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Sam Penny TR 13

INTRODUCTION
When choosing a chronic health disorder I chose to
research Diabetes Mellitus. I chose diabetes because of
the enormous impact it is having on the Australian
population now and will have in the future. Some of the
startling facts that bought my attention to Diabetes are
that

• “Diabetes is the fastest growing chronic disease in


Australia.
• 3 million people in Australia currently have the
disease.
• One in four people in Australia have pre Diabetes.”1
• “Diabetes is the leading cause of renal failure.
• Diabetes is the leading cause of new adult
blindness.”2

Diabetes Mellitus is the name for a group of diseases that


are known as
• Diabetes Mellitus Type 1
• Diabetes Mellitus Type 2
• Gestational Diabetes
• Secondary Diabetes
• LADA Latent autoimmune Diabetes in adults

Simply put Diabetes Mellitus, a metabolic syndrome


disorder is the bodies’ inability to control blood glucose
levels due to the pancreas either making an
ineffective/inefficient amount of insulin or none at all. The
body uses insulin to allow the cells in our body to take up
glucose once it has been converted from carbohydrates
(starch and sugar) via the digestive system and uses this
glucose for energy. Without this process when the renal
threshold is reached sugar is excreted in our urine not
before causing serious damage to virtually all systems of
the body. The two major types affecting the population are
Type 1 and Type 2. The main difference between them are
Type 1 “generally occurs to people under 30”3 also known
as juvenile Diabetes and or Insulin dependant Diabetes
Mellitus IDDM and Type 2 “generally occurs to people over
Sam Penny TR 13

30”4 also known as late onset and or non insulin


dependant Diabetes Mellitus NIDDM.
Sam Penny TR 13

PATHOPHYSIOLOGY

Type 1
Although Type 1 “Generally occurs to people under 30 it
can occur at any age. It makes up approx 10% of
people with Diabetes”5 .This is where the pancreas
produces little or no insulin which has been a gradual
destruction of the beta cells in the islets if langerhans in
the pancreas. This destruction is secondary to an
autoimmune response or virus in the body. Other
causes may be hereditary and stress. This destruction
occurs years prior to diagnosis . “The person will only
manifest signs and symptoms where there is a 15% or
less reduction of secretion of insulin function present”6

Type 2
“Generally occurs to people over 30 although it is
increasingly being seen in young adults and accounts
for approximately 90% of people with Diabetes”7 The
pancreas is able to produce insulin although it is usually
inefficient/ineffective to meet the bodies’ needs or is
poorly utilized. Type 2 Diabetes is usually seen in obese
adults or adults with hypertension and can itially be
treated with diet and exercise and not always but also
with oral hypogylcaemics. As the disease progress’s
some patients may have to eventually use insulin to
treat the disease
Sam Penny TR 13

CLINICAL MANIFESTATIONS

SHORT TERM

HYPOGLYCAEMIA
“Hypo’s occur when blood sugar levels are less then
3.5mmol/l”8 and are caused by, skipping meals, eating
foods low in carbohydrates, not eating enough before
exercise and too much insulin. The Diabetic client will
present with symptoms as follows,
• Sweating
• Headache
• Shaking
• Dizziness
• Pale pallor
• Tired
• Hungry
Then followed by
• Confusion
• Change in behaviour
• Slurred speech
• May appear drunk

HYPERGLYCAEMIA
“Is defined as three successive blood glucose levels
above 16mmol/l”9 As Michelle McAllister states in her
power point presentation this can be caused by, illness,
inactivity, weight gain, stress not enough medication
and hormonal changes. The Diabetic client will present
with symptoms as follows,
• Tiredness
• Thirst
• Frequent passing of urine
• Blurred vision
• Itchiness
• Leg cramps
Sam Penny TR 13

LONG TERM

As discussed earlier Diabetes left untreated will


eventually damage virtually all body systems. Some of
the more common outcomes of the disease process of
Diabetes are,

NEUROPATHY
“A disease process of nerve degeneration and loss of
function”10 The patient will typically have pain,
numbness and loss of sensation particularly in the feet.
This is why daily inspection of the feet is so important.
A mirror can be utilized for the client to get an accurate
assessment of the condition of the soles of there feet.

RETINOPATHY
“A disorder of the retinal blood vessels characterised by
haemorrhages and leakage of blood and serum into the
retina”11 This leakage “decrease or block the blood flow
within the retina”12Retinopathy is also the leading cause
of adult blindness.

NEPHROPATHY
Completely painless damage to the kidneys which can
lead to chronic renal failure and eventually require
dialysis. Diabetes and hypertension are the most
common cause and the leading cause of kidney
transplant. “Preventing and treating any condition that
may impair renal function such as urinary tract
infection’s or hypertension reduce the development of
diabetic nephropathy”13
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NURSING INTERVENTIONS

INTERVENTION

Weighing the client and identifying eating patterns that


need changing.

RATIONALE
Type 2 Diabetes accounts for approximately 90% of
people with Diabetes. Type 2 Diabetes main risk factors
are obesity and a sedentary lifestyle so monitoring
weight will alert the client when they are within the
healthy weight range for there age group or when they
are drifting outside those ranges. This is also an
opportune time to discuss eating habits as diet and
weight are closely linked along with exercise. The nurse
can guide the client as to the foods to stay away from ie
saturated fats, sugars and high GI foods. The nurse can
also refer to appropriate allied health team member like
dietien for healthy eating and physio for exercise.

