Ver 7 PPT - PCB - Diabetes Mellitus

CARE OF PATIENTS WITH
ALTERED FUNCTIONS OF
ENDOCRINE SYSTEM
Diabetes Mellitus
ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

Objectives
• Define diabetes mellitus.
• Describe the pathophysiology of diabetes mellitus.
• State the 3 types of diabetes mellitus.
• Identify the causes of diabetes mellitus.
• Identify the signs and symptoms of diabetes mellitus
• Identify the complications of diabetes mellitus.

Objectives
• Explain the common investigations used to diagnose
diabetes mellitus.
• Outline the medical management of patients with diabetes

mellitus.
• Outline 2 nursing process in the care of patients with

diabetes mellitus.
• Outline the health education plan for patients with diabetes

mellitus.

Definition of Diabetes Mellitus
A group of metabolic disorders characterized primarily by abnormal

glucose metabolism, with the key feature of elevated blood glucose.

Pathophysiology Of Diabetes Mellitus
• When the food you eat is digested, it is
broken down into Glucose.
• The beta cells in the Islets of

Langerhans in the pancreas, secretes
hormone called Insulin.
• In a normal person, insulin helps the

glucose to move from the bloodstream
into the cells, where it is used as
energy.

Pathophysiology Of Diabetes Mellitus
• In a person with diabetes, the body is
unable to effectively use the insulin
produced or the amount of insulin produced
by the pancreas is not enough for the
body’s needs.
• As a result, glucose cannot enter the cells

and remains in the bloodstream.
• This lead to an increase of glucose level in

the blood. A raise of blood glucose level is
known as Hyperglycaemia.

Types of Diabetes Mellitus
• Type 1 Diabetes • Type 2 Diabetes • Gestational Diabetes
https://www.t1international.com/type-1-diabetes/ https://www.webmd.boots.com/diabetes/ss/slideshow-type-2-diabetes-overview https://www.dietburrp.com/indian-diet-plan-for-

gestational-diabetes/

Differences Between Type 1 And Type 2 Diabetes Mellitus
TYPE 1 DM TYPE 2 DM
The beta cells in the pancreas unable The beta cells in the pancreas can
to produce insulin. No insulin still produce insulin but the amount
production. produced are not enough or the body
is unable to effectively use the
insulin.
Usually diagnosed in childhood or Usually diagnosed in adults over 40
adolescence. year of age.

TYPE 1 DM TYPE 2 DM
Not related with excess body Often related to excess body weight.
weight.
Sudden onset of signs & Gradual onset of signs & symptoms e.g.
symptoms e.g. weight loss, fatigue, polyuria, polydipsia, polyphagia
polyuria, polydipsia, polyphagia, and numbness or tingling sensation in
fatigue, presence of glucose and the hands and feet.
ketones in the urine.

TYPE 1 DM TYPE 2 DM
Totally dependent for May required either oral hypoglycaemic
subcutaneous insulin injection for medications or administer
survival. subcutaneous insulin injection to control
the blood glucose level.
Develop into metabolic acidosis Develop into Hyperosmolar

known as Diabetic Ketoacidosis. Hyperglycaemic Non-Ketotic State
(HHNKS).

TYPE 1 DM TYPE 2 DM
Cannot be prevented as this is an It can be prevented or delayed with a
autoimmune disorder when the healthy lifestyle such as keeping to
body’s immune system destroys the healthy weight, doing exercises
beta cells in the pancreas. regularly and eating a well balanced
diet.

Causes of Diabetes Mellitus
• Hereditary.
• Pancreatic Disorder.
• Disorder of other endocrine glands e.g pituitary/ suprarenal

glands.
• Autoimmune disorder e.g. Insulin resistance.
• Pregnancy.

Signs and Symptoms of Diabetes Mellitus
Signs
• Urine analysis shows presence of glucose in urine
• Capillary blood glucose level > 10mmol/L
• Persistent itchiness around genital areas.
• Poor wound healing and/or infection.

Symptoms
• Frequent urination (Polyuria)
• Excessive thirst (Polydipsia)
• Excessive hunger (Polyphagia)
• Extreme fatigue/ lethargy
• Feeling of nausea and/or vomiting.

