DIABETES

MELLITUS
Diabetes Mellitus

A group of metabolic diseases

characterized by elevated levels
of glucose in the blood
resulting from defects in insulin
secretion, insulin action, insulin
receptors or any combination
of conditions.
Diabetes Mellitus

A chronic disorder of
impaired glucose
metabolism, protein and
fat metabolism
Diabetes Mellitus

BASIC PATHOLOGY
: Insulin problem
(deficiency or impaired
action)
Diabetes Mellitus

Insulin is a hormone
secreted by the BETA
cells of the pancreas
Stimulus of insulin-
HYPERGLYCEMIA
Diabetes Mellitus

Action of insulin: it promotes

entry of Glucose into the body
cells by binding to the insulin
receptor in the cell membrane
INSULIN : Physiology
Insulin Metabolic Functions:
1. Transports and metabolizes
GLUCOSE
2. Promotes GLYCOGENESIS
3. Promotes GLYCOLYSIS
4. Enhances LIPOGENESIS
5. Accelerates PROTEIN SYNTHESIS
Diabetes Mellitus

 Affects the metabolism of carbohydrate,

protein, and fat

 End Result : HYPERGLYCEMIA

Review A&P
 Role of Insulin

 Insulin:
 Counters metabolic
activity that would
increase blood glucose
levels
 Enhances transport of
glucose into body cells
 Lowers blood glucose
levels
Physiology Cont: Glucose Control
Patho: DM Type 1
Patho Cont: DM Type 2
Normal Physiology
Pathophysiology-Cont.:DM Type 2
DM 1&2: The big difference…
DM TYPE 1 DM TYPE 2
No endogenous insulin Some endogenous insulin

Tx requires insulin injections Tx diet and exercise 1st, then

pills and /or insulin
Usually < age 30 yrs. Usually over 30 yrs. (peaks at
50)
Ketosis prone (DKA) no ketosis

Former names: IDDM NIDDM (maturity/adult- onset)

(Juvenile) Diabetes Type II
Diabetes Type I
Thin to normal body Usually Overweight
weight
Acute metabolic complications Chronic vascular complications
(DKA)
 Diabetes: Clinical Manifestations

THE 3
P’s

POLYDYPSIA

POLYURIA POLYPHAGIA

18
Diabetes Clinical Manifestations
Cont: Signs and Symptoms
Early signs
 3 P’s
 Weight loss
 Fatigue/Always tired
 Visual Blurring

Late signs
 Any of the 3 Polys
 Infections
 Numbness/ tingling of feet or
leg pain
 Slow healing wounds
 Chronic Complications
 Diabetes: Dx Tests
Check MD orders or agency
 Fasting
Blood Glucose (FBS): protocol for frequency of
BS Monitoring
<100 mg/dL In General:
 70-110 mg/dL AC&HS if pt able to eat;
Q4-6 hours if NPO or tube
feedings

*Random/Casual Blood
Glucose*:<200 mg/dL

 Oral
Glucose Tolerance Test
(OGTT): < 140 mg/dL

 GlycosylatedHemoglobin
(HgbA1C): 4-6%
 Diabetes: Diagnostic Tests Cont.
 Glycosylated hemoglobin test – Hemoglobin A1C (HbA1c)
 measuresthe amount of glycosylated hemoglobin
(hemoglobin that is chemically linked to glucose) in blood.
 Normal -4-6%
 Target range DM patient <7%
 Acute Complications
 Diabetic Ketoacidosis  Hyperglycemic-Hyperosmolar
(DKA) Nonketotic Syndrome (HHNS)
 BS > 300 mg/dL  BS > 800 mg/dL
 Classic symptoms  Similar symptoms
 Ketosis  No Ketosis

Check urine for

ketones
(ADA)
Chronic Complications of DM
 MANAGEMENT OF DM
 Regular Blood Glucose Monitoring

Drug Therapy Diet

26 Exercise
Dietary Management
 Carbohydrate 45-65% total daily calories
 Protein-15-20% total daily calories
 Fats—less than 30% total calories, saturated fats
only 10% of total calories
 Fiber—lowers cholesterol; soluble—legumes, oats,
fruits Insoluble—whole grain breads, cereals and
some vegetables. Both increase satiety. Slowing
absorption time seems to lower glycemic index.
Dietary Management

 Consistent, well-balanced small meals several

times per day
 Exchange system or counting carbohydrates
Management: Exercise
 Helps regulate blood  Increases insulin
glucose effectiveness and
sensitivity in the body.

