DISEASE

STUDY
DIABETES MELLITUS II
Third RLE Rotation
BDH SURGERY WARD

Prepared By:
Sunga Jean Aubrey S.A
BSN II-A
Name: Patient X (Marlyn Veraguas)
Age: 34 Years Old
Gender: Female
Date of Birth: December 14,1985
Address: San Ildefonso, Bulacan
Religion: Catholic
Name of mother: Mrs. E. Veraguas
Name of Father: Mr. A. Veraguas
Ordinal Position: 1st Among 5 children
Chief Compliant: Infected wound on posterior neck, hyperthermia
Date of Admission: March 5,2020
Date of Interview: March 6,2020
Informants: Live-in partner (Michelle Torres)

WHAT IS DIABETES?
 Diabetes is a chronic disease that occurs when the pancreas is no longer able
to make insulin, or when the body cannot make good use of the insulin it
produces.
  It is a disease in which the body’s ability to produce or respond to the
hormone insulin is impaired, resulting in abnormal metabolism of
carbohydrates and elevated levels of glucose in the blood and urine.
 Diabetes mellitus refers to a group of diseases that affect how your body
uses blood sugar (glucose). Glucose is vital to your health because it's an
important source of energy for the cells that make up your muscles and
tissues. It's also your brain's main source of fuel.
 The underlying cause of diabetes varies by type. But, no matter what type of
diabetes you have, it can lead to excess sugar in your blood. Too much sugar
in your blood can lead to serious health problems.
 Chronic diabetes conditions include type 1 diabetes and type 2 diabetes.
Potentially reversible diabetes conditions include prediabetes — when your
blood sugar levels are higher than normal, but not high enough to be
classified as diabetes — and gestational diabetes, which occurs during
pregnancy but may resolve after the baby is delivered.

WHAT IS INSULIN?
 Insulin is a hormone made by the pancreas, that acts like a key to let glucose
from the food we eat pass from the blood stream into the cells in the body to
produce energy. All carbohydrate foods are broken down into glucose in the
blood. Insulin helps glucose get into the cells.

 Not being able to produce insulin or use it effectively leads to raised glucose
levels in the blood (known as hyperglycemia). Over the long-term high
glucose levels are associated with damage to the body and failure of various
organs and tissues.

Types of diabetes
 THREE MAIN TYPES OF DIABETES – TYPE 1, TYPE 2 AND
GESTATIONAL DIABETES
Type 1 diabetes-
 can develop at any age
 occurs most frequently in children and adolescents
 when you have type 1 diabetes, your body produces very little or no insulin,
which means that you need daily insulin injections to maintain blood
glucose levels under control
Type 2 diabetes –
 is more common in adults and accounts for around 90% of all diabetes cases
 when you have type 2 diabetes, your body does not make good use of the
insulin that it produces
 the cornerstone of type 2 diabetes treatment is healthy lifestyle, including
increased physical activity and healthy diet
 over time most people with type 2 diabetes will require oral drugs and/or
insulin to keep their blood glucose levels under control
Gestational diabetes (GDM)
 is a type of diabetes that consists of high blood glucose during pregnancy
and is associated with complications to both mother and child
 GDM usually disappears after pregnancy but women affected and their
children are at increased risk of developing type 2 diabetes later in life.

The patient (Ms.V) was diagnosed with DM II, last 2014. According to her, she
inherit this disease to her maternal’s side. Her grandmother died due to DM while
her mother is diabetic. On the other hand, two of her siblings was also known to be
diabetic. As of now, she is not using or injecting insulin, she was only having a
monthly consultation with the doctor and she is trying to have a DM diet. She
admitted that even if she was diagnosed with DM, she is still fond of drinking soft
drinks such as coke but she also claimed that she was flushing it by drinking lot of
water, 10-12 glasses a day. Also, she claimed that she really love sweets even
before she was diagnoses which she think that may be a also a contributory factor
on the disease she acquired.

CAUSES

The exact cause of diabetes mellitus is actually unknown, yet there are factors that contribute to
the development of the disease.
Type 1 Diabetes Mellitus
 Genetics. Genetics may have played a role in the destruction of the beta cells in type 1
DM.
 Environmental factors. Exposure to some environmental factors like viruses can
cause the destruction of the beta cells.
Type 2 Diabetes Mellitus
 Weight. Excessive weight or obesity is one of the factors that contribute to type 2 DM
because it causes insulin resistance.
 Inactivity. Lack of exercise and a sedentary lifestyle can also cause insulin resistance
and impaired insulin secretion.
Gestational Diabetes Mellitus
 Weight. If you are overweight before pregnancy and added extra weight, it makes it
hard for the body to use insulin.
 Genetics. If you have a parent or a sibling who has type 2 DM, you are most likely
predisposed to GDM.

