Assessment

 Increased frequency of urination (polyuria)
 Increased thirst or fluid intake (polydipsia)
 Weight loss despite hunger
 Increased food intake (polyphagia)
 Family history
 Weakness and fatigue, dizziness
 Recurrent blurred vision
 Pruritis,skin infections,vaginitis
Type 1 Diabetes Mellitus
 Ketonuria
Type 2 Diabetes Mellitus
 Obese
Nursing Intervention
 Plan a Physical Activity Program
 Help the client to choose an exercise regimen and to set resonable goals, because any increase in activity is beneficial.
 Instruct client to start at a well tolerated intensity level and duration, with gradual increase in intensity and duration until present
exercise goals are reached.
 Prevent Complications from Physical Activity
 Instruct to be adequately hydrated before starting exercise.
 Instruct to avoid alcohol and beta-blockers because they may increase the risk of hypoglycemia and hyperglycemia.
 Provide Instructions on Blood Glucose Monitoring
 Discuss the normal blood glucose range, goals for good control (individualized for each client), when to test, how to record test
results, amd what to do when abnormal results are obtained.
 Normal blood glucose level: 70-100 mg/dL
 Instruct to obtain glucose monitoring 30 mins-1 hour before meal.
 Provide Instruction on Insulin Administration
 Insulin syringes- capacities of 0.25, 0.30, 0.50 and 1 mL. Instruct that short syringe are not recommended for obese cients because
variability of insulin absorption when injected into adipose tissue.
 Insulin Pens- can hold 150-300 "U" of insulin.
 Needle-Free Technology- Jet injectors, which are pen-like devices, can be used in place of insulin syringes for deivery of insulin.
The problem of safe disposal of needles is avoided.
 Insulin Storage- avoid temperature extremes of less than 36 degrees F or greater than 86 degrees F. Vials in use can be kept at
room temperatures for about 1 month. Mark the date on the vial when it was initially opened. Do not use any insulin beyond its
expiration date.
 Site Selection and Rotation- Instruct the client to give injections in one area, about an inch apart, until the whole area has been
used, before changing to another site. Tell the client to avoid sites above muscles that will be exercised heavily that day, because
exercise increases the rate of absorption. Emphasize the importance of adhering to definite injection plan for avoiding tissue
damage. Rotate injection sites in one area to decrease the variability of absorption.
Surigical Client
 Monitor for rejection, adverse effects of immunosuppressive agents, infection, and occlusion of vessels.
 Careful monitoring for changes in vital signs, laboratory values, fluid and electrolyte status, and physical manifestations is
important to determine the onset of complications: thrombosis, infection, and rejection.
Screening and Diagnosis Guidelines for Diabetes Mellitus
GUIDELINES FOR TESTING FOR DM
 Testing for DM should be considered in all adults at age 45.
 If results are normal, testing should be repeated at 3-year intervals.

Testing should be considered at a younger age or performed more often for clients with the following risk factors:
 Obesity (>120% of desirable body weight or a BMI above 25kg/m2)
 Habitual physical inactivity
 Polycystic ovary syndrome
 DM in a first-degree relative
 Racial predisposition (as in African-American, Hispanic, Native American populations)
 In woman who have given birth to a bay weighing more than 9 pounds or who have a history of gestational DM.
 Hypertension (BP >130/80mmHg)
 A high density lipoprotein level <35mg/dl or triglyceride level >250 mg/dl
 On previous testing, impaired glucose tolerance or impaired fasting glucose levels.

