Diabetes Training website

Diabetes Training

Pro Health Train- for all areas of residential care

This online diabetes training course meets State of Maine requirements under the

Ch. 113 : Regulations Governing the Licensing and Functioning of Assisted Housing Programs- Level 4, section 7.1.4.

Created by:

Heather Anne Fraser MSM, RN-BSN, SAS

Holistic registered nurse, RN business consultant, healthcare learning architect

cell- (207) 317-1649

info@prohealthtrain.com

This online independent review takes about 1 hour, with an online quiz. You must pass the quiz with 100% (25 questions-True/false, multiple choice) but you can repeat it if needed. We will also have a 1 hour in-person meeting at your workplace.

Course format from the Ch. 113, level 4 section 7.1.4 requirements:

https://www.maine.gov/sos/cec/rules/10/ch113.htm

7.1.4 Unlicensed assistive personnel must be trained by a registered professional nurse in regard to the management of persons with diabetes. Review of this training shall be on an annual basis.

7.1.4.1 Dietary requirements

7.1.4.2 Anti-Diabetic Oral medications – inclusive of adverse reactions and interventions, hyper and hypoglycemic reactions

7.1.4.3 Insulin mixing including insulin action

7.1.4.4 Insulin storage

7.1.4.5 Injection techniques and site rotation

7.1.4.6 Treatment and prevention of insulin reaction including signs/symptoms

7.1.4.7 Foot care

7.1.4.8 Lab testing, urine testing and blood glucose monitoring; and

7.1.4.9 Standard Precautions- Documentation of training shall be included in the employee record 7.1.5 Urine testing shall not be done around medication or areas where food is stored or prepared. Proper Standard Precautions relative to body fluids shall be implemented

some helpful definitions:

Diabetes: a disease of the endocrine system in which the body is unable

to maintain a normal blood sugar level

Endocrine system- the body's chemical messenger glands

Glands- organs in the body that produce and release hormones (chemical messengers) into the bloodstream that perform specific functions

Hormones: the body's chemical messengers, produced by glands

Pancreas: an endocrine gland located just below the stomach which produces 2 hormones to maintain a normal blood sugar level;

glucagon and insulin

Glucagon- raises glucose in the bloodstream

Insulin- a hormone produced by the pancreas (admininstered by injection) which lowers glucose in the bloodstream

Metabolism- chemical reactions in the body that convert food into energy

3 main types of diabetes:

Type 1- limited insulin production, often hereditary in children
Type 2- ineffective insulin, often adults with too much blood sugar
Gestational diabetes- during pregnancy

Common causes:

Heredity/genetics
Overweight- can't produce enough insulin to meet demands of increased body mass
llicit drug use- organ damage, decreased pancreas function
Gestational
Autoimmune disorders
Medication side effects

Treatment:

maintain a healthy body weight, diet and exercise
oral meds and insulin injection meds as ordered

Normal blood sugar range: 70-110

Blood sugar testing should be done before eating or drinking anything with calories

to ensure accuracy for proper treatment

Hypoglycemia:

fasting blood sugar below 70mg/dl

Not enough glucose in the blood to provide needed energy-

severe effects can lead to unconciousness, seizures, death

Hypo means low

Signs and symptoms:

sudden hunger
headache
shaking
sweating
fatigue
dizziness
nervousness
confusion
blurred vision
numbness/ tingling

Treatment:

if conscious- give sugary food/drink, then recheck blood sugar in 10-15 minutes
If the person is confused or unconscious, call 911, lay person on their side, give glucagon injection at 90 degree angle into a large muscle (upper arm, thigh, buttock) if ordered with training

”hyper” means high

Hyperglycemia:

fasting blood sugar above 110mg/dl

Too much sugar in the blood causes decay throughout the body

Signs and symptoms:

increased thirst
increased urination
fatigue
nausea/ vomiting
confusion
fruit smelling breath

Complications:

blindness
kidney failure
organ damage
nerve damage
amputations
wounds that don't heal

Treatment:

if conscious- give oral meds with water/ insulin if ordered, then recheck blood sugar in 10-15 minutes
If the person is confused or unconscious, call 911, lay person on their side in case of vomiting

7.1.4.1- Dietary requirements:

Limiting dietary sugar, increasing exercise and maintaining a normal body weight are keys to help manage diabetes. The prescriber may order a diabetic diet to include a daily intake limit of 200 grams of carbohydrate, 25 grams of fat and 60 grams of protein. Three low -carb meals per day with low sugar, high protein snacks in between can help maintain consistent blood sugar levels.

