Professional Documents
Culture Documents
Diabetes Mellitus also called Insulin Dependent Diabetes Mellitus starts in childhood or adolescence is
usually more severe than that beginning in middle or old age. Patients have little or no ability to produce
the hormone and are entirely dependent on insulin injections for survival.
Diabetes Mellitus also called adult-onset diabetes or Noninsulin Dependent Diabetes Mellitus. This form
of diabetes occurs most often in people who are overweight and who do not exercise. Type II is
considered a milder form of diabetes mellitus because of its slow onset and can usually be controlled
with diet and oral medication. In Type II diabetes, the pancreas may produce enough insulin, however,
cells have become resistant to the insulin produced and it may not work as effectively. Symptoms can
begin so gradually that a person may not know that he has it.
Gestational Diabetes Mellitus is any degree of glucose intolerance with its onset during pregnancy.
Hyperglycemia develops during pregnancy because of the secretion of placental hormones, which
causes insulin resistance. After delivery, blood glucose levels in women with Gestational diabetes
mellitus usually return to normal. However, many women who have had Gestational diabetes mellitus
develop type 2 diabetes later in life. Therefore, a woman who has Gestational diabetes mellitus should
be counseled to maintain her ideal body weight and to exercise regularly to reduce her risk for type 2
diabetes.
MANAGEMENT OF DIABETES
PURPOSE: Maintain blood glucose as near as normal as possible, delay or prevent onset of
diabetic complications.
FOODS ALLOWED:
Choose foods with low glucose index compose of:
a. 45-55% carbohydrates
b. 30-35% fats
c. 10-25% protein
Coffee, tea, broth, spices and flavorings can be used as desired
Exchange groups include milk, vegetables, fruits, bread/starch, meat (divided in lean,
medium fat, and high fat), and fat exchanges.
The number of exchanges allowed from each group is dependent on the total number
of calories allowed
Non-nutritive sweeteners (sorbitol) in moderation with controlled, normal weight
diabetics.
FOODS TO BE AVOIDED
Concentrated sweets or regular soft drinks
EXERCISE
PURPOSE
Helps burn fats which in excess may lead to obesity that can cause serious
complications
Not allowed during period of stress (illness or surgery).
INSULIN
Insulin increases glucose transport into cells and promotes conversion of glucose to glycogen,
decreasing serum glucose levels. Primarily acts in the liver, muscle, adipose tissue by attaching to
receptors on cellular membranes and facilitating transport of glucose, potassium and magnesium.
Hormone secreted by the alpha cells of the islets of langerhans in the pancreas. Increase blood glucose
by stimulating glycogenolysis in the liver.
If normal blood glucose levels are not achieved after 2-3 months of lifestyle modifications,
treatment with an oral antihyperglycemic drug is often prescribed. However, the patient should be
clearly advised that the ability of any drug therapy to improve the health of any diabetic patient is aided
by appropriate changes in diet and activity level.
OBESITY
Obesity is a medical condition in which excess body part has occumulated to the extent
that it may have an adverse effect on health, leading to reduce life expectancy. Body
mass index, which compares weight and height, is used to define a person as overweight
when their BMI is between 25 kg/m2 and 30kg/m2 and obese when it is greater than 30
kg/m2 . The primary treatment for obesity is dieting and physical exercise. If this fails,
antiobesity drugs may be taken to reduce appetite or inhibit fat absorption.
GENETICS/HEREDITARY
In a study of 200 adults with type 2 diabetes, about 2/3 reported atleast one close
relative with diabetes and nearly 50 % had atleast two relatives with the disease. In
particular, people whos mother had diabetes where twice as likely to get the disease as
those whos father had diabetes.
RACE
Diabetes occurs more often in Hispanic/Latino Americans, African-Americans, Native
Americans, Asian Americans, Pacific Islanders, and Alaska Natives.
HYPERTENSION
Hypertension, or high blood pressure, is a major risk factor of diabetes. High blood
pressure is generally defined as 140/90 mmHg or higher. Low levels of HDL ( good
cholesterol) and high triglyceride levels also put you at risk.
SEDENTARY LIFESTYLE
Being inactive – exercising fewer than 3 times a week makes you more likely to develop
diabetes.
AGE
Some doctors advise anyone over 45 to be screened for diabetes. That’s because
increasing age puts you at higher risk of developing type 2 dibetes. It’s important to
remember, though, that people at any age can develop diabetes.
PREVENTION
Maintain body weight and prevent obesity through proper nutrition and physical
activity/exercise.
Encourage proper nutrition – eat more dietary fiber, reduce salt and fat intake, avoid
simple sugars like cakes and pastries; avoid junk foods.
Promote regular physical activity and exercise to prevent obesity,hypercholesterolimia,
and enhance insulin action in the body.
Advise smoking cessation for active smokers and prevent exposure to second hand
smoke. Smoking among diabetes increases risk for heart attack and stroke.