GUIDELINES FOR DIAGNOSIS OF DM
 Fasting plasma glucose level above 126mg/dl (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours.
 Manifestations of DM plus casual plasma glucose concentration above 200mg/dl (11.1mmol/L). Casual is defined as any tie

strenuous exercise can lead to falsely decreased values MANAGEMENT OF COMPLICATIONS  Major interventions particularly in the early phases.45% of clients with type 1 DM are found to have nephropathy 15 – 20 years after diagnosis. polydipsia.  When retinopathy threatens vision. include achievement of euglycemia and normalization of blood pressure. This damage leads in turn to a complex of pathologic changes and manifestations :  Intercapillary glomerulosclerosis  Nephrosis  Gross albumin Uria  Hypertension  Risk Factors: .  Although extensive photocoagulation usually diminishes peripheral vision and may decrease night vision.  35% . and unexplained weight loss. its success in preserving good visual acuity makes worthwhile despite side effects. outpatient laser therapy (photocoagulation) is usually recommended.  Vitrectomy. 2 hours after eating <140 mg/dl Normal glucose tolerance 140-199mg/dl Impaired glucose tolerance >200 mg/dl Diagnosis of DM FASTING BLOOD GLUCOSE LEVEL  Provides the best indication of overall glucose homeostasis and is preferred method of diagnosing DM  Normal: 70-110 mg/dL  Sample is drawn when the client has not ingested any nutrients other than water for al least 8 hours  The blood sample generally reflects glucose level from hepatic production  <126mg/dL indicates Diabetes mellitus  Values between 110-125 mg/dL indicates IFG CASUAL BLOOD GLUCOSE LEVEL  Clients may also diagnosed with DM based on clinical manifestation and a casual (random) blood glucose level is greater than 200 mg/dL  Sample can be drawn anytime of daw without regard to fasting  Elevated blood glucose level may:  occur after meals  After stressful events  In sample drawn from an IV site  Or in cases of DM POSTLOAD BLOOD GLUCOSE LEVEL • Postload or postprandial (after a meal) glucose level can also be drawn and used to diagnosed DM. of day without regard to time since last meal. This test should be performed using a glucose load containing the equivalent of 75g of anhydrous glucose dissolved in water.  Nephropathy  Single most common cause of stage 5 CKD. blood glucose level should return to fasting levels within 2 hours. Classic manifestations include polyuria. PLASMA GLUCOSE VALUES Fasting plasma glucose <110 mg/dl Normal fasting glucose 110-125mg/dl Impaired fasting glucose >126 mg/dl Diagnosis of DM Oral glucose tolerance test.  A 2-hour postload glucose level above 200mg/dl during an oral glucose tolerance test.  20 % of clients with type 2 DM are found to have nephropathy 5 to 10 years after diagnosis. • Postload glucose samples are drawn 2 hours after a standard meal and reflects the effeciency of insulin-mediated glucose uptake by peripheral tissues • Normally. A 2-hour postload glucsoe level greater than 200 mg/dL during an oral glucose tolerance test (OGTT) is confirmation for a diagnosis of diabetes mellitus • In older adults. postload levels are higher typically increasing by 5-10 mg/dL per decade after 50 years because of the normal decline in glucose tolerance associated with aging • Smoking and drinking coffee can lead to falsely elevated values at 2 hours • Whereas.surgical procedure that removes the vitreous and replace it with saline solution. or if the vitreous is too scarred or clouded with blood.  Consequence of nephropathy includes damage and eventual obliteration of the capillaries that supply the kidney.  If the extent or location of the damage makes photocoagulation ineffective. vitrectomy is performed.

