This document provides an overview of diabetes mellitus (DM), including its causes, types, symptoms, diagnostic criteria, management, and nursing considerations. DM is characterized by high blood glucose levels due to defects in insulin production or action. There are four main types of DM: type 1, type 2, secondary, and gestational. Management involves diet, exercise, medication including oral hypoglycemics and insulin, monitoring, and patient education on self-care. Nurses assess and care for patients with DM by addressing issues such as nutrition, fluid balance, skin integrity, and anxiety.

1. P R E S E N T E D B Y :
D R . P A L L A V I P A T H A N I A
DIABETES MELLITUS

2.  Diabetes mellitus (DM) is a group of diseases
characterized by high levels of blood glucose
resulting from defects in insulin production, insulin
action, or both.
 The term diabetes mellitus describes a metabolic
disorder of multiple aetiology characterized by chronic
hyperglycaemia with disturbances of carbohydrate, fat
and protein metabolism resulting from defects in
insulin secretion, insulin action, or both.
What is diabetes?

4. RISK FACTORS

5. Who are
prone ...?

6. Classification / Etiology of diabetes mellitus
1. Type 1 diabetes
2. Type 2 diabetes
3. Secondary diabetes
4. Gestational diabetes

7. Type 1 diabetes
• Occur at any age, but usually <30
years
• Usually thin at diagnosis
• Can be due to genetic,
immunologic or environmental
factors
• Can have islet cell antibodies
• No endogenous insulin , so
require exogenous insulin
• Diabetic ketoacidosis prone

8. Type 2 Diabetes
• Onset at age , usually >30
years
• Usually obese at diagnosis
• Can be due to hereditary or
environmental factors
• No islet cell antibodies
• Decreased insulin production
or decreased sensitivity to
insulin
• Oral anti-diabetic agents may
improve blood glucose levels
• Diabetic keto-acidosis is rare

9. Gestational Diabetes
• Onset usually in 2nd or 3rd
trimester
• Placental hormones
reduces action of insulin
• Treated with diet or insulin

10. PATHOPHYSIOLOGY

12. SIGN AND SYMPTOMS

16. Diagnostic Criteria
• Polyuria, Polyphagia , Polydipsia plus plasma
glucose concentrations > 200 mg/dl
• Fasting plasma glucose concentrations > 126
mg/dl
• 2- hour post-parandial plasma glucose
concentration > 200 mg/dl
•Glycosylated hemoglobin

17. Fasting Plasma Glucose

18. Diagnostic range of blood sugar (plasma glucose)
Normal
glucose
tolerance
Impaired
glucose
tolerance
Diabetes
mellitus
Fasting plasma glucose
(mg/dL)
<110 110-126 >126
Between 0-120 min (mg/dL) <200 <200 200 at
least
once
2 hours after glucose load
(mg/dL)
<140 >140, but
<200
>200

19. Urinalysis
Glycosuria
Ketone bodies

20. Management of
Diabetes Mellitus

21. Management
Nutrition
Exercise
MonitoringDrugs
Education

22.  The major components of the treatment of diabetes
are:
Management of DM
• Diet and
ExerciseA
• Oral hypoglycaemic
therapyB
• Insulin TherapyC

23. Dietary Considerations
• BMI
• Activity level
• Age / Sex
• Present food habits
• Economic status
• Complications in Diabetes
• Treatment of Diabetes

24.  Diet is a basic part of management in every case.
 Dietary treatment should aim at:
◦ ensuring weight control
◦ providing nutritional requirements
◦ allowing good glycaemia control with blood glucose levels as
close to normal as possible
A. Diet

25. The following principles are recommended as
dietary guidelines for people with diabetes:
 Dietary fat should provide 25-35% of total intake of
calories but saturated fat intake should not exceed 10% of
total energy.
 Cholesterol consumption should be restricted and limited
to 300 mg or less daily.
 Protein intake can range between 10-15% total energy (0.8-
1 g/kg of desirable body weight).
 Excessive salt intake is to be avoided. It should be
particularly restricted in people with hypertension and
those with nephropathy.
A. Diet (cont.)

