INTRODUCTION Diabetes Mellitus (DM) is a chronic disease, which can occur when there is a lack of insulin secretion or when the body cannot effectively use insulin (a hormone produced by the pancreas that lowers glucose in the blood thus, regulating blood sugar). A common effect of uncontrolled diabetes due to the absence or insufficient production of insulin is an increased concentration of glucose in the blood (hyperglycemia) and may further lead to serious damage to the different body systems, especially the nerves and blood vessels. There are two major types of DM: TYPE 1 TYPE 2
Commonly known as: Insulin- Commonly known as: Non-Insulin Dependent Diabetes Mellitus Dependent Diabetes Mellitus (IDDM) (NIDDM) Due to Heredity (Hereditary). Lifestyle-related (such as It may also result from excessive body weight and progressive failure of the physical inactivity)
pancreatic beta cells.
Onset: Juvenile or childhood onset; Onset: Adult onset However, it can occur in an older individual due to destruction of the pancreas by alcohol, disease or removal by surgery. Pathologic Etiology: Pathologic Etiology: Absolute deficiency (No insulin Lack/ inadequate insulin produced) Insulin resistance
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. steroid diabetes induced by high doses of glucocorticoids. In people with prediabetes. Prediabetes is a common condition related to diabetes.Main Treatment: administration of Insulin Acute complication: (Diabetic Ketoacidosis)
daily Main Treatment: OHA (Oral Hypoglycemic Agent) DKA Acute complication: HHNK (Hyperglycemic Hyperosmolar Nonketotic Coma)
DM is also associated with the following: Gestational diabetes. Diabetes affects approximately 26 million people in the United States.4 million people died from consequences of high blood sugar. an estimated 3. while another 79 million gave pre-diabetes.and middle-income countries. although this is not inevitable. Diabetes was the 7th leading cause of death in the United States listed on death certificates in 2007. an estimated additional 7 million people in the United States have diabetes and don't even know it. * Key Facts (According to World Health Organization): 346 million people worldwide have diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes. WHO projects that diabetes death will double between 2005 and 2030. which is hyperglycemia that is recognized during pregnancy. the blood sugar level is higher than normal but not yet high enough to be considered diagnostic of diabetes. and several forms of monogenic diabetes. Impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG) are intermediate conditions in the transition between normality and diabetes. which is due to genetic defects of insulin secretion. In addition. Other forms of diabetes mellitus include congenital diabetes. More than 80% of diabetes deaths occur in low.
Altered mental status These symptoms of untreated diabetes are related to elevated blood sugar levels. Insulin is an anabolic hormone. ASSOCIATED SIGNS: . fat and carbohydrate metabolism. the clinical assessment of diabetes mellitus includes: 3 CARDINAL SIGNS: .Slow healing wound = due to poor circulation which is conducive for bacterial growth. . The inability of insulin to perform normally has effects on protein. as of 2010. and rises considerably after age 65 years. DM suppresses the satiety center causing increased hunger.Nausea and Vomiting .Changes in vision . that is. one that encourages storage of fat and
.Weight Loss = due to prolonged cellular starvation.
Globally. Risk begins to rise significantly at about age 45 years.Polyuria = also known as hyperosmolar diuresis. . and loss of glucose in the urine. with type 2 making up about 90% of the cases
CAUSE The exact cause is still unknown.Warm & dry skin . an estimated 285 million people had diabetes. These are the following: Stress Heredity = due to the “diabetogenic gene” Lifestyle.Polyphagia = also known as cellular starvation. particularly Obesity Auto-immune Ethnicity Age = Increasing age is a significant risk factor for type 2 diabetes. SIGNS AND SYMPTOMS Generally. .Fatigue . there are certain factors that that can lead to DM. However. . which causes an increased urine output.Syncope .Polydipsia = also known as hyperosmolar dehydration causing excessive thirst.
increased serum lipids. acetone breath. Metabolic Syndrome “Syndrome X” It is a set of abnormalities in which insulin-resistant diabetes (Type 2 DM) is almost always present along with hypertension.Diabetic nephropathy= DM is the leading cause of endstage renal disease which requires dialysis or transplantation. illness or infection. . Microvascular effects: . Peripheral Vascular Disease. central obesity.protein. COMPLICATIONS Diabetes Mellitus leads to the following complications which can either have microvascular or macrovascular effects. Fluctuations in blood glucose levels can lead to blurred vision. Its hallmark is albumin excretion. It can lead to blindness. Its clinical manifestations include Kussmaul’s respiration. A relative or absolute insulin deficiency eventually leads to weight loss despite an increase in appetite.Coronary Artery Disease.
