D I A B E T E S

WELCOME TO TODAY'S CLASS / TODAY'S AGENDA

CARE OF CHILD / BUTC

M E L L I T U S

BICOL UNIVERSITY
TABACO CAMPUS

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 WELCOME TO
TODAY'S CLASS!
TODAY'S AGENDA
WELCOME TO TODAY'S CLASS / TODAY'S AGENDA

DIABETES MELLITUS

CARE OF CHILD / BUTC

PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS

WHO IS A RISK FACTOR

CLASSIFICATION OF DIABETES MELLITUS

TIPS

CASE PRESENTATION

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WHAT IS DIABETES
MELLITUS?

Diabetes mellitus is an endocrine

Before insulin was produced synthetically
disorder in which the pancreas cannot
in 1921, women with type 1 diabetes died
produce adequate insulin to regulate body
before reaching childbearing age, were
glucose levels. The disorder affects 3% to 5%
subfertility, or had spontaneous miscarriages
of all pregnancies and is the most frequently
early in pregnancy. Now that both type 1
seen medical condition in pregnancy. It is
and type 2 diabetes can be well managed,
increasing in incidence as more and more
challenges have developed.
obese adolescents develop type 2 diabetes.

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 WHAT IS DIABETES MELLITUS?

How to manage both type 1 and type 2 diabetes during pregnancy to achieve a healthy
glucose/insulin balance during pregnancy
How to protect an infant in utero from the adverse effects of increased glucose levels
How to care for the infant in the first 24 hours after birth until the infant's insulin-glucose
regulatory mechanism stabilizes

Reproductive planning may be a fourth concern, as women with diabetes may not be good
candidates for oral contraceptives because progesterone interferes with insulin activity and
therefore increases blood glucose levels.

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PATHOPHYSIOLOGY
AND CLINICAL MANIFESTATIONS

The primary concern for any woman with this disorder is controlling the balance
between insulin and blood glucose levels to prevent hyperglycemia or
hypoglycemia. Both of these conditions are dangerous during pregnancy not
only because of long-term effects on the woman's health but also because the
threat to normal fetal growth. Infants of women with unregulated diabetes are
five times more apt to be born large for gestational age born with birth
anomalies.

If a woman's insulin production is insufficient, glucose cannot be used by body

cells. The cells register the need for glucose, and the liver quickly converts
stored glycogen to glucose to to increase the serum glucose level. Because
insulin is still not available, however, the body cells still cannot use the glucose
so the serum glucose levels rise (hyperglycemia). When the level of blood glucose
reaches 150mg/100 mL (normal level is 80 to 120 mg/dL), the kidneys begin to to
excrete quantities of glucose in the urine ( glycosuria). in an attempt to lower the
level. This causes large quantities of fluid to be excreted with urine (polyuria).

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PATHOPHYSIOLOGY
AND CLINICAL MANIFESTATIONS

As dehydration begins to occur, the blood serum becomes concentrated and the
total blood volume decreases. With the reduced blood flow, cells do not receive
adequate oxygen, and anaerobic metabolic reactions cause large stores of lactic
acid to pour out of muscles into the bloodstream. To replace needed glucose, fat
is mobilized from fat stores and metabolized for energy, pouring large amounts
of acidic ketone bodies into the bloodstream.

As the process continues, protein stores are tapped in a final attempt to find a
source of energy. Utilizing protein for energy this way reduces the supply of
protein to body cells. As cells die, they release potassium and sodium, which is
lost from the body in the extensive polyuria. These factors combined create an
immediate severe metabolic acidosis. Long term effects are vascular narrowing
that leads to kidney, heart, and retinal dysfunction.

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 For a quick history regarding diabetes mellitus, Joseph von Mering and Oskar Minkowski are the ones
commonly credited with the formal discovery (1889) of a role for the pancreas in causing the condition.
At the beginning of the 20th century, physicians hypothesized that the islets of the pancreas secrete a
substance (named insulin) that metabolizes carbohydrates. The discovery and purification of insulin for
clinical use paved the way for treatment. It is now quite clear that diabetes happens WHEN your body
isn't able to take up sugar (glucose) into its cells and use it for energy.
This then results in the buildup of glucose in the bloodstream So, when the blood glucose level rises
above 160 to 180 mg/dL (8.9 to 10.0 mmol/L), glucose spills into the urine. When the level of glucose in the
urine rises even higher, the kidneys excrete additional water to dilute a large amount of glucose. Because
the kidneys produce excessive urine, people with diabetes urinate in large volumes frequently (polyuria).
Excessive urination creates abnormal thirst (polydipsia). Because excessive calories are lost in the urine,
people may lose weight. To compensate, people often feel excessively hungry.

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WHO IS MOST LIKELY A RISK FACTOR?