 Gastrointestinal – commonly affects gastrointestinal tract. mannitol may be ordered but the client must drink fluids after the test to clear the dye from the kidneys. vomiting. phenytoin.  Produced sharp. When axon and dendrites are not nourished.  Side effects: dizziness.  Sensory neuropathy is the most common type.  Poor glycemic control. diarrhea. tingling.  The client describes tingling.  Unsuccesful treatment of nephropathy progress to stage 5 kidney disease (ESRD) Treatment:  Hemodialysis  Peritoneal dialysis  Kidney transplantation Neuropathy  Most common chronic complication of DM.  Serum creatinine levels should be assessed before the administration of the contrast dye or other nephrotoxic agents. sleepiness.  Pupillary .  Tought to eat low-protien diet and avoid nephrotoxic drugs ( e.g. numbness. Orthostatic hypotension may occur. • May be alleviated with Metoclopramide (Reglan)  Genitourinary  Bladder hypotonicity or neurogenic bladder is a common manifestation. The environment should be well lighted at night. numbness.interferes with the pupil’s ability to adapt to the dark. dry mouth. stabbing. they depend on diffusion of nutrients and oxygen across the membrane. gastrointestinal. Abdominal pain. postprandial hypoglycemia. symmetrical and affecting the lower extremities. blurred vision. • Client may have dysphagia. Resting tachycardia is another possible effect.  Cardiovascular – evidenced by an abnormal response to exercise.  May be mild or so severe that the quality of life is affected.  Commonly assessed by bilateral. Autonomic Neuropathy  Manifest itself in its effect on pupillary. burning and mild to total sensory loss.  If contrast dye is required for radiographic study.  Lyrica also approved as an adjunctive treatment for partial onset of seizures in adults.  Manifestation includes :  Straining with urination  Infrequent urge to urinate with long periods of time between voiding  Decreased urine stream .first medication approved by the FDA to treat pain that occurs with DPN and postherpetic neuralgia (phn). A fixed heart rate may be noted.  Treatment includes: foot care education to prevent trauma and ulcers.  Because nerve fibers do not have their own blood supply.  Both temporary and permanent neurologic problems may develop in clients with DM.  Client with high blood glucose level often experiences nerve pain .  Pregabalin(Lyrica).  Identified causes of diabetic nephropathy: • Vascular insufficiency • Chronic elevations in blood glucose level • Hypertension • Cigarette smoking  Clients with mononeuropathy or polyneuropathy and may have sensory or motor impairment. nausea.  Duration of disease and  Hypertension  Clients with nephropathy monitor their blood glucose levels and blood pressure at home. their transmission of impulses slows.  Treatment may include surgical decompression for compression lesions.  Painful neuropathy may be treated with tricyclic antidepressant. Clients are at risk for accidents when driving at night. Gentamicin)  ACE inhibitors – to decrease microalbuminuria. Polyneuropathy  Or diffuse neuropathy involves the sensory and autonomic nerves. or carbamazepine. stabbing pains usually caused by an infarction of the blood supply. Mononeuropathy  Or focal neuropathy involves a single nerve or group of nerves. Pupil dilation is inadequate. • Gastroparesis may give feeling of stomach fullness. constipation or fecal incontinence. or burning sensation referred as Diabetic Peripheral Neuropathy (DPN). swelling of hands and feet. malabsorption. cardiovascular. and genitourinary functions.

or Sildenafil (Viagra) may improve functions. Weight reduction EXERCISE Regularly scheduled. Hypoglycemia may result as well as rebound hyperglycemia (Somogyi effect) Commonly results in increased appetite and weight gain GENERAL HEALTH The American Diabetes Association (2003) recommends the following goals of treatment: Glycemic control HbA1c <7% Preprandial glucose 90-130 mg/dl Peak Postprandial glucose <180 mg/dl GENERAL HEALTH b. Lipid control . BP < 130/80 mmhg c.  Women with autonomic neuropathy may experience painful intercourse. autonomic neuropathy can contribute to erectile dysfunction and retrograde ejaculation.  In male client. MEDICAL MANAGEMENT DIET Dietary control with caloric restriction of CHO and saturated fats to maintain ideal body weight.  Penile injections. Mechanism: Stimulation of insulin secretion from functioning beta cells Reduction of hepatic glucose production Enhancement of peripheral sensitivity to insulin Reduced absorption of CHO in the intestines Oral Anti-diabetic Agents SULFONYLUREAS Chlorpropamide Tolbutamide Glimepiride Glizide BIGUANIDES Metformin Glucophage MEDICATIONS Insulin therapy for patients with Type 1 DM who require replacement. implantable devices. which estrogen-containing lubricants can resolve. moderate exercise performed at least 3o minutes most days of the week promotes: Utilization of CHO Assists weight control Enhances the action of insulin Improves cardiovascular fitness MEDICATION Oral antidiabetic agents for patients for patients with Type 2 DM who do not achieve glucose control with diet and exercise.

LDL <100 mg/dl HDL >40 mg/dl Triglycerides <150 mg/dl d. Microalbumin (spot urine) <30 mcg/mg creatinine .