Symptoms
• Blurred vision
• Unexplained weight loss despite eating a lot.
• Numbness or tingling sensation in arms and feet.

https://www.dreamstime.com/stock-illustration-diabetes-complications-affected-organs-
affects-nerves-kidneys-eyes-vessels-heart-skin-image62041410

Complications of Diabetes Mellitus
Acute complications
• Hypoglycaemia
• Hyperglycaemia
• Diabetic Ketoacidosis (DKA)
• Hyperosmolar Non-Ketotic Hyperglycaemia

Complications of Diabetes Mellitus
Chronic Complications
• Diabetic retinopathy.
• Diabetic nephropathy.
• Cardiovascular diseases.
• Peripheral vascular disease.
• Diabetic neuropathy.

Common Investigations
• Urine labstix test for glucose, ketone & protein
• Random blood glucose
• Oral Glucose Tolerance Test (OGTT)
• Fasting blood glucose
• Glycosylated Haemoglobin (HbA1c) test

Medical Management of Patients With Diabetes Mellitus
Management for hyperglycaemia
 Inform doctor immediately if Blood Glucose Level (BGL) is high

(including ‘HI’ on glucometer).
 Administration of short-acting insulin (Intravenous or subcutaneous route)

as ordered by doctor.
 Blood specimen for urgent blood glucose maybe ordered.

Medical Management of Patients with Diabetes Mellitus
 Monitor Blood Glucose level every 15 mins as ordered by doctor.
 Continue to check blood glucose every 15 mins and provide appropriate

treatment with doctor’s advice until hyperglycaemia has resolved.

Management for hypoglycaemia
 Inform doctor immediately if Blood Glucose Level (BGL) is less than

4 mmol/L (including ‘LO’ on glucometer).
 Check and record vital signs, conscious level and SPO2.

If patient is alert and conscious:
 Serve glucose drink (mix 15gm of glucose powder in 100mls of water).
 Recheck blood glucose 15 mins later as ordered by doctor.
 If repeat blood glucose is still less than 4 mmoI/L or ‘LO’ on glucometer,

the doctor may order to repeat glucose drink or administer I/V Dextrose 10%.

If patient is unconscious, drowsy or NBM:
 Check and record vital signs, conscious level and SPO2. Inform doctor to
review patient immediately.
 The doctor will order I/V Dextrose 10% drip.
 Recheck blood glucose 15 mins.

 If repeat blood glucose is still less than 4 mmoI/L or ‘LO’ on glucometer,

the doctor may administer I/V Dextrose 50% as bolus.
 Continue to check blood glucose every 15 mins and provide appropriate

treatment with doctor’s advice until hypoglycaemia has resolved.
 Withhold all insulin or oral hypoglycaemic medications until review by

doctor.

Nursing Process in the Care of Patients with Diabetes
Mellitus
Nursing Diagnosis 1:
Non-compliance to medication related to knowledge deficit to the treatment
regimen.
Nursing Goal:
Patient will be able to verbalize and demonstrate knowledge of proper
insulin administration, identify signs and symptoms of hypoglycaemia and
hyperglycaemia upon discharge.

Mellitus
Intervention:
Assess patient’s ability to understand the information and language spoken.
Rationale:
This assessment helps ensure information is presented in a manner that
patient understand.

Mellitus
Intervention:
Teach patient to check expiry date on the insulin vial and when to discard
after opening.
Rationale:
Insulin will lose its efficacy when is past the expiry date.

Mellitus
Intervention:
Teach patient on the proper storage of insulin.
Rationale:
Extreme temperature will make insulin lose its efficacy.

Mellitus
Intervention:
Teach patient how to accurately withdraw insulin from the vial using the
insulin syringe.
Rationale:
To ensure accurate dosage of insulin for administration.

Mellitus
Intervention:
Educate patient to rotate the injection sites. Explain that injection sites should be
at least 2 fingers spacing apart.
Rationale:
Injections at the same site may result in hardening of the skin (skin hypertrophy).

Mellitus
Intervention:
Explain the importance of inserting the needle at 90 degree to the skin.
Rationale:
This ensures deep subcutaneous administration of insulin.

Mellitus
Intervention:
Educate patient and caregiver to recognize the signs and symptoms of
hypoglycaemia and hyperglycaemia.
Rationale:
Recognizing the signs and symptoms will allow patient and caregiver to
implement appropriate treatment and seek medical attention promptly.