SIGNS AND SYMPTOMS

Early signs and symptoms

The early signs and symptoms of type 2 diabetes can include:

1. Frequent urination- When blood sugar levels are high, the kidneys try to
remove the excess sugar by filtering it out of the blood. This can lead to a person
needing to urinate more frequently, particularly at night.

2. Increased thirst
The frequent urination that is necessary to remove excess sugar from the blood can
result in the body losing additional water. Over time, this can
cause dehydration and lead to a person feeling more thirsty than usual.

3. Always feeling hungry

People with diabetes often do not get enough energy from the food they eat.
The digestive system breaks food down into a simple sugar called glucose, which
the body uses as fuel. In people with diabetes, not enough of this glucose moves
from the bloodstream into the body’s cells.
As a result, people with type 2 diabetes often feel constantly hungry, regardless of
how recently they have eaten.

4. Feeling very tired

Type 2 diabetes can impact on a person’s energy levels and cause them to feel very
tired or fatigued. This tiredness occurs as a result of insufficient sugar moving
from the bloodstream into the body’s cells.

5. Blurry vision
An excess of sugar in the blood can damage the tiny blood vessels in the eyes,
which can cause blurry vision. This blurry vision can occur in one or both of the
eyes and may come and go. If a person with diabetes goes without treatment, the
damage to these blood vessels can become more severe, and permanent vision loss
may eventually occur.

6. Slow healing of cuts and wounds

High levels of sugar in the blood can damage the body’s nerves and blood vessels,
which can impair blood circulation. As a result, even small cuts and wounds may
take weeks or months to heal. Slow wound healing also increases the risk of
infection.

7. Tingling, numbness, or pain in the hands or feet

High blood sugar levels can affect blood circulation and damage the body’s nerves.
In people with type 2 diabetes, this can lead to pain or a sensation of tingling or
numbness in the hands and feet.This condition is known as neuropathy, and it can
worsen over time and lead to more serious complications if a person does not get
treatment for their diabetes.

8. Patches of dark skin

Patches of dark skin forming on the creases of the neck, armpit, or groin can also
signify a higher risk of diabetes. These patches may feel very soft and velvety.
This skin condition is known as acanthosis nigricans.

9. Itching and yeast infections

Excess sugar in the blood and urine provides food for yeast, which can lead to
infection. Yeast infections tend to occur on warm, moist areas of the skin, such as
the mouth, genital areas, and armpits.The affected areas are usually itchy, but a
person may also experience burning, redness, and soreness.
Common Symptoms
Diabetes symptoms vary depending on how much your blood sugar is elevated.
Some people, especially those with prediabetes or type 2 diabetes, may not
experience symptoms initially. In type 1 diabetes, symptoms tend to come on
quickly and be more severe.
Some of the signs and symptoms of type 1 and type 2 diabetes are:

 Increased thirst
 Frequent urination
 Extreme hunger
 Unexplained weight loss
 Presence of ketones in the urine (ketones are a byproduct of the breakdown
of muscle and fat that happens when there's not enough available insulin)
 Fatigue
 Irritability
 Blurred vision
 Slow-healing sores
 Frequent infections, such as gums or skin infections and vaginal infections

Type 1 diabetes can develop at any age, though it often appears during childhood
or adolescence. Type 2 diabetes, the more common type, can develop at any age,
though it's more common in people older than 40.
DIAGNOSIS
 Glycated hemoglobin (A1C) test - This blood test indicates your average
blood sugar level for the past two to three months. Normal levels are below
5.7 percent, and a result between 5.7 and 6.4 percent is considered
prediabetes. An A1C level of 6.5 percent or higher on two separate tests
means you have diabetes.
 Random blood sugar test. Blood sugar values are expressed in milligrams
per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when
you last ate, a blood sample showing that your blood sugar level is 200
mg/dL (11.1 mmol/L) or higher suggests diabetes, especially if you also
have signs and symptoms of diabetes, such as frequent urination and
extreme thirst.
 Fasting blood sugar test. A blood sample is taken after an overnight fast. A
reading of less than 100 mg/dL (5.6 mmol/L) is normal. A level from 100 to
125 mg/dL (5.6 to 6.9 mmol/L) is cosidered prediabetes.
If your fasting blood sugar is 126 mg/dL (7 mmol/L) or higher on two
separate tests, you have diabetes.
 Oral glucose tolerance test. This test is less commonly used than the
others, except during pregnancy. You'll need to fast overnight and then drink
a sugary liquid at the doctor's office. Blood sugar levels are tested
periodically for the next two hours.
A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading
between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates
prediabetes. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours
suggests diabetes.

