DIABETE MELLITUS

INTRODUCTION
 Diabetes is a condition that results from lack of the hormone insulin in a person's
blood, or when the body has a problem using the insulin it produces (insulin
resistance).
 Diabetes happens when your body isn't able to take up sugar (glucose) into its
cells and use it for energy. This results in a buildup of extra sugar in your
bloodstream.
 Insulin is a hormone made by your pancreas; an organ located behind your
stomach. Your pancreas releases insulin into your bloodstream.
 If you have diabetes:
o Your pancreas doesn’t make any insulin or enough insulin.
Or
o Your pancreas makes insulin, but your body’s cells don’t respond to it and
can’t use it as it normally should.
 If glucose can’t get into your body’s cells, it stays in your bloodstream and your
blood glucose level rises.
 If your blood glucose level remains high over a long period of time, your body’s
tissues and organs can be seriously damaged. Some complications can be life-
threatening over time.

ANATOMY OF PANCREAS

The pancreas is a long, slender organ, most of which is located posterior to the
bottom half of the stomach. The pancreas has an endocrine function. Its pancreatic
islets—clusters of cells formerly known as the islets of Langerhans— secrete the
hormones glucagon, insulin, somatostatin, and pancreatic polypeptide (PP).
TYPES
Diabetes mellitus is a group of metabolic disorders characterized by elevated
levels of blood glucose(hyperglycemia) resulting from defects in insulin production &
secretion, decreased cellular response to insulin or both.

Type 1 diabetes
This type is an autoimmune disease, meaning your body attacks itself. In
this case, the insulin-producing cells in your pancreas are destroyed. Up to 10%
of people who have diabetes have Type 1. It’s usually diagnosed in children and
young adults (but can develop at any age). It was once better known as “juvenile”
diabetes. People with Type 1 diabetes need to take insulin every day. Therefore,
it is also called insulin-dependent diabetes.

Type 2 diabetes:
With this type, your body either doesn’t make enough insulin or your
body’s cells don’t respond normally to the insulin. This is the most common type
of diabetes. Up to 95% of people with diabetes have Type 2. It usually occurs in
middle-aged and older people. Other common names for Type 2 include adult-
onset diabetes and insulin-resistant diabetes. Your parents or grandparents may
have called it “having a touch of sugar.”

RISK FACTORS
 Obesity
 Race
 Hypertension
 Physical activity
 Familial history
 Gestational diabetes
CAUSES
The cause of diabetes, regardless of the type, is having too much glucose
circulating in your bloodstream. However, the reason why your blood glucose levels are
high differs depending on the type of diabetes.
Type 1 diabetes: This is an immune system disease. Your body attacks and
destroys insulin-producing cells in your pancreas. Without insulin to allow glucose to
enter your cells, glucose builds up in your bloodstream. Genes may also play a role in
some patients. Also, a virus may trigger the immune system attack.
Type 2 diabetes: Your body’s cells don't allow insulin to work as it should to let
glucose into its cells. Your body's cells have become resistant to insulin. Your pancreas
can’t keep up and make enough insulin to overcome this resistance. Glucose levels rise
in your bloodstream.

SYMPTOMS
 Increased thirst.
 Weak, tired feeling.
 Blurred vision.
 Numbness or tingling in the hands or feet.
 Slow-healing sores or cuts.
 Unplanned weight loss.
 Frequent urination.
 Frequent unexplained infections.
 Dry mouth.
Other symptoms:
 In women: Dry and itchy skin, and frequent yeast infections or urinary tract
infections.
 In men: Decreased sex drive, erectile dysfunction, decreased muscle
strength.
PATHOPHYSIOLOGY

PATHOGENESIS
DM is a chronic disorder characterized by impaired metabolism and by vascular
and neurologic complications. A key feature of diabetes is elevated blood glucose,
called hyperglycemia. The blood glucose level is normally regulated by insulin, a
hormone produced by the beta cells in the islets of Langerhans located in the pancreas.
. The ingestion of carbohydrates triggers the secretion of a larger volume of insulin
(bolus secretion). Insulin that is produced in one's own body is called endogenous.
Insulin that is obtained from other sources and administered to a person is called
exogenous.