7.1.4.2.- Anti-diabetic oral medications:

7.1.4.3- Insulin types, insulin mixing and action

insulin types and actions

Remember the 8 "rights" when administering insulin

Insulin dosage

This chart is called a "sliding insulin scale" - it is an example of the dose to give, based on checking the blood sugar with a glucometer

glucometer reading

how many units to give

7.1.4.3- Insulin mixing and action

How to mix 2 different types of ordered insulin (clear and cloudy)-

***see the previous chart for insulin types***

Be sure that no air or cloudy insulin gets injected into the clear insulin vial
After inserting air into both vials, be sure to draw out the clear insulin first
Draw slowly from the clear insulin to avoid drawing out too much or you will need to start with a new syringe
Check the order first to see how many units of inslin are ordered for each

Roll the bottle of cloudy insulin between your palms
Wipe the top of both insulin bottles with an alcohol pad
Insert ________ units of air into the cloudy insulin vial first
Then insert________ units of air into the clear insulin vial, turn the bottle upside down and draw out the units without any air in the syringe
Lastly, insert the needle into the cloudy vial, turn the vial upside down and draw out the units without any air in the syringe

7.1.4.4 Insulin storage

Refer to all package inserts for proper storage
Insulin vials should be initialed and dated with permanent ink when opened, then discarded after 28 days
Keep refrigerated insulin between 36-46* F and away from heat/ sunlight
Discard vials containing clumps or particles, be sure clear insulin is clear

7.1.4.5 Injection techniques and site rotations

Insulin should be injected at a 45-90 degree angle into the subcutaneous layer (inner, fatty layer) where it is absorbed into the bloodstream and distributed throughout the body.

The best injection sites are:

Abdomen, at 1least an inch away from the bellybutton
Back of upper arms
thighs

Rotate injection sites for better absorption and to avoid bruising

7.1.4.6 Treatment and prevention of insulin reaction

Too much insulin can lead to hypoglycemia, insulin shock and

cause diabetic coma, brain damage and death, due to:

ignoring signs of hypoglycemia
injecting too much insulin by mistake
missing a meal
excessive exercise without carb intake

7.1.4.7 Foot care

Diabetes can cause nerve damage with loss of feeling and increase the risk for infections, especially in the feet with poor fitting shoes or the presence of cuts, blisters, broken nails. The following measures should be taken to avoid infections that can lead to chronic wounds or amputations.

Daily foot inspection for cuts, blisters, broken nails and signs of infection
Gently wash with lukewarm water, pat dry
Keep feet warm, clean and dry (especially between toes) and use a protective moisturizer
File nails rather than cutting
Do not walk barefooted
Avoid smoking

7.1.4.8 Lab testing, urine testing and blood glucose monitoring

Lab testing

A1C Test- measures the average blood sugar level over the past 2 -3 months:

Normal- below 5.7%

Prediabetes- 5.7%- 6.4%

High- above 6.5%

Fasting Blood Sugar Test- blood sample is checked after an overnight fast (not eating) NPO

Normal- 99 mg/dL or lower

Prediabetes- 100- 125mg/dl

High- 126mg/dl and above

Glucose monitoring

tip- the video uses a cotton ball to wipe the finger, but use an alcohol pad instead!

7.1.5 Urine testing-shall not be done around medication or areas where food is stored or prepared. Proper standard precautions relative to body fluids shall be implemented

7.1.4.9. Standard precautions

7.1.5 Urine testing-shall not be done around medication or areas where food is stored or prepared. Proper standard precautions relative to body fluids shall be implemented

7.1.6 No medications, including those brought into the facility by the resident, family or friends, shall be administered or discontinued without a written order signed by a licensed prescriber

You are now ready to take the diabetes quiz! Your quiz results will be automatically forwarded

to our grading inbox- after passing with a grade of 85% or better we will email you your

annual diabetes training certificate-