Guest Author - Julie Reeser, RN
The body uses glucose to fuel the cells. In the same way that we need stomach acid, mechanical grinding, and enzymes to break food into useable components, the cells need insulin to use glucose. In a Type II diabetic, the insulin produced by the pancreas is no longer efficient. This leads to two major complications, excess glucose in the bloodstream and deficient glucose in the cells.
The risk of excess glucose in the bloodstream is mostly related to the changes this causes in blood viscosity. The blood literally becomes thicker, causing less blood flow into the capillary areas. This is hazardous to such vital organs as the kidneys and the heart, as well as minute structures such as the eye. Many diabetics end up with a complication called neuropathy due to damage caused to the nerve structures. This lack of proper blood flow also contributes to ulcers. If a diabetic develops a wound, it may not heal for an extended period of time, and may become a source of infection and disability.
The risks of deficient glucose in the cells are especially noticed in the brain. Lack of glucose to the brain can result in seizure, atrophy, and dementia. If the brain signals to the body that it isnít receiving the proper amount of fuel, it will trigger the liver to release stored glucose, called glycogen, causing a worsening of the elevated blood glucose level.
Nurses measure blood glucose levels and use routine sliding scales to administer insulin as ordered. This extra insulin assists the cells in allowing the glucose to transport into the cell for use. Many Type II diabetics are not on insulin at home, and the sudden need for it in the hospital can be frightening and confusing. It is important to explain to them that research shows a lower mortality rate with tightly controlled blood glucose levels (1). It is also important that they know that when they are sick, they are at greater risk of elevated blood glucose. This means that once they are better, there is a good chance they will be discharged home on oral antiglycemics. Many patients on steroid treatment will also have higher blood glucose levels requiring more frequent and often, higher, doses of insulin therapy.
Nurses can teach their Type II diabetics many useful ways to keep their glucose metabolism under control. The first is to stress to them that not all carbohydrates are bad. Adding fiber and protein to a carbohydrate slows the release of the glucose into the bloodstream, allowing the pancreas more time to get the insulin working. Exercise has been shown to increase the cellsí insulin use and efficiency, and is probably the most important lifestyle change to be made. Getting their HbA1c levels tested can help the Type II diabetic see the larger picture of how their eating and lifestyle are affecting their blood sugars. Staying hydrated is another important, but simple, measure that many diabetics often overlook. Teaching the diabetic to keep their food full of color and flavor will help them be sure to keep the fiber and nutrient value of their foods high. A plate of carbohydrates tends to be pale in color. Another trick is to teach the diabetic to chew the carbohydrate foods that they choose to eat very slowly. They should hold the food in their mouth much longer than would seem normal. The saliva contains an enzyme, amylase, that breaks down the carbohydrate into simple sugars, and is therefore, sweet-tasting. This will often satisfy the cravings many diabetics get for sugary snacks.
As the health care professional that spends the most time with this patient population, every opportunity to teach, talk, listen, and demonstrate should be taken. This is a rapidly increasing segment of our society, and they deserve every chance to get it right. Many times, they want to know how to make it better, but need a place to start. Giving them your attention may be that first step that leads them to a healthier lifestyle.