INTERVENTION

Educate client on proper injection technique.

RATIONALE

“Absorption of insulin is more consistent when insulin is


always injected in the same anatomical site. Absorption
is fastest in the abdomen followed by the arms, thighs
and buttocks. The current recommendation is to
administer insulin into the sub cutaneous tissue of the
abdomen. Injection of insulin into the same site over
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time will result in lipotrophy and lipohypertrophy with


reduced insulin absorption”14

HEALTH TEACHING PROGRAM

This is extremely important with the client with


Diabetes as “A well planned education program helps
alleviate anxiety creates autonomy in management and
results in a well managed client”15 When compiling a
health teaching program my aim would be to
• Promote recovery
• Maintain or improve function
• Manage disease or symptom progression
• Improve health and wellbeing
With Diabetes I would be educating the client in areas
of
• Diet
• Exercise
• Blood glucose monitoring
• Management of complications

Diet
I would explain the importance of diet in controlling
Blood Glucose Levels. Also explain the importance of
regular healthy meals with nutritious snacks high in
fibre with a low G I index foods low in fats and sugar
and reduction of alcohol intake. I would also explain the
importance of eating a wide variety of nutritious foods
including plenty of fruits and vegetables.
Carbohydrates are also important for long term energy
especially before exercise to prevent a hypoglycaemic
attack from occurring.
Sam Penny TR 13

EXERCISE
Because obesity and Diabetes go hand in hand
exercise is extremely important as it also “stimulates
the uptake of of glucose by muscle cells lowering blood
glucose levels and increasing the absorption of injected
insulin”16 But this can lead to hypoglycaemia so extra
nutritional intake prior to exercise is important.

BLOOD GLUCOSE MONITORING


The client should be aiming for a blood glucose level of
between approximately 3.5mmol/l and 8 mmol/l. The
client should always wash there hands before taking
blood glucose levels because food stuffs on the fingers
can influence the reading. The client should use a
different finger each time and the edges of the tips of
their fingers as this area is the least painful. Blood
glucose levels should be taken at least half an hour
before food or at least an hour and a half after eating.

MEDICATION
As with all medication I would explain to take exactly
as directed from their treating Dr. I would explain to my
client why they are either on oral hypoglycaemics or
insulin. I would explain the importance of compliance
with medication to reduce the likelihood of future
complications due to elevated blood sugars. If my client
were to need insulin I would explain the correct
injecting technique and ask the client to show me them
administering insulin themselves to ensure safe and
correct. I would explain the importance of rotating the
site and that the abdomen followed by the thighs are
the best place for absorption of injected insulin.
Sam Penny TR 13

REFERENCES

1.Power Point Presentation


Diabetes Mellitus Div2 Education Program
McAllister M slide 5 10/2/09

2.Diseases A Nursing Process Approach to Excellent


Care
Forth Edition (2006) Lippincott Williams and Wilkins
Pg 1111 Paragraph 2

3.Power Point Presentation


Diabetes Mellitus Div2 Education Program
McAllister M slide 11 10/2/09

4.Power Point Presentation


Diabetes Mellitus Div2 Education Program
McAllister M slide 12 10/2/09

5.Diseases A Nursing Process Approach to Excellent


Care
Forth Edition (2006) Lippincott Williams and Wilkins
Pg 1110 Paragraph 3

6.Power Point Presentation


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Diabetes Mellitus Div2 Program


McAllister M slide 11 10/2/09

7.Power Point Presentation


Diabetes Mellitus Div2 Education Program
McAllister M slide 12 10/2/09

8.Power Point Presentation


Diabetes Mellitus Complex Care
McAllister M slide slide 28

9.Power Point Presentation


Diabetes Mellitus Complex Care
McAllister M slide 36

10.King,J.,Hawley,R.,Weller,B (2008)
Pg 312 Australian Nurses’ Dictionary 4th Edition
Baillere Tindall

12.Diseases A Nursing Process Approach to Excellent


Care
Forth Edition (2006) Lippincott Williams and Wilkins
Pg 1189 Paragraph 5

13.Funneell,R.,Koutouludis,G.,Lawrence,K (2009)
Pg 714 Paragraph 4 Tabbner’s Nursing Care 4th Edition
Theory and Practice. Churchill Livingstone Edinburgh

14.Gulanick,M.,Myers,J MSN RN (2003)


Pg 995 Nursing Care Plans and Intervention
Fifth Edition Mosby

15.Funneell,R.,Koutouludis,G.,Lawrence,K (2009)
Pg 714 Paragraph 7 Tabbner’s Nursing Care 4th Edition
Theory and Practise. Chuchill Livingstone Edinburgh

16.Funneell,R.,Koutouludis,G.,Lawrence,K (2006)
Pg 112 Paragraph 5 Tabbners’ Nursing Care 4th Edition
Theory and Practise. Churchill Livingstone Edinburgh
Sam Penny TR 13