10.2 Diabetes and Metabolic Conditions

Diabetes Mellitus: Type 1 and Type 2

Diabetes mellitus is a disorder in which the body cannot properly move glucose (sugar) from the blood into the cells. Glucose is the cell's fuel, and insulin is the hormone that unlocks the cell door for it. Without enough working insulin, blood sugar rises while the cells starve.

• Type 1 diabetes: the pancreas makes little or no insulin because the immune system destroys the insulin-producing cells. It usually appears in childhood or young adulthood and always requires injected insulin for survival
• Type 2 diabetes: the body still makes insulin, but the cells resist it, and over time production may fall. It is far more common, is linked to age, weight, and inactivity, and is managed with diet, activity, oral medications, and sometimes insulin

You do not manage the medication — nurses do — but you manage the daily rhythm around it: meals on time, snacks as ordered, accurate intake records, and sharp observation.

Why the Details Add Up: Long-Term Complications

Uncontrolled blood sugar slowly damages the eyes (diabetic retinopathy and blindness), the kidneys (nephropathy and failure), the nerves (neuropathy and numbness), and the blood vessels, which is why diabetes raises the risk of heart attack, stroke, and foot amputation. Residents do not feel this damage day to day, which is exactly why the unglamorous CNA routines — on-time meals, honest meal-percentage charting, daily foot checks, and measured intake and output when ordered — are what keep a resident's long-term risk down. Accurate documentation is not paperwork for its own sake: the nurse adjusts care based on what you record.

Low Sugar vs. High Sugar: Know Both Cold

The single most-tested diabetes concept is distinguishing hypoglycemia (low blood glucose) from hyperglycemia (high blood glucose). Learn this comparison:

A memory aid: low sugar acts like too much insulin — the person is shaky, sweaty, and confused and needs sugar now. High sugar acts like not enough insulin — the person is thirsty, urinating constantly, and may smell fruity. When in doubt about which one you are seeing, treat it as low and call the nurse immediately; untreated hypoglycemia can cause coma and death within a short time, while hyperglycemia is comparatively slower. Never give food or drink to a resident who cannot swallow safely — get the nurse instead.

Why Meal Timing Matters

Insulin and many oral diabetes medications are given to peak when food arrives. If a resident receives insulin and the meal tray is late — or the resident eats only part of the meal — the medication has no sugar to work on and blood glucose crashes. Therefore:

• Serve diabetic residents' meals on time, before other non-urgent tasks
• Note how much of each meal the resident actually eats and report poor intake (many facilities use percentage estimates — e.g., ate 50%)
• Offer the between-meal and bedtime snacks the care plan orders; they are part of the treatment, not extras
• If a resident refuses a meal after receiving insulin, tell the nurse immediately, not at the end of the shift

Foot Care: Protecting What Diabetes Damages

Diabetes injures small blood vessels and nerves over time, causing peripheral neuropathy (loss of feeling in the feet) and poor circulation. A resident may not feel a blister, a pebble in a shoe, or water that is too hot — and poor circulation means small wounds heal slowly and can progress to ulcers and even amputation. Your role:

• Inspect the feet daily during care: look between the toes and at the soles for redness, blisters, cracks, corns, or breaks in the skin, and report any finding
• Wash and dry the feet carefully, especially between the toes; test water temperature first
• Apply lotion to dry skin if the care plan directs, but not between the toes (moisture there invites breakdown and fungus)
• Never cut a diabetic resident's toenails unless your facility's policy, the care plan, and your training specifically permit it — nail cutting for diabetic residents is commonly restricted to the nurse or podiatrist
• Make sure shoes and socks fit well with no wrinkles or tight elastic, and never let the resident walk barefoot

Sick Days and Prompt Reporting

Illness, infection, vomiting, diarrhea, and stress all push blood sugar around — often upward — even when a resident is eating poorly. On sick days, observe and report: how much the resident is eating and drinking, any vomiting or diarrhea, fever, unusual drowsiness or confusion, and changes in breathing. Any abnormal sign — a behavior change, a foot wound, a meal refused after insulin, a fruity odor on the breath — is reported to the nurse promptly. In diabetes care, your eyes and your reporting are the early-warning system.