Diabetes mellitus


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this was my practice teaching of Diabetec mellitus of 45 min, and i had to cmplete this ..

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Diabetes mellitus

  1. 1.
  2. 2. Diabetes Mellitus<br />
  3. 3. Definition:-<br />Diabetes mellitus is a chronic systemic disease characterized by either a deficiency of insulin or a decrease ability of the body to use insulin. <br />
  4. 4. Anatomy & Physiology:-<br />
  5. 5. Classification of D.M.:-<br />
  6. 6. Type-I Diabetes mellitus:-<br />In this form of diabetes mellitus the Beta cells of pancreas that normally produce insulin which are destroy by an auto-immune response. <br />As a result insulin injection are needed to control the elevated blood sugar level.<br />
  7. 7. Causes:-<br />1) Genetic factors.(HLA)<br />2) Immunological factors.<br />3) Environmental factors.<br />
  8. 8. Patho-physiology:-<br />
  9. 9.
  10. 10. Type-2 Diabetes mellitus:-<br />It refers from decreased sensitivity to insulin or decrease production of insulin.<br />This type of patient firstly treated by diet and exercise and secondary by oral hypoglycemic drug. <br />
  11. 11. Causes:-<br />1) Age- > 65yrs.<br />2) Obesity<br />3) Family history.<br />
  12. 12. Gestational D.M. :-<br />Onset is during pregnancy usually 2nd & 3rd trimester.<br />It may be due to hormonal secretion by the placenta which inhibit the action of insulin.<br />
  13. 13. 4) Associated with other conditions:-<br />It is a form of non- insulin dependent diabetes mellitus, in which the disease is associated with other disease, hormonal abnormalities, drugs such as gluco-corticoids and oestrogen containing preparation.<br />
  14. 14. 5) Impaired Glucose Tolerance:-<br />Most common in people who are susceptible to artherosclerosis disease, obese or non-obese patient , previous history of hyperglycemia, <br />
  15. 15. Clinical Manifestation:-<br />Polydypsia.<br />Polyphasia.<br />Polyuria.<br />Hyperglycemia.<br />Blurred vision.<br />Diabetic ketosis.<br />Diabetic ketoacidosis.<br />Dry skin.<br />Slow healing wound.<br />Weakness.<br />
  16. 16. Investigations:-<br />1) Fasting blood glucose.<br />2) Random blood glucose.<br />3) Postprandial blood glucose level.<br />4) Oral glucose tolerance test.<br />5) Urine test for ketonuria.<br />6) Urine test for proteinuria. <br />
  17. 17. Complications:-<br />1) Chronic complications:-<br /> -Macrovascular complication.<br /> (coronary artery d/s, cerebrovascular d/s, Hypertension etc.)<br /> -Microvascular complications.<br /> (Retinopathy, nephropathy)<br /> -Neuropathic complications:-<br /> (Sensorimotor neuropathy, autonomic neuropathy)<br /> -Mixed:-<br /> (Foot ulcer)<br />
  18. 18. Acute Complications:-<br />-Hypoglycemia.<br /> -Hyperglycemia.<br /> -Diabetic ketoacidosis.<br /> -Diabetic retinopathy.<br /> -Diabetic nephropathy.<br /> -Diabetic neuropathy.<br />
  19. 19. Management:-<br />The main management or goal is to normalise insulin activity and blood glucose level to reduce the vascular and nephropathic complications.<br />5 main components of management of diabetes mellitus patient’s are:- <br />
  20. 20. Cont..<br />1) Diet<br />2) Exercise<br />3) Monitoring<br />4) Education<br />5) Medication<br />
  21. 21. Pharmacological t/t:-<br /> (A) Insulin therapy:-<br />Insulin may be grouped into several categories based on the onset, peak and duration of action…….<br /> 1) Rapid acting:-<br />Eg. Lispro, Aspart<br /> onset- 10-15min.<br /> duration- 8hrs.<br />2) Short acting:-<br />Eg. Humalog R, Novolin R<br /> onset- ½-1hr<br /> duration- 4-6 hrs<br />
  22. 22. 3) Intermediate acting :-<br />Eg. ProtamineHagedorn, Novolin L<br /> onset- 2-4 hrs<br /> duration- 16-24hrs.<br />4) Long acting :-Eg. Ultralenate<br /> onset-6-8 hrs.<br /> duration-20-30hrs.<br />5) Very long acting:-<br />Eg. Glargine<br /> onset- 1hr.<br /> duration- 24hrs <br />
  23. 23. (B) Oral diabetic agent:-<br /> -Sulfonylureas<br /> (stimulate pancreas to stimulate insulin)<br /> -Biguanides-<br /> (helps to decrease the glucose level)<br /> -Alpha glucosidase inhibitors<br /> (delaying absorption of glucose)<br /> -Thiazolidinediones<br /> (promote insulin action)<br /> -Meglitinides-<br /> ( decrease glucose level)<br />Surgical Management:-<br />Pancreas transplantation<br />
  24. 24. Nursing Management:-<br />Assessment:-<br /> - Assess the general condition of the patient.<br /> - Assess the past and medical history of the patient.<br /> - Assess for the etiological factors responsible in client.<br /> - Assess for signs and symptoms in the client.<br /> - Assess for the type of diabetes and type of insulin used foe the patient.<br /> -Assess for the investigation for the patient. <br />
  25. 25. Nursing Diagnosis:-<br />Risk for fluid volume deficit related to polyuria and dehydration.<br />Imbalance nutrition related to imbalance of insulin, food and physical activity.<br />Deficient knowledge about diabetes self care skills/ information.<br />Potential self-care deficit related to physical impairments or social factors.<br />Anxiety related to loss of control, fear of inability to manage diabetes, misinformation related to diabetes, fear of diabetes complications.<br />
  26. 26. Intervention:-<br />1) Maintaining fluid and electrolyte balance<br />Intake and output are measured.<br />I/V fluids and electrolytes are administered as prescribed.<br />Oral intake is encouraged when it is permitted.<br />Vital signs are monitored hourly for signs of dehydration.<br />2) Improving nutritional intake…<br />Meal planning is implemented, with the control of glucose as the primary goal.<br />An appropriate caloric intake allows the patient to achieve and maintain desired body weight.<br />
  27. 27. 3) Reducing anxiety..<br />Provide emotional support and sets aside time to talk with the patient.<br />Any misconception the or family may have regarding diabetes are dispelled.<br />Positive reinforcement is given for the self care behaviours.<br />4) Improving self care..<br />
  28. 28. Assignment:-<br />M.M-10 Time-10mins<br />1) Define diabetes mellitus.<br />2) Enlist the types of diabetes mellitus.<br />3) Write down the clinical manifestations of diabetes mellitus.<br />(Write your name and roll no. on the top of the answer sheet.)<br />