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Diabetes is a complex, chronic illness that requires continuous medical care with multiple risk-reduction strategies beyond glycemic control.
Ongoing self-management education and support are critical in preventing acute complications and reducing risks for long-term complications. Blood glucose (BG) monitoring is essential for positive patient outcomes.
Hypoglycemia (low BG) can be dangerous and should be treated as soon as possible.undefined#ref6">6
Diabetes mellitus (DM) is a chronic disorder caused by the inadequate production of insulin by the pancreas or the inadequate use of insulin by the cells. It is a condition of the inadequate metabolism of carbohydrates, fats, and proteins. The functioning pancreas secretes insulin and maintains glucose levels in a precise range. Insulin normally reduces BG levels by transporting glucose into the cells for use as energy and for storage as glycogen. When insulin is reduced, hyperglycemia occurs, depriving cells of fuel.
There are two primary forms of DM:
The principal symptoms of DM are polyuria, polyphagia, polydipsia, weight loss, and fatigue. Patients may experience pruritus, especially in the genital area, and a fruity odor to the breath may be noted when ketosis occurs. Diagnostic tests of blood and urine are used to point to the common signs and symptoms of DM.2
Untreated or poorly managed diabetes has multiple systemic complications. Even if the patient is compliant with treatment, retinopathy, which leads to blindness, can be a complication. Other systemic complications include neuropathy, atherosclerosis, renal failure, myocardial infarction, and stroke.1
A review of laboratory results, such as a hemoglobin A1C, provides a more accurate picture of the patient’s glycemic control over time than a fasting BG test, and it should be reviewed when discussing diet.3
The hemoglobin A1C is a stable glycoprotein formed when glucose binds to hemoglobin A in the blood. The A1C test is a diagnostic test and is defined as the estimated average glucose. It is usually performed twice a year and shows how well BG levels have been controlled over a 3-month period.3,6
The occurrence of diabetes is a growing problem in an aging population, as approximately one-quarter of people over 65 years old have diabetes and one-half have prediabetes.6 This proportion is expected to continue to rise in coming years and decades. Older adults with diabetes have higher rates of premature death, functional disability, accelerated muscle loss, and coexisting illnesses (e.g., hypertension, coronary heart disease, stroke).5 They are at greater risk for polypharmacy, cognitive impairment, urinary incontinence, and food insecurity, which may impact self-management abilities.5
If signs of hypoglycemia are present, perform a point-of-care BG for confirmation.
Rationale: Weight loss of 5% to 10% of body weight for a patient who weighs 91 kg (200 lb) can increase the ability to manage BG levels safely.
All patients diagnosed with DM, whether insulin dependent or not, should perform frequent BG monitoring to avoid complications such as hypoglycemia or hyperglycemia.
Taking oral antidiabetic medication and being diet compliant are not guarantees that hypoglycemia or hyperglycemia will not occur or that BG levels will remain within safe parameters.
Association of Diabetes Care & Education Specialists (ADCES). (n.d.). Resources on glucose monitoring. Retrieved November 16, 2020, from https://www.diabeteseducator.org/practice/practice-tools/diabetes-management-tools/glucose-monitoring-resources
Evert, A.B. and others. (2019). Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Diabetes care, 42(5), 731-754. doi:10.2337/dci19-0014
Joint Commission, The. (2020). National patient safety goals for the ambulatory health care program. Retrieved November 16, 2020, from https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2020/npsg_chapter_ahc_jul2020.pdf
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