CARE FOR

THE
CLIENT
WITH

(CLINICAL MANIFESTATION,
ASSESSMENT & DIAGNOSTIC FINDINGS,
OVERALL MANAGEMENT OF DIABETES
AND NURSING MANAGEMENT)
 CLINICAL MANIFESTATION
• Classic clinical manifestations of all types of diabetes
include the “three Ps”:
• Polyuria
• Polydypsia
• Polyphagia
• Other symptoms include:
• Fatigue and weakness
• Dry skin
• Sudden vision changes
• Tingling or numbness in hands or feet
• Skin lesions or wounds that are slow to heal and
recurrent infections.
• Type 1 diabetes may be associated with sudden weight
loss or nausea, vomiting, abdominal pains if DKA has
developed.
 ASSESSMENT AND DIAGNOSTIC
FINDINGS
• CRITERIA FOR THE DIAGNOSIS OF DIABETES

• American Diabetes Association (ADA, 2004)-Diagnostic

criteria for Diabetes Mellitus

1. Symptoms of diabetes plus casual plasma glucose

concentration equal to or greater than 200 mg/dL (11.1
mmol/L). Casual is defines as any time of day without regard
to time since last meal. The classic symptoms of diabetes
include polyuria, polydypsia, polyphagia and unexplained
weight loss.
or
2. Fasting Plasma Glucose (FPG) or Fasting Blood Sugar (FBS)
greater than or equal to 126 mg/dL (7.0 mmol/L). Fasting is
defined as no caloric intake for atleast 8 hours.
 or
3. Two-hour postload glucose equal to or greater
than 200 mg/dL (11.1 mmol/dL) during an oral
glucose tolerance test. The test should be
performed as described by the World Health
Organization, using a glucose load containing
the equivalent of 75 g anhydrous glucose
dissolved in water.

4. In the absence of unequivocal hyperglycemia

with acute metabolic decompensation, these
criteria should be confirmed by repeat testing on
a different day. The third measure is not
recommended for routine clinical use.
• ABNORMAL LABORATORY VALUE FOR
GLUCOSE

• Fasting Plasma Glucose (FPG) or Fasting

Blood Sugar(FBS)
• 126 mg/dL (7.0 mmol/L) above
• Random Plasma Glucose (RPG) or Random
Blood Sugar (RBS)
• 200 mg/dL (1.1 mmol/L) above

• NORMAL LABORATORY VALUE FOR

GLUCOSE

• Glucose, Fasting: 70-110 mg/Dl

• Glucose, monitoring: 60-110 mg/dL
• Glucose, 2-hr postprandial: < 140 mg/dL
OVERALL MANAGEMENT OF DIABETES

• Five components in Diabetes

management:

1. Nutritional therapy
2. Exercise
3. Monitoring
4. Pharmacologic therapy
5. Education
 1.) Nutritional Therapy
 Meal Planning and Related Teaching
o Caloric requirements
o Caloric distribution
 Carbohydrates
 Fats
 fiber
 Other Dietary Concerns
o Alcohol consumption
o Sweeteners
o Misleading Food Labels
 2. ) Exercise
 General Precautions for Exercise in
People With Diabetes

• Use proper footwear and, if

appropriate, other protective
equipment.
• Avoid exercise in extreme heat or cold.
• Inspect feet daily after exercise.
• Avoid exercise during periods of poor
metabolic control.
 3.) Monitoring

• Self-Monitoring of Blood Glucose

• Continuous Glucose Monitoring
System
• Glycated Hemoglobin
• Urine Glucose Testing
• Testing for Ketones
 4.) Pharmacologic Therapy

• Insulin Therapy and Insulin

Preparations
• Insulin Regimens
Two general approaches to
insulin therapy:
- Conventional Regimen
- Intensive Regimens
• Insulin Regimens
Two general approaches to insulin therapy:
- Conventional Regimen
- Intensive Regimens
• Complications of Insulin Therapy
- Local Allergic Reactions
- Systemic Allergic Reactions
- Insulin Lipodystrophy
- Resistance to Injected Insulin
- Morning Hyperglycemia
• Alternative Methods of Insulin Delivery
- Insulin Pens
- Jet Injectors
- Insulin Pumps
- Implantable and Inhalant Insulin
Delivery
- Transplantation of Pancreatic Cells
 Oral Anti-diabetic Agents
• Sulfonylureas
• Non-sulfonylureas
• Biguanides
• Alpha-glucosidase inhibitors
• Thiazolidinediones
 Other pharmacologic therapy
• Pramlintide (Symlin)
• Exanatide (Byetta)
 5.) NURSING MANAGEMENT
 Patient Education
 Developing a Diabetic Teaching Plan
o Organizing Information
o Assessing Readiness to Learn
o Determining Teaching Methods
 Implementing the Plan
o Teaching Experienced Patients
o Teaching Patients to Self-Administer
Insulin
- Storing Insulin
- Selecting Syringes
- Preparing the Injection: Mixing Insulins
- Withdrawing Insulin
 - Selecting and Rotating the Injection Site
- Preparing the Skin
- Inserting the Needle
- Disposing of Syringes and Needles
• Promoting Home and Community-Based
Care
- Teaching Patients Self-Care.
- Continuing Care