Managing Diabetes Complications

#1 - Cardiovascular Disease and Diabetes

I. Development of cardiovascular disease in diabetes

A. Incidence
B. Potential mechanism of accelerated atherogenesis

1. Endothelial dysfunction
2. Hyperinsulinemia
3. Glycated proteins
4. Abnormal lipids
5. Coagulation defects
6. Inflammation

II. Risk factors contributing to heart disease

A. Dyslipidemia
B. Lipoprotein (a)
C. Hypertension
D. Hyperglycemia
E. Elevated homocysteine
F. Tobacco use
G. Obesity
H. Sedentary lifestyle

III. Interventions to reduce risk of heart disease in persons with diabetes

A. Metabolic control

1. Blood glucose control
2. Blood pressure control
3. Blood lipid control

B. Physical activity/weight loss
C. Medical Nutrition Therapy
D. Pharmacological therapy
E. Role of health care professional

Behavioral/Learning Objectives:

1. Describe how cardiovascular disease develops in persons with diabetes.
2. Identify 3 risk factors contributing to heart disease.
3. List 3 interventions to decrease the risk of heart disease in persons with diabetes.

#2 - Retinopathy and Nephropathy and Diabetes

Retinopathy

I. Incidence

II. Risks of vision loss

III. Glaucoma & Cataracts

IV. Screening

V. History of retinopathy/Management/Treatment

A. Non-proliferative retinopathy

1. Mild
2. Moderate
3. Severe
4. Very Severe

B. Proliferative

VI. Prevention

Nephropathy

I. Incidence

II. Five Stages

III. Screening

A. Blood pressure
B. Urinary Albumin

IV. Treatment

A. Hypertension
B. Glycemic Control
C. Protein Intake

V. Treatment of End Stage Renal Disease

A. Hemodialysis
B. Peritoneal Dialysis
C. Kidney Transplant

VI. Prevention

Behavioral/Learning Objectives:

1. List 2 ways to prevent retinopathy.
2. Define the screening recommendations for diabetes eye exams.
3. State the name of the test that detects protein in the urine the earliest.
4. List 2 treatment options for end stage renal disease.

#3 - Diabetic Ulcers and Nephropathy

I. Prevalence and Incidence

II. Risk Factors

III. Possible Progression

IV. Neuropathy – Sensory, Autonomic, and Motor

V. Osteomyelitis

VI. Charcot Foot

VII. Wound and Infection

VIII. Prevention

IX. Diabetes Management

X. Off-Loading

XI. Treatments

XII. Dressings

Behavioral/Learning Objectives:

1. State the Common Diabetic Ulcers
2. Describe an evaluation of a Diabetic Foot
3. Explain the Diabetic Plan of Care

#4 - Acute Complication of Diabetes

I. Hypoglycemia

A. Causes
B. Signs/symptoms
C. Prevention
D. Treatment

II. Hyperglycemia

A. Causes
B. Signs/symptoms
C. Prevention
D. Treatment

III. Ketoacidosis

A. Causes
B. Signs/symptoms
C. Prevention
D. Treatment

IV. Hyperosmolar Hyperglycemic Nonketotic Syndrome

A. Definition
B. Signs/symptoms
C. Causes
D. Prevention
E. Treatment

V. Case examples

Behavioral/Learning Objectives:

1. State 2 ways to prevent hypoglycemia.
2. List 2 signs and symptoms of ketoacidosis.
3. Define hyperosmolar hyperglycemic nonketotic syndrome.
4. Identify how to appropriately treat hypoglycemia.