DIABETIC KETOACIDOSIS
Ketoacidosis is a serious condition that can lead to diabetic coma or even death. When the cells
don’t get the glucose they need for energy, your body begins to burn fat for energy, which produces
ketones. Ketones are acids that build up in the blood and appear in the urine when your body doesn’t
have enough insulin. Ketoacidosis may happen to anyone with diabetes, though it is rare in people with
Type 2.
CLINICAL MANIFESTATIONS
NEPHROPATHY
Kidneys are remarkable organs. Inside them are millions of tiny blood vessels that act as filters.
Their job is to remove waste products form the blood. Diabetes can damage the kidneys and cause them
to fail. High levels of blood sugars make kidneys filter too much blood. At this extra work is hard on the
filters. After many years, they start to leak and useful protein is lost in the urine.
CLINICAL MANIFESTATIONS
The kidneys work hard to make up for the failing capillaries so kidney disease produces no
symptoms until most all functions are gone. The first symptom of kidney disease is often fluid build up.
Other symptoms of kidney disease include:
Loss of sleep
Poor appetite
Weakness
Microalbuminuria
RETINOPATHY
Retinopathy is a damage to the retina caused by complications of diabetes mellitus, which can
eventually lead to blindness. It is an ocular manifestation of systematic disease which affects up to 80%
of all patients who have had diabetes for 10 years or more.
CLINICAL MANIFESTATIONS
Blurring of vision
Few specks of blood
Floating spots
HYPOGLYCEMIA
Hypoglycemia, sometimes called an insulin reaction, can happen even during those times where
you’re doing all you can to manage your diabetes.
CLINICAL MANIFESTATIOS
Shakiness
Dizziness
Sweating
Hunger
Pale skin color
Clumsy or jerky movements
Confusion
NEUROPATHY
Neuropathy affects all peripheral nerves: pain fibers, motor neurons, autonomic nerves. It
therefore necessarily can affect all organs and systems since all are innervated
CLINICAL MANIFESTATIONS
MACROVASCULAR DISEASES
Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels
supplying the brain. Hypertension is the most important cause; it damages the blood vessel lining,
endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process
which is not always complete and perfect. Sustained hypertension permanently changes the
architecture of the blood vessels making them narrow, stiff, deformed, uneven and more vulnerable to
fluctuations in blood pressure. A fall in blood pressure during sleep can then lead to a marked reduction
in blood flow in the narrowed blood vessels causing ischemic stroke in the morning. Conversely, a
sudden rise in blood pressure due to excitation during the daytime can cause tearing of the blood
vessels resulting in intracranial hemorrhage. Cerebrovascular disease primarily affects people who are
elderly or have a history of diabetes, smoking, or ischemic heart disease. Myocardial infarction (MI) or
acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood
supply to part of the heart, causing some heart cells to die. This is most commonly due to occlusion
(blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an
unstable collection of lipids (fatty acids) and white blood cells (especially macrophages) in the wall of an
artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a
sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium).
PERIPHERAL VASCULAR DISEASE
In peripheral vascular disease, a diabetic client can develop arterial occlusion and
thrombosis that can lead to gangrene but this can be developed years after you have been
diagnosed of diabetes mellitus and not properly treating it. Both the types of diabetes mellitus
have a risk to develop this type of disease.
CLINICAL MANIFESTATIONS
DIAGNOSTIC EXAMS
Fasting blood glucose testing involves measuring blood glucose after not eating or
drinking for 8 to 12 hours (usually overnight).
The A1C blood test measures the average blood glucose level during the past 2 to 3
months. It is used to monitor blood glucose control in people with known diabetes, but is not
normally used to diagnose diabetes. Normal values for A1C are 4 to 6 percent. The test is done
by taking a small sample of blood from a vein or fingertip.
NURSING DIAGNOSIS
NURSING DIAGNOSIS: Risk for fluid volume deficit related to frequent urination.
Goal: Provision of fluid balance. Demonstrate adequate hydration as evidenced by stable vital
signs, palpable peripheral pulses, good skin turgor and capillary refill, individuality appropriate
urinary output.
NURSING DIAGNOSIS: Imbalanced Nutrition: less than body requirements related to inability to
utilize nutrients.
Goal: Maintain normal nutritional status. Demonstrate stabilized weight or gain toward
usual/desired range.
NURSING DIAGNOSIS: Risk for infection related to insufficient knowledge on proper wound
care.
Goal: Have knowledge on proper wound care. Identify interventions to prevent or reduce risk of
infection. Demonstrate techniques, lifestyle changes to prevent development of infection
EVALUATION
Participated in planning the activities and started showing operation in every task he makes.
The client will be able to gain knowledge about possible complications of the disease.
Demonstrated compliance with dietary restrictions and to take his medication as scheduled and
how to manage any side effects of therapy.
Experienced increase comfort.