TREATMENT
Management of type 2 diabetes includes:

 Weight loss
 Healthy eating
 Regular exercise
 Possibly, diabetes medication or insulin therapy
 Blood sugar monitoring
These steps will help keep your blood sugar level closer to normal, which can
delay or prevent complications.

 Weight loss
Losing weight can lower your blood sugar levels. Losing just 5 to 10 percent of
your body weight can make a difference, although a sustained weight loss of 7
percent or more of your initial weight seems to be ideal. That means someone who
weighs 180 pounds (82 kilograms) would need to lose a little less than 13 pounds
(5.9 kilograms) to make an impact on blood sugar levels.
Controlling portions and eating healthy foods are simple ways to start taking
weight off.

 Healthy eating
Contrary to popular perception, there's no specific diabetes diet. However, it's
important to center your diet around:

 Fewer calories
 Fewer refined carbohydrates, especially sweets
 Fewer foods containing saturated fats
 More vegetables and fruits
 More foods with fiber
A registered dietitian can help you put together a meal plan that fits your health
goals, food preferences and lifestyle. He or she can also teach you how to monitor
your carbohydrate intake and let you know about how many carbohydrates you
need to eat with your meals and snacks to keep your blood sugar levels more
stable.

 Physical activity
Everyone needs regular aerobic exercise, and people who have type 2 diabetes are
no exception. Get your doctor's OK before starting an exercise program. Choose
activities you enjoy, such as walking, swimming and biking, so that you can make
them part of your daily routine.
Aim for at least 30 to 60 minutes of moderate (or 15 to 30 minutes of vigorous)
aerobic exercise most days of the week. A combination of exercises — aerobic
exercises, such as walking or dancing on most days, combined with resistance
training, such as weightlifting or yoga twice a week — offers more benefits than
either type of exercise alone.
Remember that physical activity lowers blood sugar. Check your blood sugar level
before any activity. You might need to eat a snack before exercising to help
prevent low blood sugar if you take diabetes medications that lower your blood
sugar. It's also important to reduce the amount of time you spend in inactive
activities, such as watching TV. Try to move around a bit every 30 minutes.

 Monitoring your blood sugar

Depending on your treatment plan, you may need to check and record your blood
sugar level every now and then or, if you're on insulin, multiple times a day. Ask
your doctor how often he or she wants you to check your blood sugar. Careful
monitoring is the only way to make sure that your blood sugar level remains within
your target range.

LIFESTYLE AND HOME REMEDIES

 Commit to managing your diabetes. Learn all you can about type 2

diabetes. Make healthy eating and physical activity part of your daily routine.
Establish a relationship with a diabetes educator, and ask your diabetes
treatment team for help when you need it.
 Identify yourself. Wear a necklace or bracelet that says you have diabetes,
especially if you take insulin or other blood sugar-lowering medication.
 Schedule a yearly physical exam and regular eye exams. Your regular
diabetes checkups aren't meant to replace regular physicals or routine eye
exams.
 Keep your vaccinations up to date. High blood sugar can weaken your
immune system. Get a flu shot every year. Your doctor will likely also
recommend the pneumonia vaccine.
The Centers for Disease Control and Prevention (CDC) also recommends the
hepatitis B vaccination if you haven't previously received this vaccine and
you're an adult between ages 19 and 59 with type 1 or type 2 diabetes. The
CDC advises vaccination as soon as possible after diagnosis with type 1 or
type 2 diabetes. If you are age 60 or older, have diabetes and haven't
previously received the vaccine, talk to your doctor about whether it's right for
you.

 Take care of your teeth. Diabetes may leave you prone to more-serious

gum infections. Brush and floss your teeth regularly and schedule
recommended dental exams. Consult your dentist right away if your gums
bleed or look red or swollen.
 Pay attention to your feet. Wash your feet daily in lukewarm water, dry
them gently, especially between the toes, and moisturize them with lotion.
Check your feet every day for blisters, cuts, sores, redness and swelling.
Consult your doctor if you have a sore or other foot problem that isn't healing.
 Keep your blood pressure and cholesterol under control. Eating healthy
foods and exercising regularly can go a long way toward controlling high
blood pressure and cholesterol. Medication also may be needed.
 If you smoke or use other types of tobacco, ask your doctor to help you
quit. Smoking increases your risk of various diabetes complications. Talk to
your doctor about ways to stop smoking or using other types of tobacco.
  If you drink alcohol, do so responsibly. Alcohol, as well as drink mixers,
can cause either high or low blood sugar, depending on how much you drink
and if you eat at the same time. If you choose to drink, do so in moderation
and always with a meal.
The recommendation is no more than one drink daily for women, no more
than two drinks daily for men age 65 and younger, and one drink a day for
men over 65. If you're on insulin or other medications that lower your blood
sugar, check your blood sugar before you go to sleep to make sure you're at a
safe level.

