NAME: GODWIN P.

ESTA YEAR & SECTION: BSN 3F

DIABETES MELLITUS

OVERVIEW OF THE CASE

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too
high. Glucose is your body’s main source of energy. Your body can make glucose, but glucose
also comes from the food you eat.
Insulin is a hormone made by the pancreas that helps glucose get into your cells to be
used for energy. If you have diabetes, your body doesn’t make enough—or any—insulin, or
doesn’t use insulin properly. Glucose then stays in your blood and doesn’t reach your cells.
Diabetes raises the risk for damage to the eyes, kidneys, nerves, and heart. Diabetes is
also linked to some types of cancer. Taking steps to prevent or manage diabetes may lower your
risk of developing diabetes health problems.

CAUSES
Overweight, obesity, and physical inactivity
You are more likely to develop type 2 diabetes if you are not physically active and are
overweight or have obesity. Extra weight sometimes causes insulin resistance and is common in
people with type 2 diabetes. The location of body fat also makes a difference. Extra belly fat is
linked to insulin resistance, type 2 diabetes, and heart and blood vessel disease. To see if your
weight puts you at risk for type 2 diabetes, check out these Body Mass Index (BMI) charts.

Insulin resistance
Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat
cells do not use insulin well. As a result, your body needs more insulin to help glucose enter
cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time, the
pancreas can’t make enough insulin, and blood glucose levels rise.

Genes and family history

As in type 1 diabetes, certain genes may make you more likely to develop type 2 diabetes. The
disease tends to run in families and occurs more often in these racial/ethnic groups:
● African Americans
● Alaska Natives
● American Indians
● Asian Americans
● Hispanics/Latinos
● Native Hawaiians
● Pacific Islanders
Genes also can increase the risk of type 2 diabetes by increasing a person’s tendency to become
overweight or have obesity.

SIGNS & SYMPTOMS

Symptoms of diabetes include
● increased thirst and urination
● increased hunger
● fatigue
● blurred vision
● numbness or tingling in the feet or hands
● sores that do not heal
 ● unexplained weight loss
Symptoms of type 1 diabetes can start quickly, in a matter of weeks. Symptoms of type 2
diabetes often develop slowly—over the course of several years—and can be so mild that you
might not even notice them. Many people with type 2 diabetes have no symptoms. Some people
do not find out they have the disease until they have diabetes-related health problems, such as
blurred vision or heart trouble.

ANATOMY AND PHYSIOLOGY

PATHOPHYSIOLOGY

DIAGNOSIS
● Fasting glucose levels of greater than 126 mg/dl on two separate occasions is considered
positive.
 ● The strictest procedure is according to the World Health Organization, which states that
the diagnosis is positive if "venous plasma glucose concentration is greater than 11.1
mmol/L 2 hours after a 75g glucose tolerance test."
● The study by Pooja Bhati et al. suggests that biomarkers of inflammation and endothelial
function are correlated with Cardiac Vagal Tone and global Heart Rate Variability (HRV),
which indicate some pathophysiological link between subclinical inflammation,
endothelial dysfunction and cardiac autonomic dysfunction in Type 2 Diabetes Mellitus

TREATMENT
For both T1DM and T2DM, the cornerstone of therapy is diet and exercise.
● A diet low in saturated fat, refined carbohydrates, fructose corn syrup, and high in fiber
and monounsaturated fats needs to be encouraged.
● Aerobic exercise for a duration of 90 to 150 minutes per week is beneficial.
● The major target in T2DM patients, who are obese, is weight loss.
● Weight management, nutritional and diet counseling combined with physical
therapy/exercise prescription is ideal.

For Type 1 (insulin dependent) Diabetes, intramuscular administration of insulin is needed.

Dosage is always expressed in USP units. Humalog is the fastest-acting insulin, acting within 15
minutes. The PZI has the longest peak of 8-20 hours and has the longest total duration of 36
hours. On the other hand, the Lantus is the only one "without peak" and lasts for 24 hours.

For Type 2 (non-insulin dependent) Diabetes, popular oral hypoglycemics include Metformin
and Sulfonylureas. Insulin sensitizers such as Rosiglitazone and Pioglitazone are also prescribed.

NURSING MANAGEMENT (DEPENDENT & INDEPENDENT)

● Monitor blood sugar and use a sliding scale to treat high levels of glucose
● Educate patient about diabetes
● Examine feet and skin and teach patient foot care
● Educate the patient on foot protection
● Monitor vitals
● Teach the patient about insulin self-injections and how to perform fingersticks
● Encourage annual visits to the dentist, ophthalmologist, cardiologist, and neurologist
● Teach the patient about hypoglycemia and how to manage it
● Teach the patient about nutrition and the importance of exercise
● Urge the patient not to smoke and to abstain from alcohol

PROGNOSIS
Diabetes is a lifelong disease and there is no cure. Some people with type 2 diabetes no longer
need medicine for blood sugar control if they lose weight and become more active. When they
reach their ideal weight, their body's own insulin and a healthy diet can control their blood sugar
level.