Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin

that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. Symptoms include frequent urination, lethargy, excessive thirst, and hunger. The treatment includes changes in diet, oral medications, and in some cases, daily injections of insulin. The most common form of diabetes is Type II, It is sometimes called age onset or adult onset diabetes, and this form of diabetes occurs most often in people who are overweight and who do not exercise. Type II is considered a milder form of diabetes because of its slow onset !sometimes developing over the course of several years" and because it usually can be controlled with diet and oral medication. The consequences of uncontrolled and untreated Type II diabetes, however, are the just as serious as those for Type I. This form is also called noninsulin dependent diabetes, a term that is somewhat misleading. #any people with Type II diabetes can control the condition with diet and oral medications, however, insulin injections are sometimes necessary if treatment with diet and oral medication is not wor$ing. The causes of diabetes mellitus are unclear, however, there seem to be both hereditary !genetic factors passed on in families" and environmental factors involved. %esearch has shown that some people who develop diabetes have common genetic mar$ers. In Type I diabetes, the immune system, the body&s defense system against infection, is believed to be triggered by a virus or another microorganism that destroys cells in the pancreas that produce insulin. In Type II diabetes, age, obesity, and family history of diabetes play a role. In Type II diabetes, the pancreas may produce enough insulin, however, cells have become resistant to the insulin produced and it may not wor$ as effectively. Symptoms of Type II diabetes can begin so gradually that a person may not $now that he or she has it. 'arly signs are lethargy, extreme thirst,

and frequent urination. (ther symptoms may include sudden weight loss, slow wound healing, urinary tract infections,gum disease, or blurred vision. It is not unusual for Type II diabetes to be detected while a patient is seeing a doctor about another health concern that is actually being caused by the yet undiagnosed diabetes. Individuals who are at high ris$ of developing Type II diabetes mellitus include people who)

are obese (more than 20% above their ideal body weight) have a relative with diabetes mellitus belong to a high-risk ethnic population (African-American, ative American, !ispanic, or ative !awaiian) have been diagnosed with gestational diabetes or have delivered a baby weighing more than " lbs (# kg) have high blood pressure ($#0%"0 mm!g or above) have a high density lipoprotein cholesterol level less than or e&ual to '( mg%d) and%or a triglyceride level greater than or e&ual to 2(0 mg%d) have had impaired glucose tolerance or impaired fasting glucose on previous testing

Diabetes mellitus is a common chronic disease requiring lifelong behavioral and lifestyle changes. It is best managed with a team approach to empower the client to successfully manage the disease. *s part of the team the, the nurse plans, organi+es, and coordinates care among the various health disciplines involved, provides care and education and promotes the client&s health and well being. Diabetes is a major public health worldwide. Its complications cause many devastating health problems. ANATOMY AND PHYSIOLOGY: 'very cell in the human body needs energy in order to function. The body&s primary energy source is glucose, a simple sugar resulting from the digestion

of foods containing carbohydrates !sugars and starches". -lucose from the digested food circulates in the blood as a ready energy source for any cells that need it. Insulin is a hormone or chemical produced by cells in the pancreas, an organ located behind the stomach. Insulin bonds to a receptor site on the outside of cell and acts li$e a $ey to open a doorway into the cell through which glucose can enter. Some of the glucose can be converted to concentrated energy sources li$e glycogen or fatty acids and saved for later use. .hen there is not enough insulin produced or when the doorway no longer recogni+es the insulin $ey, glucose stays in the blood rather entering the cells.

PATHOPHYSIOLOGY:

Image Source) www.caninsulin.com/Pathophysiolo y!al o"ithm.htm DIAGNOSTI# T$ST: Several blood tests are used to measure blood glucose levels, the primary test for diagnosing diabetes. *dditional tests can determine the type of diabetes and its severity.

*andom blood glucose test + for a random blood glucose test, blood can be drawn at any time throughout the day, regardless of when the person last ate, A random blood glucose level of 200 mg%d) ($$,$ mmol%)) or higher in persons

who have symptoms of high blood glucose (see -.ymptoms/ above) suggests a diagnosis of diabetes,

0asting blood glucose test + fasting blood glucose testing involves measuring blood glucose after not eating or drinking for 1 to $2 hours (usually overnight), A normal fasting blood glucose level is less than $00 mg%d), A fasting blood glucose of $22 mg%d) (3,0 mmol%)) or higher indicates diabetes, 4he test is done by taking a small sample of blood from a vein or fingertip, 5t must be repeated on another day to confirm that it remains abnormally high (see -6riteria for diagnosis/ below),

!emoglobin A$6 test (A$6) + 4he A$6 blood test measures the average blood glucose level during the past two to three months, 5t is used to monitor blood glucose control in people with known diabetes, but is not normally used to diagnose diabetes, ormal values for A$6 are # to 2 percent (show figure '), 4he test is done by taking a small sample of blood from a vein or fingertip,

7ral glucose tolerance test + 7ral glucose tolerance testing (7844) is the most sensitive test for diagnosing diabetes and pre-diabetes, !owever, the 7844 is not routinely recommended because it is inconvenient compared to a fasting blood glucose test,

The standard (-TT includes a fasting blood glucose test. The person then drin$s a /0 gram liquid glucose solution !which tastes very sweet, and is usually cola or orange flavored". Two hours later, a second blood glucose level is measured. (ral glucose tolerance testing is routinely performed at 12 to 13 wee$s of pregnancy to screen for gestational diabetes, this requires drin$ing a 04 gram glucose solution with a blood glucose level drawn one hour later. 5or women who have an abnormally elevated blood glucose level, a second (-TT is performed on another day after drin$ing a 644 gram glucose solution. The blood glucose level is measured before, and at one, two, and three hours after drin$ing the solution.

