Diabetes is a metabolic disorder characterized by hyperglycemia due to defects in insulin secretion or action. There are three main types: type 1 diabetes results from beta cell destruction and requires insulin therapy; type 2 involves insulin resistance and sometimes relative insulin deficiency; gestational diabetes occurs during pregnancy. Chronic hyperglycemia can lead to microvascular complications affecting the eyes, kidneys, and nerves as well as increased cardiovascular risk. Treatment involves lifestyle changes, oral hypoglycemic medications or insulin depending on the type and severity of diabetes.

2. Introduction
 Diabetes is a disorder characterized by
hyperglycemia or elevated blood glucose
(blood sugar). Our bodies function best
at a certain level of sugar in the
bloodstream. If the amount of sugar in
our blood runs too high or too low, then
we typically feel bad. Diabetes is the
name of the condition where the
blood sugar level consistently runs
too high. Diabetes is the most common
endocrine disorder.

3. Definition
 Diabetes mellitus is a metabolic
disorder characterized by the
presence of hyperglycemia due to
defective insulin secretion, defective
insulin action or both. Note: The
chronic hyperglycemia of diabetes is
associated with relatively specific
long-term microvascular complications
affecting the eyes, kidneys and
nerves, as well as an increased risk
for cardiovascular disease (CVD).

4. Types
Type 1 diabetes:
 It is also called insulin-dependent diabetes.
It
used to be called juvenile-onset diabetes,
because it often begins in childhood.
 A number of medical risks are associated
with type 1 diabetes. Many of them stem
from damage to the tiny blood vessels in
your eyes (called diabetic retinopathy),
nerves (diabetic neuropathy), and
kidneys (diabetic nephropathy). Even
more serious is the increased risk of heart
disease and stroke.

5. Cont….
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.

6. Cont….
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.

7. Pathophysiology
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

8. Cont….
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

9. Cont….
Glycerol convert Ketone bodies
Ketoneuria
Decreased pH level in the blood
Ketoacidosis
Cardiac Arrest

10. Clinical Manifestation
 Polydipsia
 Polyphagia
 Polyuria
 Weightloss
 Blurred Vision
 Ketone Urine
 Pruritis
 Skin infestation
 Vaginitis
 Weakness
 Fatique
 Poor wound
healing
 Recurrent infection
 Hyperglycemia
 Depression

11. Diagnostic Evaluation
i)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.
ii) Random Blood Sugar:-
 Any time random blood sugar can be taken.
iii) 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)

12. Cont….
iv) Glycated Hemoglobin:-
 Measures glycemic control over the period of
irreversible reaction of glucose hemoglobin
through freely permiable.
v) 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 sustacal, IV glucose or 1mg of
glucagon subcutaneously.

13. 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.

14. Cont….
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.

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

16. Cont….
IV. Meglitinides:-
Prandin – 1-3 times/ day-Stimulate
insulin secretion.
V. Thiazolodine-diones:-
Avandia (od)- Increase insulin action at
receptors.

17. Insulin Therapy
Duration of action:
 Short, Intermediate and Long acting
Drugs: 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

18. Diet 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.

19. Nursing Management
 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 – effect of
diabetes on life style, finances, family
life etc.

20. 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
hypoglysemic agents.

21. Complication
Acute:
 Hypoglycemia
 Diabetic Keto-acidosis
 Cataract
 Pyodermia
Chronic:
 Retinopathy
 Nephropathy
 Cardiopathy