 Must monitor insulin

and food intake to match
exercise regimen.
Drug Therapy
INSULIN
&
ORAL ANTIDIABETIC AGENTS
Interventions: Insulin

Insulin therapy:

 Opens the door for glucose to enter the cell & be used for
energy
 Drug Therapy: Insulin Types
 Fast-acting insulin BOLUS
 Rapid Acting Insulin Analogs Used to lower
 Aspart, blood sugar
Lispro, Glulisine
after eating a
 Regular Human Insulin meal

 Intermediate-acting insulin
 NPH Human Insulin
 Pre-Mixed Insulin BASAL
 Humulin 70/30, Humalog 75/25 Used to lower
blood sugar
 Long-acting insulin throughout the
 Insulin Glargine, Insulin Detemir day and night
Drug Therapy Cont.: Insulin

 Onset - how soon it starts to work in the blood

 Peak - when the insulin has the greatest effect
on blood sugar levels
 Duration – how long it keeps working
Drug Therapy-Insulin Cont:
Rapid Acting “Logs”
Humalog (insulin lispro)
Novolog (insulin aspart)

 Bolus insulin
 Onset 15 min; peaks 1-2 hrs;
lasts 4-6 hours
 Ideal for meal coverage

“Give the shot while

the plate is hot!”
 Drug Therapy-Insulin Cont:
Short Acting: Regular Insulin
Regs
 Bolus insulin
 Onset ½-1 hr; peaks 2-4 hrs; lasts 6-8
hrs

Give 30 minutes to 1
hour before a meal
Drug Therapy-Insulin Cont:
Rapid Acting
(Humalog/Novolog) VS. Short Acting (Regular
Insulin)

Rapid onset Delayed onset

1-2 hour peak Peaks in 2-4 hr
Limited duration Lasts 6-8 hours
 Drug Therapy-Insulin Cont:
Intermediate acting: NPH Insulin

 Basal insulin: covers blood sugar

between meals

 Satisfies overnight insulin requirement

 Onset 1-2 hrs, peaks 6-10 hrs, lasts 12+
hrs

 Need snack if NPH given at 5 pm

(only)

 Ideal to be given at 9 pm (HS) to

address Dawn Phenomenon
 Drug Therapy-Insulin Cont:
L ong-Acting: Peakless Insulins!!!
Lantus (insulin glargine)
Levimir (insulin detimir)
 Basal Insulin
 Onset 1.5 hrs; no peak (max effect in 5 hrs); lasts 24 hours
 No risk for hypoglycemia
 Do not mix with other insulins – becomes inactivated when mixed with
other insulins
Drug Therapy-
Insulin Cont:
Hypoglycemia
 BS < 60-70 mg/dL

 An acute
complication
of insulin administration

 Tx: (15/15 or
20/20 Rule)

 Give 15/20 g simple

carb and recheck
BG in 15/20 minutes
Other Methods of Insulin Administration

For Uncontrolled DM 1 0r 2

Rapid-acting insulin
 Continuous IV insulin infusion
 Used to maintain glycemic control in
hospitalized patients with high blood
glucose levels; in DKA and HHNS

 Regular insulin may be used IV

 May also be given preoperatively or

postoperatively

 More frequent BS monitoring ( q1-2 hours

per agency protocol)
Diabetes Mellitus
ORAL HYPOGLYCEMIC
AGENTS
These may be effective when used
in TYPE 2 DM that cannot be
treated with diet and exercise
These are NEVER used in
pregnancy!
Diabetes Mellitus
ORAL HYPOGLYCEMIC AGENTS
 There are several agents:
Sulfonylureas
Biguanides
Alpha-glucosidase inhibitors
Thiazolidinediones
Meglitinides
Acute Complication
of Insulin and (some) Oral Meds
Hypoglycemia
Hyperglycemia
Health Teaching
Health Teaching: Foot Care
 Daily cleanse feet in warm soapy
water
 Rinse and dry carefully
 Inspect, don’t break blisters
 Trim nails to follow natural curve
of toe
 Always wear breathable shoes
such as leather
 No crossing of the legs
 No cream between toes
 Inspect visually daily
Health Teaching

 Storage & dose  Interpretation of results

preparation
 Frequency of testing
 Syringes

 Blood glucose
monitoring
Health Teaching
 Injection techniques ( intrasite rotation)

 Dietary management

 Quit smoking

 Stress Management (stress increases blood sugar)