M$DI#ATIONS: .hen diet, exercise and maintaining a healthy weight aren&t enough, you may need the help of medication. #edications used to treat diabetes include insulin. 'veryone with type 6 diabetes and some people with type 1 diabetes must ta$e insulin every day to replace what their pancreas is unable to produce. 7nfortunately, insulin can&t be ta$en in pill form because en+ymes in your stomach brea$ it down so that it becomes ineffective. 5or that reason, many people inject themselves with insulin using a syringe or an insulin peninjector,a device that loo$s li$e a pen, except the cartridge is filled with insulin. (thers may use an insulin pump, which provides a continuous supply of insulin, eliminating the need for daily shots. The most widely used form of insulin is synthetic human insulin, which is chemically identical to human insulin but manufactured in a laboratory. 7nfortunately, synthetic human insulin isn&t perfect. (ne of its chief failings is that it doesn&t mimic the way natural insulin is secreted. 8ut newer types of insulin, $nown as insulin analogs, more closely resemble the way natural insulin acts in your body. *mong these are lispro !9umalog", insulin aspart !:ovo;og" and glargine !;antus". * number of drug options exist for treating type 1 diabetes, including) < Sul%onylu"&a '"u s. These medications stimulate your pancreas to produce and release more insulin. 5or them to be effective, your pancreas must produce some insulin on its own. Second generation sulfonylureas such as glipi+ide !-lucotrol, -lucotrol =;", glyburide !Dia8eta, -lynase >resTab, #icronase" and glimepiride !*maryl" are prescribed most often. The most common side effect of sulfonylureas is low blood sugar, especially during the first four months of therapy. ?ou&re at much greater ris$ of low blood sugar if you have impaired liver or $idney function.

< M& litini'&s. These medications, such as repaglinide !>randin", have effects similar to sulfonylureas, but you&re not as li$ely to develop low blood sugar. #eglitinides wor$ quic$ly, and the results fade rapidly. < (i uani'&s. #etformin !-lucophage, -lucophage =%" is the only drug in this class available in the 7nited States. It wor$s by inhibiting the production and release of glucose from your liver, which means you need less insulin to transport blood sugar into your cells. (ne advantage of metformin is that is tends to cause less weight gain than do other diabetes medications. >ossible side effects include a metallic taste in your mouth, loss of appetite, nausea or vomiting, abdominal bloating, or pain, gas and diarrhea. These effects usually decrease over time and are less li$ely to occur if you ta$e the medication with food. * rare but serious side effect is lactic acidosis, which results when lactic acid builds up in your body. Symptoms include tiredness, wea$ness, muscle aches, di++iness and drowsiness. ;actic acidosis is especially li$ely to occur if you mix this medication with alcohol or have impaired $idney function. < Alpha! lucosi'as& inhi)ito"s. These drugs bloc$ the action of en+ymes in your digestive tract that brea$ down carbohydrates. That means sugar is absorbed into your bloodstream more slowly, which helps prevent the rapid rise in blood sugar that usually occurs right after a meal. Drugs in this class include acarbose !>recose" and miglitol !-lyset". *lthough safe and effective, alpha glucosidase inhibitors can cause abdominal bloating, gas and diarrhea. If ta$en in high doses, they may also cause reversible liver damage. < Thia*oli'in&'ion&s. These drugs ma$e your body tissues more sensitive to insulin and $eep your liver from overproducing glucose. Side effects of thia+olidinediones, such as rosiglita+one !*vandia" and pioglita+one hydrochloride !*ctos", include swelling, weight gain and fatigue. * far more serious potential side effect is liver damage. The thia+olidinedione troglit+eone !%e+ulin" was ta$en off the mar$et in #arch 1444 because it caused liver failure. If your doctor prescribes these drugs, it&s important to have your liver chec$ed every two months during the first year of therapy. @ontact your

doctor immediately if you experience any of the signs and symptoms of liver damage, such as nausea and vomiting, abdominal pain, loss of appetite, dar$ urine, or yellowing of your s$in and the whites of your eyes !jaundice". These may not always be related to diabetes medications, but your doctor will need to investigate all possible causes. < D"u com)inations. 8y combining drugs from different classes, you may be able to control your blood sugar in several different ways. 'ach class of oral medication can be combined with drugs from any other class. #ost doctors prescribe two drugs in combination, although sometimes three drugs may be prescribed. :ewer medications, such as -lucovance, which contains both glyburide and metformin, combine different oral drugs in a single tablet.

N+,SING INT$,-$NTIONS:

Advice patient about the importance of an individuali9ed meal plan in meeting weekly weight loss goals and assist with compliance, Assess patients for cognitive or sensory impairments, which may interfere with the ability to accurately administer insulin, :emonstrate and e;plain thoroughly the procedure for insulin self-in<ection, !elp patient to achieve mastery of techni&ue by taking step by step approach, *eview dosage and time of in<ections in relation to meals, activity, and bedtime based on patients individuali9ed insulin regimen, 5nstruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia, =;plain the importance of e;ercise in maintaining or reducing weight, Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack before e;ercising to avoid hypoglycemia, Assess feet and legs for skin temperature, sensation, soft tissues in<uries, corns, calluses, dryness, hair distribution, pulses and deep tendon refle;es, >aintain skin integrity by protecting feet from breakdown,

Advice patient who smokes to stop smoking or reduce if possible, to reduce vasoconstriction and enhance peripheral flow,