A.

Classification and Characteristics of Diabetes Mellitus

 Diabetes Mellitus
- It is a group of metabolic diseases characterized by hyperglycemia over a prolonged
period.
- A chronic disorder of carbohydrate, protein, and fat metabolism.
 Classifications of Diabetes
- Type 1 Diabetes (IDDM)
- Type 2 Diabetes (NIDDM)
- Gestational Diabetes
 Type 1 Diabetes (IDDM)
- This results from the pancreas’ failure to produce enough insulin.
- Previously referred as “Insulin Dependent Diabetes Mellitus”
- Common among children and young adult
- It can be due to genetic, immunologic or environmental factors.
 Type 2 Diabetes (NIDDM)
- This usually begins with insulin resistance and as the disease progresses a lack of
insulin may develop.
- Previously referred as “Non-Insulin Dependent Diabetes Mellitus”
- It mostly affects middle age and older people
- This can be due to hereditary or environmental factors.

 Gestational Diabetes
- This occurs to pregnant women without a previous history of diabetes develop a
high blood glucose level.
 - Can be caused by hormonal fluctuation.
- Reversible after delivery.
 Characteristics of Diabetes Mellitus
- 3Ps = Polyuria, Polydipsia, and Polyphagia
- Fatigue
- Weight Loss
- Blurry vision
- Headache
- Slow healing of wounds
- Itchy skin
- Frequent infections
B. Laboratory Findings

Laboratory Test Indication

Glycated hemoglobin (A1C) test  This blood test, which doesn't require
fasting, indicates the average blood sugar
level for the past two to three months. It
measures the percentage of blood sugar
attached to hemoglobin, the oxygen-carrying
protein in red blood cells.
Oral glucose tolerance test  For this test, the patient needs to fast
overnight, and the fasting blood sugar level
is measured. Then the patient will drink a
sugary liquid, and blood sugar levels are
tested periodically for the next two hours.
  Normal
 Blood sugar level less than 140 mg/dL (7.8
mmol/L)
Diabetes
 A reading of more than 200 mg/dL (11.1
mmol/L) after two hours
Pre Diabetes
 A reading between 140 and 199 mg/dL (7.8
mmol/L and 11.0 mmol/L) indicates
prediabetes.
Random blood sugar test  A blood sample will be taken at a random
time. Regardless of when the patient last ate,
a blood sugar level of 200 milligrams per
deciliter (mg/dL) — 11.1 millimoles per
liter (mmol/L) — or higher suggests
diabetes
Fasting blood sugar test  A blood sample will be taken after an
overnight fast. A fasting blood sugar level
 less than 100 mg/dL (5.6 mmol/L) is
normal. A fasting blood sugar level from
100 to 125 mg/dL (5.6 to 6.9 mmol/L) is
considered prediabetes. If it's 126 mg/dL (7
mmol/L) or higher on two separate tests,
you have diabetes.

Test For Gestational Diabetes

Initial glucose challenge test
 The patient will begin the glucose challenge test
by drinking a syrupy glucose solution. One hour
later, the patient will have a blood test to
measure your blood sugar level. A blood sugar
level below 140 mg/dL (7.8 mmol/L) is usually
considered normal on a glucose challenge test,
although this may vary at specific clinics or labs.

Follow-up glucose tolerance testing
 For the follow-up test, the patient will be
asked to fast overnight and then have the
fasting blood sugar level measured. Then the
patient will drink another sweet solution this
one containing a higher concentration of
glucose and the blood sugar level will be
checked every hour for a period of three
hours.

Fasting Blood Glucose Tolerance Random Blood

Result* A1C Test Sugar Test Test Sugar Test
Diabetes 6.5% or 126 mg/dL or above 200 mg/dL or 200 mg/dL or above
above above
Prediabete 5.7 – 6.4% 100 – 125 mg/dL 140 – 199 mg/dL  N/A
s
Normal Below 5.7% 99 mg/dL or below 140 mg/dL or  N/A
below