. Renal Diseases And as mentioned earlier. elevated triglycerides. It is caused by under dose of insulin.Diabetic neuropathy = this can lead to non-traumatic amputations of the lower extremities because of foot wounds and ulcers that does not heal easily. increased LDL but decreased HDL cholesterol.Diabetic retinopathy = this is a progressive impairment in retinal circulation and its first sign is blurring of vision. Macrovascular effects: If these three microvascular effects continued to progress it will lead to the following: . . Extremely elevated glucose levels can lead to lethargy and coma. and stress or surgery. the two types of DM have acute complications like: Diabetic Ketoacidosis (DKA) this is a life-threatening complication of Type 1 DM. Hypertension. as well as abnormal blood clotting and inflammatory responses.
and abdominal pain.this determines the percent of glucose attached to RBC for 3-4 months (90-120 days) RBS (Random Blood Sugar) NORMAL VALUES 70-110 mg/dL 110-170 mg/dL (30 mins after blood sugar test) 80-110 mg/dL (2 hours after)
Fasting Blood Sugar The fasting blood glucose (FBS) test is the preferred way to diagnose diabetes. IVF rehydration and Sodium Bicarbonate. if it FBS result is slightly elevated to <120 mg/dL HbA1C (Glycosyliated Hgb): . After the person has fasted overnight (at least 8 hours).nausea & vomiting. Hence. diagnosis can be accomplished through the following: DIAGNOSTIC PROCEDURES MEASUREMENT FBS (Fasting Blood Sugar) OGTT (Oral Glucose Tolerance test): . A blood glucose level of 200 mg/dl or higher indicates diabetes. DIAGNOSIS Early detection of these complications and implementation of appropriate treatment strategies will reduce the risk for adverse outcomes from these complications. a single sample of blood is drawn and sent to the laboratory for analysis. A random blood glucose test can also be used to diagnose diabetes. When fasting blood glucose stays above 100mg/dl.used for gestational DM and to confirm FBS result (esp. on different days indicate diabetes.also known as Oral Glucose Challenge Test . A fasting plasma glucose level of more than 126 mg/dl on two or more tests.
. Hyperglycemic Hyperosmolar Nonketotic Coma (HHNK) this is a complication of Type 2 DM which is manifested by severe hyperglycemia & dehydration. The treatment is the same with DKA except for giving Sodium Bicarbonate. It is treated with insulin drip. This can also be done accurately using a glucose meter. It is easy to perform and convenient.
Diabetes: A person has diabetes when two diagnostic tests done on different days show that the blood glucose level is high. such as polycystic ovary syndrome. or a 2-hour glucose level of 153 mg/dl. the person fasts overnight (at least eight but not more than 16 hours).but in the range of 100-126mg/dl. and The person should not be taking medicines that could affect the blood glucose. this is known as impaired fasting glucose (IFG). MANAGEMENT Management of Diabetes Mellitus reflects the triad of M. After this test. the person should not smoke or drink coffee. Glucose tolerance tests may lead to one of the following diagnoses: Normal response: A person is said to have a normal response when the 2-hour glucose level is less than 140 mg/dl. as an inpatient in a hospital). (Usually. the oral glucose tolerance test (OGTT)is a gold standard for making the diagnosis of type 2 diabetes.D. Then first. and all values between 0 and 2 hours are less than 200 mg/dl. not even a cold). Impaired glucose tolerance: A person is said to have impaired glucose tolerance when the fasting plasma glucose is less than 126 mg/dl and the 2-hour glucose level is between 140 and 199 mg/dl. The person should be normally active (not lying down. or more.A. Oral glucose tolerance test Though not routinely used anymore. the fasting plasma glucose is tested. II. the glucose is in a sweet-tasting liquid that the person drinks. a 1-hour glucose level of 180 mg/dl or more. Gestational diabetes: A pregnant woman has gestational diabetes when she has any two of the following: a fasting plasma glucose of 92 mg/dl or more.) Blood samples are taken at specific intervals to measure the blood glucose. which
. for example. For the test to give reliable results: The person must be in good health (not have any other illnesses. the person receives 75 grams of glucose. It is still commonly used for diagnosing gestational diabetes and in conditions of prediabetes. The morning of the test. With an oral glucose tolerance test.
. Activities/ exercises appropriate for DM patients are based on weight reduction which improves tissue sensitivity to insulin and allow its proper use by target tissues. PREVENTION: Simple lifestyle measures have been shown to be effective in preventing or delaying the onset diabetes. There should be a monitoring of glucose before. Type 2 diabetic individuals frequently take oral medications although many also use insulin to improve glycemic control. the prevention of diabetic ketoacidosis and nonketotic acidosis. the avoidance of sustained hyperglycemia or symptomatic hypoglycemia. moderateintensity activity on most days. Medications vary depending on the type of diabetes the client has wherein the primary medication used in type 1 diabetes management is insulin (on which the type 1 diabetic patient is dependent for survival). weight control. and the immediate detection and treatment of long-term diabetic complications. Other goals are normal growth and development. More activity is required for weight control. during and after the exercise period. exercise.stands for the following:
Primary management goals for diabetes patients include the achieving of blood glucose levels that are as close to normal as possible and the prevention of diabetic complications. Being physically active – at least 30 minutes of regular. Obesity is very common in type 2 diabetes and contributes greatly to insulin resistance. normal body weight. Diet. One should: Achieve and maintain healthy body weight. A Diabetic diet includes a low calorie but high fiber diet. and medications are the mainstays of diabetic care.
