for nursing students

2. DEFINITION
• Diabetes mellitus is a metabolic disorder
characterized by the presence of
hyperglycemia due to defective insulin
secretion, defective insulin action or both.

3. CLASSIFICATION
• Type 1 diabetes:- It is also called insulin-dependent
diabetes. It used to be called juvenile-onset diabetes,
because it often begins in childhood. It is also known as
insulin dependent diabetes mellitus
• Type 2 diabetes:- The body does not produce enough
insulin for proper function, or the cells in the body do
not react to insulin (insulin resistance). With Type 2
diabetes, the pancreas usually produces some insulin.
But either the amount produced is not enough for the
body's needs, or the body's cells are resistant to it.
Insulin resistance, or lack of sensitivity to insulin,
happens primarily in fat, liver, and muscle cells.

4. • Gestational Diabetes:- This type affects
females during pregnancy. Some women have
very high levels of glucose in their blood, and
their bodies are unable to produce enough
insulin to transport all of the glucose into their
cells, resulting in progressively rising levels of
glucose. Diagnosis of gestational diabetes is
made during pregnancy.

5. • Due to any factor
• Deficiency of insulin due to glucose enter the cells,
remaining glucose enter the blood.
• Hyperglycemia, by the renal tubules and Diversion of
water it leads to osmotic changes
• Decreased water reabsorption.
• Polyuria

6. • Dehydration takes places
• Polydipsia
Muscle protein breakdown by it changes glucose to
fatty acids by gluconeogenesis
• Hyperglycemia
• Glucose is completely absent fat is act as a
glucose and fat broken down by fatty acids

7. • Glycerol convert Ketone bodies
• Ketoneuria
• Decreased pH level in the blood
• Ketoacidosis
• Cardiac Arrest

8. CLINICAL MANIFESTATIONS
• Polydipsia
• Polyphagia
• Polyuria
• Weightloss
• Blurred Vision
• Ketone Urine
• Pruritis
• Skin infestation
• Vaginitis
• Weakness
• Fatigue
• Poor wound healing
• Recurrent infection
• Hyperglycemia
• Depression

9. DIAGNOSIS
• )Fasting Blood Sugar:- Over night nil per oral -
8hrs, then find out the blood sugar. Avoid smoke
because vaso-construction occur in the blood
vessels.
• Random Blood Sugar:- Any time random blood
sugar can be taken.
• Oral glucose Tolerance Test:- Evaluate insulin
response to glucose loading FBS is obtained
before the ingestion of a 50 to 200g glucose load
and blood samples are drawn at ½ , 1, 2, 3hrs
(may be 4 or 5hrs sampling)

10. • Glycated Hemoglobin:- Measures glycemic
control over the period of irreversible reaction of
glucose hemoglobin through freely permiable.
• C – Peptide Assay (Connecting Peptide Assay):-
Cleaved from the pro- insulin molecules during its
conversion to insulin. C- Peptide act as a marker
for endogenous insulin production. Test can be
performed after an overnight fast or after
stimulation with IV glucose or 1mg of glucagon
subcutaneously.

11. MEDICAL MANAGEMENT
• Oral Anti diabetic Agents:
 Ist Generation:-
1.Tolbutamide – 500-2000mg/day-QSH
2. Chloropromide-100-500mg/day-od
3. Tolasamide-100mg/day-(od or bd)
Action: Stimulate beta cells of pancreas to
secrete insulin. Mild Diuretic.

12. II Generation:-
1.Glipizide – 2.5 to 40mg/day (bd)
2.Glyburide – 1.5 to 12mg/day (bd)
• Action: Increase tissue response to insulin.
Mild Diuretic.

13.  III Generation:-
Alpha-Glucosidase Inhibitors = Biguanides
(Precose) – 75 to 100mg/day
Action: Increase tissue response to insulin and
decrease hepatic production of glucose.

14. IV GENERATION
Meglitinides:- Prandin – 1-3 times/ day-
Stimulate insulin secretion.
Vth GENERATION Thiazolodine-diones:-
Avandia (od)- Increase insulin action at
receptors

15. INSULIN THERAPY
• Duration of action: short ,intermediate and long
 Short acting=> Humalog (insulin lispro injection)
 Intermediate=> Lente-Regular
 Long-acting => Ultralente-Regular
• The starting dosage: 0.5units/kg/day.
• Sites:
 Inside and Outside of Upper arm
 Except Umbilicus – around the abdomen
 Thigh and Gluteal

16. DIETARY MANAGEMENT
• Improving good glucose and lipid levels.
• Providing consistency day to day food intake.
• Facilitating weight management.
• Providing adequate nutrition for all stages of
life.

17. NURSING INTERVENTIONS
• Closely monitor blood glucose levels to detect
Hypoglycemia.
• A program planned exercise according the
tension.
• To reduce stress and tension.
• Check feet and legs for skin temperature,
sensation and dryness.
• Teach the action, use and side effects of diabetes
medication on life style, finances, family life etc.

18. NURSING DIAGNOSIS
• Nutrition more than body requirement r/t intake
in excess of activity expenditures.
• Risk for injury r/t effects of insulin, inability to
eat.
• Activity intolerance related to poor glucose
control.
• Risk for impaired skin integrity related to
decreased sensation and circulation to lower
extremities.
• Knowledge deficit r/t use of oral hypoglycemic
agents.

19. COMPLICATIONS
• Acute :
o Hypoglycemia
o Diabetic Keto-acidosis
o Cataract
o Pyodermia
• Chronic:
o Retinopathy
o Nephropathy
o Cardiopathy

20. THANK YOU