C. Diagnostic Tests to Monitor Diabetes Management

 A1C Test
 - The A1C test measures average blood sugar level over the past 2 or 3 months. An
A1C below 5.7% is normal, between 5.7 and 6.4% indicates you have prediabetes,
and 6.5% or higher indicates diabetes.
 Fasting Blood Sugar Test
- This measures blood sugar after an overnight fast (not eating). A fasting blood sugar
level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates prediabetes, and
126 mg/dL or higher indicates diabetes.
 Glucose Tolerance Test
- This measures the blood sugar before and after drinking a liquid that contains
glucose. The patient needs to fast (not eat) overnight before the test and have blood
drawn to determine fasting blood sugar level. Then drink the liquid and have the
blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward. At 2
hours, a blood sugar level of 140 mg/dL or lower is considered normal, 140 to 199
mg/dL indicates prediabetes, and 200 mg/dL or higher indicates diabetes.
 Random Blood Sugar Test
- This measures blood sugar at the time it was tested. This test can be taken at any time
and does not require to fast first. A blood sugar level of 200 mg/dL or higher
indicates diabetes.
D. Health Promotion
E. Nursing Diagnosis and Interventions
 Nursing Diagnosis
 Chronic Pain
- Many people with diabetes develop peripheral neuropathy and suffer from chronic
pain in their hands and feet. This pain can be quite severe and difficult to manage, and
may affect their quality of life and independence and may even affect their ability to
walk around.
 Deficient or Imbalanced Fluid Volume
- When blood sugar levels rise, the body tries to flush out the excess sugar by
increasing fluid excretion through urination and thirst. The increase may cause the
body to become dehydrated and have electrolyte imbalances.
 Risk for Impaired Skin Integrity
- If the patient has developed peripheral neuropathy because of their diabetes, the risk
for a wound or ulcer developing is significantly increased. Often patients with
neuropathy have a lowered sensation of pain, and so they may not realize if they have
received an injury to their feet or if a pressure ulcer is developing.
 Nursing Interventions
 Educate about home glucose monitoring.
- To identify and control glucose changes, discuss glucose monitoring at home with the
patient based on individual factors.
 Encourage client to read labels.
- The customer must select foods with a low glycemic index, high fiber content, and
low-fat content.
  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 this 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.
 Check injection sites periodically.
- Insulin absorption can vary day to day in healthy sites and is less absorbable in
lipohypertrophic tissues.
 Report BP of more than 160 mm Hg (systolic). Administer hypertensive as
prescribed.
- Hypertension is commonly associated with diabetes.
 Educate patient on the correct rotation of injection sites when administering insulin.
- Injection of insulin in the same site over time will result in lipoatrophy and
lipohypertrophy with reduced insulin absorption. Repeated use of an injection site can
cause the development of fatty masses called lipohypertrophy which can impair in the
absorption of insulin when used again.
 Instruct patient on the proper injection of insulin.
- The 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.
 Educate the patient about the health benefits and importance of exercise in the
management of diabetes.
- Exercise decreases blood glucose levels by stimulating glucose absorption and
improving insulin utilization.
 Explain the importance of weight loss to obese patients with diabetes.
- Weight loss is an important factor in the treatment of diabetes. Losing 5- 10% of total
body weight can reduce or eliminate the need for medications and significantly
improve blood glucose levels.
F. Community Based Care for Diabetes Mellitus
 Community-based Diabetes Self-Management Education
o This is to empower people with diabetes to reach their daily and lifetime goals for
living well with diabetes.
 Diabetes Prevention Program
 Project Dulce
o It is an American Diabetes Association (ADA)-recognized care management
program developed in 1997 by the Scripps Whittier Diabetes Institute (SWDI) in
collaboration with San Diego County, federally qualified health centers, and San
Diego State University.
 Screening, Patient Education, Coaching, and Social Support
G. Medical Management
  Dietary Management and Physical Activity
o Modifying eating habits and increasing physical activity are typically the first
steps toward reducing blood sugar levels.
 Insulin Therapy
o People with type 1 diabetes require multiple insulin injections each day to
maintain safe insulin levels. Insulin is often required to treat type 2 diabetes too.
Using an insulin pump is an alternative to injections. The pump is about the size
of a pager and is usually worn on a belt. Insulin is delivered through a small tube
that is placed under the skin.
o The doctor will determine the dose and how often the insulin should be
administered. There is no standard insulin dose as it depends on factors such as
body weight, when the person eats, how often the person exercise and how much
insulin the person’s body produces.
 Oral Medications
o Sometimes blood sugar levels remain high in people with type 2 diabetes even though
they eat in a healthy manner and exercise. When this happens, medications taken in
pill form may be prescribed. The medications work in several different ways. These
include improve the effectiveness of the body's natural insulin, reduce blood sugar
production, increase insulin production and inhibit blood sugar absorption. Oral
diabetes medications are sometimes taken in combination with insulin.
H. Insulin Therapy