Assessment and Management of

Patients With Diabetes Mellitus

Prepared by Dr. Mohamed
Idirss
 Out Line
Definition of diabetes mellitus
Risk factors for diabetes mellitus
Diabetes and its classification
Overview in type I and 2 diabetes
Pathophysiology of diabetes
Clinical manifestations of diabetes
Diagnostic findings of diabetes
Management of diabetes
Monitoring glucose levels and ketones
Pharmacologic therapy
Insulin therapy
 Out Line
Complications of insulin
Oral antidiabetic agents
Nursing management
Patient education
Acute complications of diabetes
Nursing process for patient newly diagnosed with diabetes
mellitus
Patient education (foot care)
Long-term complications of diabetes
Special issues in diabetes care
Nursing process for patient with diabetes as a secondary
diagnosis
 Learning Objectives
On completion of this lecture, the student will be able to:
Differentiate between type I and type 2.
Describe etiologic factors associated with diabetes.
Relate the clinical manifestations of diabetes to the
associated pathophysiologic alterations.
Explain the dietary modifications used for management
of people with diabetes.
Describe the relationships among diet, exercise, and
medication.
Differentiate between hyperglycemia with DKA and
HHNS
Cont.
Describe management strategies for a person with
diabetes to use during “sick days”.
Describe the major macrovascular, microvascular, and
neuropathic complications of diabetes.
Use the nursing process as a framework for care of
patients with diabetes.
 Diabetes Mellitus
Definition:
Is a group of metabolic diseases characterized by
increased levels of glucose in the blood (hyperglycemia)
resulting from defects in insulin secretion, insulin action,
or both.
 Diabetes and its Classification
Type I diabetes: Insulin-dependant diabetes (IDDM).

Type II diabetes: non Insulin-dependant diabetes

(NIDDM).

Gestational diabetes mellitus.

Diabetes mellitus associated with other conditions or

syndrome.
 Overview
In type I diabetes

 In type 2 diabetes
 Pathophysiology of Diabetes
 Type I diabetes

 Type 2 diabetes

Gestational Diabetes
 Clinical Manifestations
Clinical manifestations of all types of include:
“Three Ps”: polyuria, polydipsia, and polyphagia
Fatigue and weakness
Sudden vision changes
Tingling or numbness in hands or feet
Dry skin
Skin lesions or wounds that are slow to heal
Recurrent infections
 Diagnostic Findings
Criteria for the diagnosis of diabetes mellitus:
Symptoms of diabetes plus casual plasma glucose
concentration equal to or greater than 200mg/dl.

Fasting plasma glucose greater than or equal to 126mg/dl

(7.0mmol/L).

Two-hour postload glucose equal to or greater than 200mg/dl

during an oral glucose tolerance test.

If fasting glucose level are normal, the diagnosis must be based
on a Glucose Tolerance test.
Management
 Monitoring Glucose levels and Ketones
 Self-Monitoring Blood Glucose (SMBG)

 Continuous Glucose Monitoring System (CGMS)

 Glycated Hemoglobin

 Urine Glucose Testing

 Testing for Ketones

Pharmacologic Therapy
 Insulin Therapy and
Insulin Preparations
 Insulin preparations vary
according to three main
characteristics:
Time course of action

Species ( source)

Manufacturer
Insulin Regimens
There are two general approaches to insulin therapy:
 Conventional

 And intensive
 Complications of Insulin
Local Allergic Reactions

Systemic Allergic Reactions

Insulin Lipodystrophy

Resistance to Injected Insulin

Morning Hyperglycemia
 Alternative methods of Insulin Delivery
Insulin Pens

Jet injectors
Cont.
Insulin Pumps

Implantable and inhalant

insulin delivery

Transplantation of pancreatic
cells

Implantable and inhalant

insulin delivery

Transplantation of pancreatic
cells
 Oral Antidiabetic Agents
Sulfonylureas

Biguanides

Nursing Management

Patient Education
 Acute Complications of Diabetes
There are three major acute complications of diabetes
related to short-term imbalances in blood glucose levels:
Hypoglycemia

Diabetic ketoacidosis (DKA)

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

 Gerontologic Considerations
In elderly patients with diabetes, hypoglycemia is a
particular concern for many reasons:
 Elderly people frequently live alone and may not
recognize the symptoms of hypoglycemia.
 With decreasing renal function, it takes longer for oral
hypoglycemic agents to be excreted by the kidneys.
 Skipping meals may occur because of decreased appetite
or financial limitations.
 Decreased visual acuity may lead to errors in insulin
administration.
 Nursing Process
The patient newly diagnosed with diabetes mellitus:

Assessment
 Nursing Diagnosis.
Potential Complications
Planning and Goals
Nursing Intervention
Evaluation
 Patient education (foot care)
Take care of your diabetes
 Cont.
Inspect your feet every day

Wash your feet every day

 Cont.
Keep the skin soft & smooth
Cont.
Smooth corns and
calluses gently

Trim your toenails each

week or when needed
Cont.
Wear shoes and socks at
all times

Protect your feet from

hot and cool

Keep the blood flowing

to your feet

Check with your health

care provider.
Long-Term Complications of Diabetes

The general categories of

long-term diabetic
complications are:
Macro vascular
Micro vascular
Neuropathy
 Foot and Leg Problem
Three diabetic complications contribute to the increased
risk of foot problems and infections include:
Neuropathy
Peripheral vascular disease
Immunocompromise

Management (teaching proper foot care )

 Special Issues in Diabetes Care
Patient with diabetes who are undergoing surgery
Management of Hospitalized Patients With Diabetes
Hyperglycemia During Hospitalization
Hypoglycemia During Hospitalization
Common Alteration in Diet
Hygiene
Stress
 Nursing Process
The Patient With Diabetes as a Secondary Diagnosis
Assessment
Nursing Diagnosis
Potential Complications
Planning and Goals
Nursing Intervention
Evaluation
Thank You