MEDICAL MANAGEMENT
1. Fasting serum glucose level ≥126 mg/dL (after at least an 8-hour fast)
2. Hemoglobin A1c ≥6.5%
3. Symptoms of diabetes (polyuria, polydipsia, polyphagia, unexplained weight
loss) plus random glucose level ≥200 mg/dL (A random reading is based on a
blood sample drawn any time of day without regard to mealtimes.)
 4. Two-hour postprandial glucose level ≥200 mg/dL during an oral glucose
tolerance test (OGTT) under specific guidelines (The test must use a glucose
load of 75 g of anhydrous glucose dissolved in water.)

MEDICAL MANAGEMENT
• Normalize insulin activity
• Intensive treatment.
• Exercise caution with intensive treatment. 
• Diabetes management 
The goals of managing diabetes are to normalize the blood glucose, serum lipids, and
body weight while meeting energy needs and achieving healthy body weight.

NUTRITIONAL MANAGEMENT
 The foundations
 Consult a professional
 Weight loss
 Other options for diabetes management

NURSING MANAGEMENT

ASSESSMENT:
• Assess the patient’s history.
• Assess physical condition.
• Assess the body mass index and visual acuity of the patient.
• Perform examination of foot, skin, nervous system and mouth.
• Laboratory examinations.
PRIORITIES:
1. Restore fluid/electrolyte and acid-base balance.
2. Correct/reverse metabolic abnormalities.
3. Identify/assist with management of underlying cause/disease process.
4. Prevent complications.
 5. Provide information about disease process/prognosis, self-care, and
treatment needs.
INTERVENTIONS:
• Educate about home glucose monitoring
• Review factors in glucose instability.
• Encourage client to read labels.
• Discuss how client’s antidiabetic medications work.
• Check viability of insulin. 
• Review type of insulin used.
• Check injection sites periodically.

TREATMENT

Treatment for diabetes mellitus is aimed at reducing blood glucose

concentrations to normal levels. Achieving this is important in promoting well-being
and in minimizing the development and progression of the long-term complications
of diabetes. 

Diabetic education and patient engagement are critical in management.

Patients have better outcomes if they can manage their diet, exercise regularly, and
independently monitor glucose. Lifelong treatment is often necessary to prevent
unwanted complications.

• Type 1 diabetes: If you have this type, you must take insulin every day.
Because Your pancreas no longer makes insulin.

• Type 2 diabetes: If you have this type, your treatments can include
medications, insulin, and lifestyle changes such as losing weight, making healthy food
choices and being more physically active.

• Prediabetes: If you have prediabetes, the goal is to keep you from

progressing to diabetes. Treatments are focused on treatable risk factors, such as
losing weight by eating a healthy diet and exercising. Many of the strategies used to
prevent diabetes are the same as those recommended to treat diabetes.
FOR MEDICATION

Metformin is the first line of the prescribed diabetic medications and

works by lowering basal and postprandial plasma glucose.

Insulin administration may also be necessary for T2DM patients,

especially those with inadequate glucose management in the advanced
stages of the disease.

In morbidly obese patients, bariatric surgery is a possible means to

normalize glucose levels.

PROGNOSIS

The prognosis of DM gets significantly influenced by the degree of

glucose management. Chronic hyperglycemia significantly increases the
risk of DM complications. The Diabetes Control and Complications Trial
and the United Kingdom Prospective Diabetes Study found that
individuals with T1DM and T2DM respectively had increased microvascular
complications with chronic hyperglycemia. Patients who can revert to
normal glucose during the progression from pre-diabetes to frank DM had
a good prognosis and may be able to slow disease progression.