Avoiding tobacco use – smoking increases the risk of cardiovascular diseases. Tobacco use cessation). To prevent this. Insulin is administered at room temperature. irritability. And since diabetes may greatly increase the risk for heart disease and peripheral artery disease. TREATMENT Diabetes treatment is highly individualized. Lipodystrophy hardening of subcutaneous tissues which becomes fibrous adipose tissues. III. it involves lowering blood glucose and the levels of other known risk factors that damage blood vessels. This is treated by decreasing the evening dose of insulin and through giving midnight snack. there is a normal blood sugar at hours of sleep but at around 2-3 am. This is treated by NPH (Neutral Protamine Hagedorn). This causes an increase of intrinsic hyperglycemic hormones that leads to rebound hyperglycemia. the treatment is administration of insulin.54 cm. measures to control blood pressure and cholesterol levels are an essential part of diabetes treatment as well (e. for Type 2 DM. the treatment includes medications particularly Oral Hypoglycemic Agents (OHA) which is the following: Alpha glucosidase inhibitor its mechanism of action is to
. depending on the type and severity of the diabetes. hypoglycemia occurs.g. Eating a healthy diet of between three and five servings of fruit and vegetables a day and reduce sugar and saturated fats intake. For Type 1 DM.’ Hypoglycemia manifested by tremors/ tachycardia. Allergic Response Somogyi phenomenon in here. and diaphoresis/ dizziness. On the other hand. so that there will not be a rapid absorption of insulin. Side effects of insulin include: Dawn phenomenon due to nocturnal release of growth hormone that antagonizes the effect of insulin and causes prebreakfast hyperglycemia. Generally. injection sites should be rotated with a distance of 2. excessive hunger. restlessness. apart and should not be massaged.
Advising clients to follow an appropriate exercise program. Testing blood glucose levels pre-meal and post-meal can help the client with diabetes make better food choices.com. including the management and prevention of other disease processes. I’ve instructed the client to take the prescribed medications as well as increase self-monitoring frequency and test urine for ketones.
decrease the absorption of carbohydrates in G. low sodium. and high fiber diet. vegetables.who. MD. Regular exercise can improve the functioning of the cardiovascular system. whole grains. low-fat dairy products. Biguanides it decreases insulin resistance. FRCP(C) Brunner and Suddarth's Textbook of Medical Surgical Nursing
IV. based on how their bodies are responding to specific foods.html MedscapeReference. Maintain adequate fluid and caloric intake by encouraging the client to adhere to prescribed dietary modifications.am/db/diabetesmanagement/#ixzz23IcRngtd http://www. fish.int/mediacentre/factsheets/fs312/en/index. the client is prescribed a low-fat.health. Discussion of importance of blood pressure monitoring and management. together with increasing physical activity are typically the first steps toward reducing blood sugar levels Typically. Modifying eating habits. I encouraged her to follow consistent meal schedules and food amounts which consist of multiple servings of fruits. Sulfonylureas the mechanism of action is to stimulate the β cells
REFERENCES: Diabetes Mellitus Managementhttp://www. lean meats. low-cholesterol. 3. tract. Discussion of the importance of glucose monitoring. 5.
. and poultry. Previous contributing author: Ruchi Mathur. 4. 2.I. With this I’ve included the following in my health teaching to my client who has Type 2 diabetes: 1. HEALTH TEACHING Patient education for diabetic patients is very important for the management of the disease. Clients should be taught specific directions for obtaining an adequate blood sample and what to do with the numbers that they receive.
instruct client to clean wounds with soap and water. inspect feet daily for redness. I’ve instructed the client to properly bathe. 8. complications of diabetes need to be taken into account. apply antibiotic ointment. particularly the foot area. V. 7. and lubricate feet. improve glycemic control. Teach the client to avoid nephrotoxic substances. and improve quality of life and selfesteem. However.improve strength and flexibility. 10. use a mirror to check the bottoms of feet. 9. and ulcerations. Teach skin care and protection. Injury to patients with loss of sensation in their feet is a limitation for weight-bearing exercise. and wear well-fitting closed toe shoes. 6. blisters. improve lipid levels. OUTCOME
. dry. Instruct the client in the care of minor wounds. Encourage the client to have annual opthalmologic examinations which allows for early detection and treatment of retinopathy. and adjust medications as renal function changes. prevent or treat urinary tract infections immediately. help decrease weight. Advising the client to avoid smoking and alcohol. and notify health care provider if signs of infection occur.