NURSING INTERVENTION

Nurses should provide accurate and up-to-date information about the patient’s
condition so that the healthcare team can come up with appropriate interventions
and management.

Nursing Assessment
The nurse should assess the following for patients with Diabetes Mellitus:

 Assess the patient’s history. To determine if there is presence of

diabetes, assessment of history of symptoms related to the diagnosis of
diabetes, results of blood glucose monitoring, adherence to prescribed
dietary, pharmacologic, and exercise regimen, the patient’s lifestyle,
 cultural, psychosocial, and economic factors, and effects of diabetes on
functional status should be performed.
 Assess physical condition. Assess the patient’s blood pressure while
sitting and standing to detect orthostatic changes.
 Assess the body mass index and visual acuity of the patient.
 Perform examination of foot, skin, nervous system and mouth.
 Laboratory examinations. HgbA1C, fasting blood glucose, lipid profile,
microalbuminuria test, serum creatinine level, urinalysis, and ECG must
be requested and performed.

INTERVENTIONS

The healthcare team must establish cooperation in implementing the following

interventions.

 Educate about home glucose monitoring. Discuss glucose monitoring

at home with the patient according to individual parameters to identify
and manage glucose variations.
 Review factors in glucose instability. Review client’s common
situations that contribute to glucose instability because there are multiple
factors that can play a role at any time like missing meals, infection, or
other illnesses.
 Encourage client to read labels. The client must choose foods described
as having a low glycemic index, higher fiber, and low-fat content.
 Discuss how client’s antidiabetic medications work. Educate client on
the functions of his or her medications because there are combinations of
drugs that work in different ways with different blood glucose control and
side effects.
 Check viability of insulin. Emphasize the importance of
checking expiration dates of medications, inspecting insulin for
cloudiness if it is normally clear, and monitoring proper storage and
preparation because these affect insulin absorbability.
 Review type of insulin used. Note the type of insulin to be administered
together with the method of delivery and time of administration. This
affects timing of effects and provides clues to potential timing of glucose
instability.
 Check injection sites periodically. Insulin absorption can vary day to
day in healthy sites and is less absorbable in lipohypertrophic tissues.

Evaluation
To check if the regimen or the interventions are effective, evaluation must be done
afterward.

 Evaluate client’s knowledge on factors that lead to an unstable blood

glucose level.
 Evaluate the client’s level of blood glucose.
  Verbalized achievement of modifying factors that can prevent or
minimize shifts in glucose level.
 Achieved timely wound healing.
 Identified interventions that can prevent or reduce risk for infection.
 Evaluate maintenance of the usual level of cognition.

DISCHARGE AND HOME CARE GUIDELINES

The responsibility of the healthcare team members does not end when the patient is
discharged.
 Patient empowerment is the focus of diabetes education.
 Patient education should address behavior change, self-efficacy, and health
beliefs.
 Address any underlying factors that may affect diabetic control.
 Simplify the treatment regimen if it is difficult for the patient to follow.
 Adjust the treatment regimen to meet patient requests.
 Establish as specific plan or contract with the patient with simple,
measurable goals.
 Provide positive reinforcement of self-care behaviors performed instead of
focusing on behaviors that were neglected.
 Encourage the patient to pursue life goals and interests, and discourage an
undue focus on diabetes.
 Educate client on wound care, insulin preparation, and glucose monitoring.
 Instruct client to comply with the appointment with the healthcare provider
at least twice a year for ongoing evaluation and routine nutrition updates.
 Remind the patient to participate in recommended health promotion
activities and age-appropriate health screenings.
 Encourage participation in support groups with patients who have had
diabetes for many years as well for those who are newly diagnosed.

REFERENCES
 Anonymous. “About Diabetes.”.2020. International Diabetes Federation.
https://www.idf.org/aboutdiabetes/whatisdiabetes.html?
gclid=EAIaIQobChMIn_PrzoyX6AIVh3ZgCh3sOAmdEAAYASAAEgIejvD_BwE
&fbclid=IwAR2v2G2Loch6KNwXzNvsCrM54vhHJVO9Hqvf_PxUQ7j69QyLR3z
JlfkWS0c

 Belleza, Marianne. “Diabetes Mellitus.”. January 19,2017. Nurses Labs.

https://nurseslabs.com/diabetes-mellitus/

 Unknown. “Diabetes: Signs and Symptoms”. November 10,2018. Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-
20371444?fbclid=IwAR1RzsJuAxF8UITkGMIuyQofe4mzjSEpMsuNbGon-
PvpPwz-ldJDSwIvsgg