Mira Begum, age 40, was admitted to the hospital with diabetes mellitus and symptoms of fever, breathlessness, and abdominal pain. Her medical history and examination revealed type 2 diabetes. Her blood work showed elevated blood glucose levels. The doctor diagnosed her with type 2 diabetes and prescribed an insulin regimen, oral medications, and a diabetic diet to control her blood sugar levels and prevent complications. The document also provides background information on diabetes, including types, causes, symptoms, investigations, complications, prevention, and nursing care considerations.

4. Patient/Client Profile :
 Name : Mira Begum Reg No : 1663/251
 Age : 40 Years Admission Date : 15.09.19
 Husband Name : Hamidul Hoque
 Address : Kaharol, Dinajpur
 Occupation : Housewife
 Husband Occupation : Farmer
 Monthly Income : 12.000
 Education Qualification : Eight
 Education Qualification : Eight
 Ward : Female Medicine Ward
 Bed : 07
 Religion : Islam

5. Patient illness History :
 Chief Complication : Diabetes Mellitus (DM)
 Past History : No family history
 Present History : Diabetes Mellitus e fever
Breathlessness
Acute Abdominal Pain
Examination of Vital Sign :
Temperature : 101 ̊ F
Pulse : 78 b/min
Blood Pressure : 120/70 mm Hg
Heart Sound : Rhymatic Normal

6. Physical Examination :
 Colour : Straw
 Appearance : Clear
 Sugar : Nil
 Raction : Acidic
 Pus cells : 01-02
 Epithelial cell : 02-03
Blood Examination :
Haemoglobin- 11.0%
FSR- 20 min 1st hour
Total Count- 8.000 Lcmm
Differential count of WBC
Neutrophil Count-68%

7. Advice/Diagnosis :
 RBC
 CBC
 S. Creatinin
 Urine for R/E
 BG 2HABF [Blood glucose 2 hours After Break
fast]

8. Doctor Order :
• Diet : Diabetic
• Inj : Disulin 30/70
18+0+12
• Cap :Omep (20mg)
1+0+1
• Tab : F/S
0+1+0
• Tab : Calcium
0+0+1
• Tab : Silagil
1+0+0

10. Normal Blood Glucose Level
Fasting : 3.6-6.1 mmoL/L
Random: <7.8 mmoL/L
Diabetes Mellitus
Fasting : ≥7.0 mmoL/L
Random : ≥11.1mmoL/L

11. Types of Diabetes Mellitus
 Type-1 ( Insulin dependent ) Diabetes mellitus as
patients have little or no ability to produce the hormone
and are entirely dependent or insulin infection for
survival.

12.  Type-2 (Non- Insulin dependent ) Diabetes mellitus
as the pancreas retains some ability to produces
insulin. Patient require treatment with oral
hypoglycaemia drugs.

13.  Gestational Diabetes Mellitus as diabetes
develops during pregnancy.

14. Causes of Diabetes Mellitus
 Absence or insufficient production of insulin or and
inability of the body to properly use insulin causes
Diabetes.
 It is cause by heridity
 Genetic
 Environmental factors
 Diet, Stress
 Pregnancy
 Pancreatic carcinoma

15.  High blood pressure
 High fat diet
 High alcohol intake
 Obesity

16. Clinical Feature of Diabetes Mellitus
 Increased thirst

17.  Frequent urination

18.  Extreme hunger

19.  Unexplained weight loss

20.  Presence of ketone in urine

21. Fatigue

22. Irritability

23.  Blurred vision

24.  Slow healing sores

25.  Frequent infection such as gums on skin and
vaginal infection .

26. Others :
Dehydration

27. Hypotension

28. Confusion

29.  Hyperventrilation

32. Investigation of Diabetes Mellitus
A. Blood glucose determination by –
1. Random blood glucose
2. Fasting blood glucose ≥7.0 mmol/L
3. 2 hour after breakfast ≥11.1 mmol/L
4. OGTT ( oral glucose tolerance test )
B. Urine Examination –
1. Sugar – Benedict test

33. Others –
1. CBC ( Complete Blood Count )
2. Fasting Lipid profile
3. S. Creatinine
4. S. electrolytes

34. Diabetes complications
 heart disease, heart attack, and stroke
 neuropathy
 nephropathy
 retinopathy and vision loss
 hearing loss
 foot damage such as infections and sores that
don’t heal
 skin conditions such
as bacterial and fungal infections
 depression
 dementia

35. Prevention Of Diabetes Mellitus
 Exercise regularly

36.  Control of carbohydrate intake

37.  Drink water and stay hydrate

38.  Increased of fiber intake

39.  Choose fruits with a low glycaemia index

40.  Control stress level

41.  Monitor the blood sugar level

42. Nursing Intervention of
Diabetes Mellitus

43.  Administer insulin or and oral anti diabetic drug as
prescribed.
 Supervised exercise program.
 Hypo-glycaemic reaction promptly by giving
carbohydrate in the form of fruits juice, hard
candy, honey or I/V dextrose .
 Provide skin cars specially to the feets and legs .
 Assist the patient to develop coping strategies.
 Keep accurate records of vital sign, weight, fluid
intake, urine output and caloric intake .

44.  Monitor Diabetic effects on the cardio vascular,
peripheral vascular and nervous system .
 Observe for sign urinary tract and vaginal
infection and monitor the patients urine for
protein and early sign of nephropathy .
 Recomment regular ophthalmologic examination .
 Teach the patient how to care for his feet ?
 Teach the patient and the family how to monitor
the patient diet .

45. Diet for Diabetes Mellitus Patient:
 To eat a varify of healthy foods from all food groups
with plenty of fibers .
 Vegetables like broccli, carrots, papers and tomatoes,
potatoes corn and green peas .
 Fruits like oranges, melon, barries, apples, bananas
and grapes .
 Grains like wheat, rice, oats, corn meal, barley.
 Protein like lean meat, chicken without skin, fish,
eggs, nuts, peanuts, dried beans .
 Dairy low fat milk, yogurt, cheese .

47. Reference :
 Definition, Normal level, Type-ref. own memories
 Risk factor –
Ref. Davidson’s 20 the ed.p-826
 Complication –
Ref. MR Khan 14 th 232-33