#5 - Inpatient Diabetes Care

I. Prevalence of diabetes in the acute care setting

II. Link between glucose control and poor outcomes

A. Immune function
B. Cardiovascular system
C. Inflammation
D. Brain function

III. Glucose management Options

A. Blood glucose monitoring

1. Frequency

B. Targets

2. Insulin

C. Oral meds

IV. Insulin protocols

V. Special Situations

A. TPN use
B. Enteral feeding
C. Glucocorticoid therapy
D. Surgery

VI. Prevention of Hypoglycemia

A. Uniformity of insulin orders
B. Accuracy of insulin dosing
C. Patient self management
D. Staffing knowledge
E. Carbohydrate intake
F. Steroid use
G. NPO status
H. Treatment

VII. Discharge considerations

VIII. Outcomes

Behavioral/Learning Objectives:

1. State 2 ways to prevent hypoglycemia in the inpatient setting.
2. Describe how hyperglycemia influences inflammation.
3. List 2 reasons why insulin may be preferable to oral diabetes agents in the inpatient setting.

#6 - Managing Other Complications of Diabetes

I. Interventions for autonomic neuropathies

A. Gastrointestinal

1. Gastroparesis

B. Genitourinary:

1. Neurogenic bladder
2. Sexual dysfunction

C. Cardiovascular

1. Orthostatic hypotension
2. Cardiac denervation
3. Abnormal cardiovascular response to exercise

D. Impaired insulin counter-regulation

1. Hypoglycemia unawareness

E. Sudomotor dysfunction
F. Abnormal pupillary function

II. Stages of Periodontal Disease

A. Gingivitis
B. Periodontitis
C. Advanced periodontitis
D. Principles of prevention

1. Control diabetes
2. Preserve natural teeth
3. Maintain good oral hygiene
4. Client education principles
5. Dental visit every 6 months: treat/refer problems

III. Flu and pneumonia/guidelines for managing illness in persons with diabetes

A. Maintain hydration
B. Frequent monitoring (blood glucose and ketones)
C. Medication use and adjustment: Rx and OTC
D. Medical Nutrition Therapy (MNT)
E. When to contact the health care professional (hcp)
F. Developing a plan for use when ill. g. Preventing illness

1. flu and pneumonia vaccinations
2. healthy eating
3. hydration
4. plenty of rest
5. not using tobacco

Behavioral/Learning Objectives:

1. Identify intervention strategies for 2 types of autonomic neuropathy.
2. State the 3 stages of periodontal disease.
3. List 3 guidelines for managing illness in persons with diabetes.

Accreditation Information

Nurses – Academy Medical Systems is an approved provider of continuing nursing education by the Illinois Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 9.0 contact hours will be rewarded to nursing professionals at the completion of this workshop.

Academy medical Systems is also a provider approved by the California Board of Registered Nursing, provider #CEP14413, for 9.0 hours. And we are also a provider approved by the Florida Board of Nursing, provider #50-19, for 9.0 hours.

Iowa Nurses - The Iowa Board of Nurses will recognize the recorded webinars as a home study program. They recognize our ANCC approved provider status as well as our CA and Fl Board of Nursing provider approval for home study products for nurses in Iowa.

All other states recognize our approved provider status listed in the above text for continuing education credit for nurses.

Dietitians - Academy Medical Systems is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 9.0 continuing professional education units (CPEUs) for completion of this program/material.

Occupational Therapist - Occupational Therapist will receive 9, continuing education hours for completion this program and a test score of 70% or better. AMS is an approved provider for the AOTA , provider # 5470.  This course is an intermediate education level.

Exercise Physiologist – ACSM recognizes AMS’s approved provider status with the ANCC and will honor our continuing education for Certified Exercise Physiologist recertification purposes.

Certified Athletic Trainers – Academy Medical Systems is recognized by the Board of Certification (BOC) to offer continuing education for certified athletic trainers. 9 hours will be awarded at the completion of this program.

Physical Therapists - PTs in the following states will receive 9 contact hours for completion of all 6 webinars: AK, CA, CO, CT, HI, IA, ID, IN, KS (Cat 2), MA, ME, MI, MN (Cat 2), MT, NE, NM, ND, OR, PA, RI, SC, SD, UT, VA (Type 2), VT, VI, WA, WY.

Because each state’s continuing education requirements for physical therapists is subject to change, please verify this information with your state board. Thank you.

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