OBESE PACIFIC ISLANDER HISPANIC BLACK

POSITIVE FAMILY HISTORY ASIAN AMERICAN NATIVE AMERICAN

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 CLASSIFICATIONS OF DIABETES MELLITUS

TYPE 1 TYPE 2
A state characterized by the destruction of the beta cells in the A state that usually arises because of insulin resistance combined

pancreas that usually leads to absolute insulin deficiency. with a relative deficiency in the production of insulin

Immune-mediated diabetes mellitus results from autoimmune

destruction of the beta cells

Idiopathic type 1 refers to forms that have no known cause

GESTATIONAL DIABETES IMPAIRED GLUCOSE

A condition of abnormal glucose metabolism that arises during HOMEOSTASIS
pregnancy.
A state between "normal" and "diabetes" in which the body is no longer

using and/or secreting insulin properly.

Possible signal of an increased risk for type 2 diabetes later in life.

Impaired fasting glucose: A state when fasting plasma glucose is at

least 110 but under 126 mg/dl

Impaired glucose tolerance: A state when results of the oral glucose

tolerance test as at least 140 but under 200 mg/dl in the 1 hr sample

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 WHEN DOES IT
COMMONLY OCCUR?

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Avoid or limit sugar Choose plain, whole Encourage the child to eat
milk yogurt than fruit Check blood sugars lots of green and orange
sweetened
flavored yogurt regularly vegetables everyday
beverages
(carrots and broccoli)

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Get more active Manage weight Limit screen time

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 WHEN TO CALL A DOCTOR?
When you experience low blood sugar When you experience high blood sugar

Be sure that you, your family, friends, and coworkers learn to recognize these symptoms
Be sure that you, your family, friends, and coworkers learn to recognize
and spot the signs of hyperglycemia. If you begin to experience these symptoms, follow
these symptoms and spot the signs of hypoglycemia. If you begin to
your diabetes management plan as recommended by your physician or primary
experience these symptoms, follow your diabetes management plan as
health care provider (e.g., some people are told to increase their insulin dose or make
recommended by your physician or primary health care provider (e.g.,
adjustments to their medications). Hyperglycemia can be treated, so be sure to ask
some people are told to eat something that contains a certain amount of
your health care provider what you should do when your blood sugar goes too high.
sugar). Hypoglycemia can be treated, so be sure to ask your health care
Untreated hyperglycemia may lead to a condition called diabetic ketoacidosis, which
provider what you should do when your blood sugar goes too low.
develops when your body doesn't have enough insulin. Not having enough insulin
means your body can't use the sugar in your blood for energy. Instead, your body
Be sure that your family, friends, and coworkers learn to spot the signs of
begins to break down fat for energy.
hypoglycemia... it just might save your life!
Breaking down fat produces ketones. Large amounts of ketones are
not good for your body as they are acidic. A buildup of ketones in
your blood leads to ketoacidosis and can be life-threatening. You
should test for ketones in your urine if your blood sugar levels go
above 13.3 mmol/L.

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IS EVERYTHING CLEAR?

QUESTIONS?

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 CASE PRESENTATION 1

A 54 year old female, house wife visited Ziga Memorial Hospital with the complaints of excessive urination, sudden

weight loss, blurred vision, increased thirst, fatigue and excessive sweating. She was experiencing these conditions

from last one month.

Past Medical History Patient was also suffering from Hypertension from last 3 years.

Past Medication History She was using Tenormin (Atenolol) 50mg OD from last 3 year

General Examination Weight: 70kg, Height: 5 foot 2 inches, BMI: 32.01kg/m2, Physical activity: daily work routine

home

Special Investigation According to the reported symptoms, patient’s blood glucose level was monitored. At that

time patient’s random blood glucose level was 196mg/dl which was beyond the normal range of the random blood

glucose level (>140mg/dl). Patient was also said to monitor her fasting glucose level that was 134mg/dl which was also

beyond the normal range (70-100mg/dl).

Treatment Neodipar-250mg BD (Neodipar is brand and its salt is Metformin HCL)

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 CASE PRESENTATION 2

Angelina Gomez, 22 years old, is pregnant with her first child. She fainted this afternoon while participating in an

aerobics class.

Family Assessment: Patient lives with the 30-year-old father of her child, Josh. She works as a fundraiser for a movie

producer. Josh works as an animation artist. Finances are rated as "workable." She fainted this afternoon while

participating in her weekly hour-long aerobics class.

Patient Assessment: Patient had a rheumatic fever with mitral stenosis as a child. She developed gestational

diabetes early in this pregnancy. Her serum glucose level is 207 mg/dl; her blood pressure is 100/60 mmHg. A uterine

monitor shows moderate-strength uterine contractions 7 minutes apart; fetal heart rate is 167 bpm. Out of nowhere,

the patient ask the nurse "I thought exercise is good for me, why did this happen?"

ACTIVITY:

Create one (1) nursing diagnosis. (NCP Making)

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