26. Exercise
• Provides physical fitness
• Carbohydrate metabolism
• Weight & insulin sensitivity
• Risk factors for cardio-
vascular disease
• Blood pressure & Cardiac
work

27.  Physical activity promotes weight reduction and
improves insulin sensitivity, thus lowering blood
glucose levels.
Exercise

28. Considerations during exercise
• Use proper footwear during
exercise
• Avoid exercise in extremes of
temperature
• Inspect feet daily
• Avoid exercise in periods of
poor metabolic control
• Do not exercise empty or full
stomach

29. Monitoring
A – A1C Levels {estimated average
BS level}
B – Blood pressure
C – Cholesterol
D – Diabetic education
E – Eye Examination
F – Foot Examination
G – Blood Glucose Examination
H – Health
I – Indications & Referral

30. Drugs
Oral Hypoglycemic
Agents Insulin

31.  There are currently four classes of oral anti-diabetic
agents:
i. Biguanides
ii. Sulphonylureas
iii. Non-sulphonylureas
iv. α-glucosidase inhibitors
v. Thiazolidinediones (TZDs)
B. Oral Anti-Diabetic Agents

32. Oral Hypoglycaemic Medications

33. C. Insulin THERAPY
Used in treatment of –
• Type 1 Diabetes
• Acute Conditions of Type 2
Diabetes

35. 35
Delivery Methods
 Insulin Syringe
 Insulin Pen
 Insulin Pump
 Jet Injector

36. Insulin Injection sites

37. Nursing Management

38. Nursing Assessment

41. Nursing Diagnosis
1) Imbalanced Nutrition Less Than Body Requirements R/T reduction of
carbohydrate metabolism due to insulin deficiency, inadequate intake due to nausea
and vomiting.
2) Fluid Volume Deficit related to osmotic diuresis from hyperglycemia, polyuria,
decreased fluid intake.
3) Impaired Skin Integrity related to decreased sensory sensation, impaired
circulation, decreased activity / mobilization, lack of knowledge of skin care.
4) Activity Intolerance related to weakness due to decreased energy production.
5) High risk of injury associated with decreased sensation sensory (visual),
weakness, and hypoglycemia.
6) Anxiety related to a lack of knowledge (diabetes management), the ability to
remember the less, diagnosis or treatment of a new way, cognitive limitations.
7) Risk for ineffective management of therapeutic rules at home due to a lack of
knowledge about the condition of the therapeutic management, inadequate support
systems.

42. Nursing diagnosis ……(Contd.)
Altered nutrition : less than
body requirements
•Abnormal glucose
metabolism
•Depletion of fat stores,
cellular proteins
•Decreased oral intake –
dislike of prescribed diet,
anorexia gastric fullness

43. Nursing diagnosis ……(Contd.)
Altered fluid –volume deficit
•Osmotic diuresis
•Vomiting
•Diarrhea
•Diabetic Keto-acidosis

44. Nursing diagnosis ……(Contd.)
Impaired skin integrity
•Abnormal pressure distribution due to peripheral
neuropathy
•Delayed wound healing

45. Nursing diagnosis ……(Contd.)
Altered systemic tissue
perfusion
•Vascular abnormalities
•Hypovolemia
•Orthostatic hypotension

46. Nursing Diagnosis
Anxiety
•Unfamiliar environment
•Lack of understanding of
diagnosis & management
•Possible changes in life-
style & roles

47. Education
• Diabetes Mellitus
• Approaches Of Management
• Dietary Requirements
• Exercise Regimen
• Oral Hypoglycemic Drugs
• Insulin therapy
• Complications
• Foot care
• Adherence to treatment & Follow-up

48.  Patients should be educated to practice self-care. This allows the
patient to assume responsibility and control of his / her own
diabetes management. Self-care should include:
◦ Blood glucose monitoring
◦ Body weight monitoring
◦ Foot-care
◦ Personal hygiene
◦ Healthy lifestyle/diet or physical activity
◦ Identify targets for control
◦ Stopping smoking
Self-Care

49. “Of course too
much is bad for
you”