Mellitus
Evaluation:
The patient will be able to perform administration of insulin and verbalize an
understanding the signs and symptoms of hypoglycaemia and hyperglycaemia
upon discharge.

Mellitus
Nursing Diagnosis 2:
Risk for impaired skin integrity on lower extremities related to altered
circulation and sensation.
Goal:
Patient will verbalize and demonstrate knowledge to take care of his/her
skin integrity upon discharge.

Mellitus
Intervention:
Inspect the feet daily for any open sores, blisters or skin infection.
Rationale:
Diabetic neuropathy can increased the risk of foot injury due to reduce in
sensation.

Mellitus
Intervention:
Moisturise the feet to keep it moist and supple.
Rationale:
Dry skin is prone to skin breakdown and skin infection.

Mellitus
Intervention:
Regular follow up for diabetic foot screening.
Rationale:
Early detection and interventions can help to prevent complications and
reduce risk of amputation.

Nursing Process in the Care of Patients With Diabetes
Mellitus
Evaluation:
Patient will be able to demonstrate knowledge to take care of his/her skin
integrity on lower extremities upon discharge.

Health Education Plan for Patients with Diabetes
Mellitus
 Diet
 Exercise
 Medication compliance e.g Oral hypoglycaemic agents or S/C insulin
 Monitor blood glucose level
 Foot care

Mellitus
 Diet
• Keep to diet plan as advised by doctor or dietitian
• Select a variety of food such as fibre-rich carbohydrates such as brown

rice, wholemeal bread, vegetables, lean meat and fruit.
• Avoid adding sugar to your beverage and choose plain water as a

healthier drink.

Mellitus
 Diet
• Choose healthier cooking methods (eg: Boiling, steaming, grilling &

roasting) are advised.
• Use natural herbs and spices to reduce the intake of salt.

Health Teaching Plan for Patients with Diabetes
Mellitus
 Exercise
• Engage in exercises regularly.
• Take small steps and choose activity the patient enjoy.
• If patient is exercising right before the next meal, take a small snack
½ to 1 hour before exercise

Health Teaching Plan for Patients with Diabetes
Mellitus
 Exercise
Benefits:
• stimulates uptake of glucose by muscle cells.
• lower blood glucose level.
• increase insulin absorption.
• decrease cholesterol and triglycerides.

Mellitus
 Medication Compliance
Oral hypoglycaemic agents (management of Type 2 DM unresponsive
to diet alone).
• Take medications on time and as advised.
• Do not take medications before exercising.

Mellitus
Insulin
• Types – short, intermediate, long-acting.
• Advise not to exercise immediately after injection.
• Take food 30 mins after injection.

Mellitus
• Always bring sweets and medical identification card when travelling out.
• Rotate injection sites to prevent skin hardening.

Mellitus
 Monitor blood glucose level
• Check the blood glucose level
- before or 2 hours after meals.
- before and after exercise.
- when patient is sick or not eating well.
- when feeling giddy, very hungry, sweaty or confused.

Mellitus
 Foot care
• Cleaning of feet
- Wash feet daily with mild soap and warm water. Do not soak feet in
very cold or very hot water.
- Dry feet well especially between the toes.
- Apply moisturizer daily to feet to keep the skin supple. Avoid applying
moisturizer between the toes.

Mellitus
 Foot care
• Checking of feet
- Inspect feet daily, look for any cuts, swelling, blisters, sore, redness
or discharges between toes, heel and sole.
- Seek help or use a mirror, if patient has difficulty checking the sole.

Mellitus
 Foot care
• Cutting of nails
- Cut the toenails straight across and do not trim too short to prevent
ingrown toenails.
- Do not cut down corners of the nail.

Mellitus
 Foot care
• Cleaning of wound on the feet
- If there is a wound, clean the wound with normal saline and dry the area
carefully.
- Cover the wound with a clean, dry dressing.
- Inspect the wound daily and see doctor or podiatrist if wound is not heal
after 2 days.
Mellitus
 Foot care
• Dealing with corns and calluses

- Do not use acid treatment or corn plasters.
- Do not attempt to use sharp instruments to remove the corns or

calluses.
- Seek medical attention from doctor or visit a podiatrist.

