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Diabetes Mellitus

A. Understanding
Diabetes mellitus is a heterogeneous group of disorders characterized by increased levels of
glucose in the blood or hyperglycemia. (Brunner and Suddarth, 2002).
Melllitus Diabetes is a collection of symptoms that arise in a person caused by the presence of
elevated levels of sugar (glucose) blood due to insulin deficiency both absolute and relative
(Arjatmo, 2002).
B. Classification
Classification of diabetes mellitus as follows:
1. Type I: insulin-dependent diabetes mellitus (IDDM)
2. Type II: Diabetes mellitus is insulin dependent (NIDDM)
3. Diabetes mellitus is associated with other conditions or syndromes
4. Gestational diabetes mellitus (GDM)
C. Etiology
1. Diabetes type I:
a. Genetic factors
Diabetics do not inherit type I diabetes itself, but inherit a genetic predisposition or tendency
toward the occurrence of diabetes mellitus type I. Genetic predisposition is found in individuals
who have HLA antigen type.
b. Immunological Factors
The existence of an autoimmune response in which antibodies directed an abnormal response to
normal tissue reacts to the body in a way that considers the network as if they were foreign
tissue. Ie autoantibodies against islet cells of Langerhans and endogenous insulin.
c. Environmental factors
Viruses or certain toxins can trigger autoimmune process that causes destruction selbeta.
2. Diabetes Type II
The exact mechanism that causes insulin resistance and impaired insulin secretion in type II
diabetes is still unknown. Genetic factors play a role in the process of insulin resistance.
Risk factors:
a. Age (insulin resistance tends to increase in age above 65 years)
b. Obesity
c. Family history
D. Pathophysiology / Pathways
E. Signs and Symptoms
A common complaint of patients DM like polyuria, polydipsia, polyphagia in DM is generally
no. Instead the patient is often disturbing complaints from complications of chronic degenerative
blood vessels and nerves. In the elderly there is a change in the pathophysiology of DM due to
the aging process, so that the clinical picture varies from asymptomatic cases to cases with
extensive complications. A recurring complaint is the presence of impaired vision due to
cataracts, tingling in the limbs and muscle weakness (peripheral neuropathy) and injuries to the
legs which are difficult to recover with treatment prevalent.

According Supartondo, the symptoms caused by diabetes mellitus in the elderly are often found
are:
1. Cataract
2. Glaucoma
3. Retinopathy
4. Itching around the body
5. Pruritus Vulvae
6. Bacterial infections of skin
7. Fungal infections in the skin
8. Dermatopati
9. Peripheral neuropathy
10. Visceral neuropathy
11. Amiotropi
12. Neurotrophic ulcer
13. Kidney disease
14. Peripheral vascular disease
15. Coronary Disease
16. Cerebral vascular disease
17. Hypertension
Osmotic diuresis due to glucosuria delayed due to high renal threshold, and can occur with
nocturia complaints of sleep disturbance, or even urinary incontinence. Feelings of thirst in
elderly diabetic patients are less felt, as a result they do not respond adequately to the
dehydration. Because it does not happen polydipsia or just happened at an advanced stage.
The disease is initially mild and there was the usual course in elderly patients with DM can
change suddenly, if the patient has an acute infection. Deficiency of insulin which had now
become relative and absolute state of ketoacidosis occur with typical symptoms of
hyperventilation and dehydration, decreased consciousness with hyperglycemia, dehydration and
ketonemia. Symptoms usually occur in hypoglycemia such as hunger, yawning and sweating a
lot is generally not present in elderly DM. Usually appears manifest as sudden headache and
confusion.
Vegetative reactions in the elderly may disappear. While the symptoms are confusion and coma
of cerebral metabolic disturbances appear more clearly.
F. Examination Support
1. Blood glucose during
2. Fasting blood glucose levels
3. Glucose tolerance test
Blood levels during fasting as a standard filter and the diagnosis of DM (mg / dl)

Not DM

DM is uncertain

DM
Blood glucose levels during
- Plasma venous
- Blood capillaries
Fasting blood glucose levels
- Plasma venous
- Blood capillaries

