyperglycemia, acidosis, ketonuria Treatment: fluids, IV insulin, electrolytes, treat cause

42. Hyperosmolar Hyperglycemic State (HHS) Occurs mainly in Type 2 DM, elderly Very high glucose (>600 mg/dL), dehydration, no significant ketosis Treatment: aggressive IV fluids, insulin, correct electrolytes

43. Acute Complication Management Flowchart Algorithm for rapid recognition and treatment of acute diabetic emergencies.

44. Chronic Complications Overview Long-term hyperglycemia damages vessels and organs Microvascular: eyes, kidneys, nerves Macrovascular: heart, brain, peripheral arteries

45. Microvascular: Retinopathy Leading cause of blindness Types: non-proliferative, proliferative, macular edema Screening: annual eye exam Treatment: laser, anti-VEGF therapy

46. Microvascular: Nephropathy Leading cause of ESRD Signs: proteinuria, declining GFR Prevention: tight BP and glucose control, ACE inhibitors/ARBs Annual urine albumin/creatinine ratio

47. Microvascular: Neuropathy Peripheral: numbness, pain, ulcers Autonomic: gastroparesis, ED, orthostatic hypotension Screen: foot exam annually Prevention: glucose control, foot care

48. Macrovascular: Cardiovascular Disease Increased risk of MI, stroke, PAD Risk factors: hypertension, dyslipidemia, smoking Prevention: BP <130/80, statins, aspirin if indicated Lifestyle + pharmacological management

49. Complication Prevention Strategies Tight glucose control Annual screening: eyes, kidneys, feet Manage BP and lipids Smoking cessation, exercise, healthy diet

50. Chronic Complication Burden Distribution of long-term complications in diabetes.

51. Special Populations Overview Management must be tailored for different groups Gestational diabetes, elderly patients, children/adolescents Consider unique risks, comorbidities, and lifestyle factors

52. Gestational Diabetes: Screening & Risks Screen at 24–28 weeks with OGTT Risks: macrosomia, neonatal hypoglycemia, maternal type 2 DM later Close monitoring required during pregnancy

53. Gestational Diabetes: Management Lifestyle modification: diet and exercise Insulin is preferred if medication needed Oral agents (metformin, glyburide) used selectively Frequent glucose monitoring essential

54. Elderly Patients Higher risk of hypoglycemia and comorbidities Individualized HbA1c targets (often <8%) Polypharmacy and drug interactions common Focus on quality of life and fall prevention

55. Children & Adolescents Most Type 1, some Type 2 (with obesity) Insulin is mainstay; pump/CGM use increasing Challenges: growth, puberty, peer/social issues School/daycare support needed

56. Self-Care & Patient Education Cornerstone of effective diabetes management Includes glucose monitoring, medication adherence, diet, exercise Patient empowerment and shared decision-making critical

57. Self-Monitoring of Blood Glucose (SMBG) Frequency depends on therapy (more with insulin) CGM improves control and reduces hypoglycemia Patients must learn to interpret and act on results

58. Foot Care Daily self-inspection of feet Annual professional exam Prevent ulcers and amputations Wear proper footwear, avoid barefoot walking

59. Sick-Day Rules Monitor glucose and ketones more frequently Continue insulin even if eating less Maintain hydration Seek medical care if vomiting or unable to control glucose

60. Empowerment & Support Diabetes self-management education (DSME) programs Support groups improve adherence Technology (apps, reminders) aids daily care Family/caregiver involvement beneficial

61. Self-Management Cycle Ongoing process of monitoring, adapting lifestyle/medications, and reassessing control.

62. Innovations in Diabetes Care Technology and research improving outcomes New medications, devices, and digital tools Patient-centered, personalized approaches

63. Continuous Glucose Monitoring (CGM) Provides real-time glucose trends Reduces hypoglycemia risk Improves HbA1c control Increasingly accessible for Type 1 and Type 2 patients

64. Insulin Pumps & Closed-Loop Systems Insulin pumps deliver continuous basal insulin Closed-loop (artificial pancreas) automates insulin delivery Improves control and quality of life Still costly but adoption growing

65. New Drug Classes SGLT2 inhibitors: renal and CV benefits GLP-1 receptor agonists: weight loss and CV protection Dual GIP/GLP-1 agonists under research Precision medicine tailoring drugs to patient profile

66. Digital Health & Apps Mobile apps for monitoring and reminders Telemedicine improves access Wearables track activity, glucose, heart rate Empower patients for self-care

67. Future Directions Stem cell therapy for beta-cell regeneration Advances in islet transplantation Gene editing potential for Type 1 diabetes Artificial intelligence for predictive care

68. Summary of Key Points Diabetes requires lifelong care and monitoring Lifestyle + pharmacological management crucial Preventing complications saves lives and costs Education and empowerment improve adherence Technology and innovation are transforming care

69. Key Takeaways Individualize care for each patient Integrate lifestyle, medication, and monitoring Screen and prevent acute/chronic complications Leverage new technology for better outcomes Support patients with education and empathy

70. Closing Thoughts Diabetes care is a team effort Healthcare providers, patients, and families must collaborate Goal: longer, healthier, and complication-free life for people with diabetes

71. Thank You! Questions & Discussion