Mellitus
 Foot care
• Activity
- Avoid massage machine, foot reflexology, acupuncture and foot

massage walking path to minimize the chances of injury.

Mellitus
 Foot care
• Footwear
- Never walk barefoot indoor or outdoor to protect the feet from injury.
- Wear comfortable and well fitted covered shoes to minimize cut or injury.
- Wear a pair of cotton socks or stockings with your shoes at all times to
minimize infection due to dampness.

Mellitus
 Foot care
 Footwear
• Never walk barefoot indoor or outdoor to protect the feet from injury.
• Wear comfortable and well fitted covered shoes to minimise cut or injury.
• Wear a pair of cotton socks or stockings with your shoes at all times to
minimise infection due to dampness.
• Do not wear open toe slippers or massage slippers.
• Always examine the inside of the shoes for stones or sharp objects that
might hurt the feet before wearing it.

References
Health Promotion Board (2017). Living with diabetes. Easy steps to good
health. https://www.hpb.gov.sg/docs/default-source/default-document-
library/living-with-diabetes-booklets---english.pdf?sfvrsn=6ecfed71_2
Tomaras, D. (2021). Nursing assessment and management of endocrine

health. In G. Koutoukidis & K. Stainton (Eds.), Tabbner’s nursing care:
Theory and Practice (8th ed. pp.1167-1180). Elsevier.
Ministry of Health (2014). Diabetes Mellitus. MOH Nursing Practice

Guidelines 1/2014. Singapore: Ministry of Health.

Health Promotion Board (2017). Living with diabetes. Easy steps to good health.
https://www.hpb.gov.sg/docs/default-source/default-document-library/living-with-diabetes-booklets---
english.pdf?sfvrsn=6ecfed71_2

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CARE OF PATIENTS WITH

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• Describe the pathophysiology of diabetes mellitus.

• State the 3 types of diabetes mellitus.

• Identify the causes of diabetes mellitus.

• Identify the signs and symptoms of diabetes mellitus

• Identify the complications of diabetes mellitus.

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• Outline the medical management of patients with diabetes

• Outline 2 nursing process in the care of patients with

• Outline the health education plan for patients with diabetes

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

A group of metabolic disorders characterized primarily by abnormal

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• The beta cells in the Islets of

• In a normal person, insulin helps the

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• As a result, glucose cannot enter the cells

• This lead to an increase of glucose level in

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• Type 1 Diabetes • Type 2 Diabetes • Gestational Diabetes

https://www.t1international.com/type-1-diabetes/ https://www.webmd.boots.com/diabetes/ss/slideshow-type-2-diabetes-overview https://www.dietburrp.com/indian-diet-plan-for-

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

Develop into metabolic acidosis Develop into Hyperosmolar

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• Disorder of other endocrine glands e.g pituitary/ suprarenal

• Autoimmune disorder e.g. Insulin resistance.

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• Urine analysis shows presence of glucose in urine

• Capillary blood glucose level > 10mmol/L

• Persistent itchiness around genital areas.

• Poor wound healing and/or infection.

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• Frequent urination (Polyuria)

• Excessive thirst (Polydipsia)

• Excessive hunger (Polyphagia)

• Extreme fatigue/ lethargy

• Feeling of nausea and/or vomiting.

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• Unexplained weight loss despite eating a lot.

• Numbness or tingling sensation in arms and feet.

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• Diabetic Ketoacidosis (DKA)

• Hyperosmolar Non-Ketotic Hyperglycaemia

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• Peripheral vascular disease.

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

• Urine labstix test for glucose, ketone & protein

• Random blood glucose

• Oral Glucose Tolerance Test (OGTT)

• Fasting blood glucose

• Glycosylated Haemoglobin (HbA1c) test

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

 Inform doctor immediately if Blood Glucose Level (BGL) is high

 Administration of short-acting insulin (Intravenous or subcutaneous route)

 Blood specimen for urgent blood glucose maybe ordered.

ITE_CE_NR Patient Care B_HC3013FP Ver 7_Jan_2022

 Monitor Blood Glucose level every 15 mins as ordered by doctor.

 Continue to check blood glucose every 15 mins and provide appropriate