<>
<80
<110
<90

100-200
80-200
110-120
90-110

> 200
> 200
> 126
> 110

WHO diagnostic criteria for diabetes mellitus at least 2 times the examination:
1. When plasma glucose> 200 mg / dl (11.1 mmol / L)
2. Fasting plasma glucose> 140 mg / dl (7.8 mmol / L)
3. Plasma glucose from samples taken 2 hours later after consuming 75 g carbohydrate (2-hour
post-prandial (pp)> 200 mg / dl
G. Management
The main goal of therapy of diabetes mellitus is trying to normalize the activity of insulin and
blood glucose levels in an attempt to reduce vascular complications, and neuropathy. Therapeutic
purposes in any type of diabetes is to achieve normal blood glucose levels.
There are 5 components in the management of diabetes:
1. Diet
2. Exercise
3. Monitoring
4. Therapy (if needed)
5. Education
H. Assessment
- Family Medical History
Are there families who suffer from diseases such as client?
- Patient Medical History and Previous Treatment
How long a client suffering from diabetes, how to handle, gets what type of insulin therapy, how
to take her medicine whether regular or not, what is being done to address the client's illness.
- Activity / Rest:
Tired, weak, difficult Moving / walking, muscle cramps, decreased muscle tone.
- Circulation
Is there a history of hypertension, AMI, claudication, numbness, tingling in the extremities, foot
ulcers are healing old, tachycardia, changes in blood pressure
- Ego Integrity
Stress, anxiety
- Elimination
Changes in the pattern of urination (polyuria, nocturia, anuria), diarrhea
- Food / Fluids
Anorexia, nausea, vomiting, do not follow the diet, weight loss, thirst, use of diuretics.
- Neurosensori
Dizziness, headache, tingling, numbness in the muscle weakness, paresthesias, visual
disturbances.
- Pain / Leisure
Abdomen tense, pain (moderate / severe)
- Respiratory
Cough with / without purulent sputum (tergangung presence of infection / no)
- Security
Dry skin, itching, skin ulcers.

I. Nursing Issues
1. High risk of nutritional deficiencies: lack of requirement
2. Lack of fluid volume
3. Impaired skin integrity
4. Risk of injury
J. Intervention
1. High risk of nutritional deficiencies: lack of demand associated with decreased oral input,
anorexia, nausea, increased metabolism of protein, fat.
Goal: patient's nutritional needs are met
Criteria Results:
- Patient is able to digest the amount of calories or the right nutrients
- Stable weight or additions to the range normally
Intervention:
- Weigh the body weight per day or according to the indication.
- Determine the diet and eating patterns of patients and compare it with foods that can be spent
on patients.
- Auscultation bowel sounds, record the presence of abdominal pain / abdominal bloating,
nausea, vomit that have not had time to digest food, maintain a state of fasting according to the
indication.
- Provide a liquid diet containing food substances (nutrients) and electrolytes immediately if the
patient is able to tolerate it orally.
- Involve the patient's family at this meal digestion according to the indication.
- Observation of the signs of hypoglycemia such as altered levels of consciousness, skin moist /
cold, rapid pulse, hunger, sensitive excitatory, anxiety, headaches.
- Collaboration perform blood sugar checks.
- Collaboration of insulin treatment.
- Collaboration with dieticians.
2. Lack of fluid volume associated with osmotic diuresis.
Purpose: fluid or hydration needs of patients are met
Criteria Results:
Patients showed adequate hydration evidenced by stable vital signs, palpable peripheral pulse,
skin turgor and good capillary refill, individually appropriate haluaran urine and electrolyte
levels within normal limits.
Intervention:
- Monitor vital signs, note the presence of orthostatic BP changes
- Monitor breathing patterns such as the respiratory kusmaul
- Assess the frequency and quality of breathing, use of auxiliary respiratory muscles
- Assess peripheral pulses, capillary refill, skin turgor and mucous membranes
- Monitor input and expenditure
- Preserve to provide fluid at least 2500 ml / day within a tolerable limit of cardiac
- Write down things like nausea, vomiting and gastric distention.
- Observe for increased fatigue, edema, increased weight, irregular pulse
- Collaboration: give normal saline fluid therapy with or without dextrosa, monitor laboratory

tests (hematocrit, BUN, Na, K)


3. Impaired skin integrity related to changes in metabolic status (peripheral neuropathy).
Objectives: impaired skin integrity can be reduced or showed healing.
Criteria Results:
Condition of the wound showed the existence of tissue repair and uninfected
Intervention:
- Assess the wound, the presence of epithelialization, discoloration, edema, and discharge, the
frequency of dressing change.
- Assess vital signs
- Assess the pain
- Perform wound care
- Collaboration of insulin and medication.
- Collaboration antibiotics as indicated.

4. Risk of injury associated with decreased visual function


Objectives: patients do not experience injury
Criteria Results: The patients can meet their needs without suffering injury
Intervention:
- Avoid slippery floors.
- Use a low bed.
- Orient the client to the room.
- Assist client in performing daily activities
- Assist patients in ambulation or position changes