Diabetes mellitus is a chronic disease characterized by high blood glucose levels due to either insufficient insulin production or the body's inability to use insulin properly. There are several types of diabetes including type 1 caused by autoimmune destruction of insulin-producing beta cells, and type 2 typically associated with obesity and aging and initially managed through lifestyle changes and oral medications. Complications of diabetes can be acute like ketoacidosis or hypoglycemia, or chronic through damage to blood vessels and nerves over many years.

2. Diabetes Mellitus

3. Definition:- Diabetes mellitus is a chronic systemic disease characterized by either a deficiency of insulin or a decrease ability of the body to use insulin.

4. Anatomy & Physiology:-

5. Classification of D.M.:-

6. Type-I Diabetes mellitus:- In this form of diabetes mellitus the Beta cells of pancreas that normally produce insulin which are destroy by an auto-immune response. As a result insulin injection are needed to control the elevated blood sugar level.

7. Causes:- 1) Genetic factors.(HLA) 2) Immunological factors. 3) Environmental factors.

8. Patho-physiology:-

10. Type-2 Diabetes mellitus:- It refers from decreased sensitivity to insulin or decrease production of insulin. This type of patient firstly treated by diet and exercise and secondary by oral hypoglycemic drug.

11. Causes:- 1) Age- > 65yrs. 2) Obesity 3) Family history.

12. Gestational D.M. :- Onset is during pregnancy usually 2nd & 3rd trimester. It may be due to hormonal secretion by the placenta which inhibit the action of insulin.

13. 4) Associated with other conditions:- 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.

14. 5) Impaired Glucose Tolerance:- Most common in people who are susceptible to artherosclerosis disease, obese or non-obese patient , previous history of hyperglycemia,

15. Clinical Manifestation:- Polydypsia. Polyphasia. Polyuria. Hyperglycemia. Blurred vision. Diabetic ketosis. Diabetic ketoacidosis. Dry skin. Slow healing wound. Weakness.

16. Investigations:- 1) Fasting blood glucose. 2) Random blood glucose. 3) Postprandial blood glucose level. 4) Oral glucose tolerance test. 5) Urine test for ketonuria. 6) Urine test for proteinuria.

17. Complications:- 1) Chronic complications:- -Macrovascular complication. (coronary artery d/s, cerebrovascular d/s, Hypertension etc.) -Microvascular complications. (Retinopathy, nephropathy) -Neuropathic complications:- (Sensorimotor neuropathy, autonomic neuropathy) -Mixed:- (Foot ulcer)

18. Acute Complications:- -Hypoglycemia. -Hyperglycemia. -Diabetic ketoacidosis. -Diabetic retinopathy. -Diabetic nephropathy. -Diabetic neuropathy.

19. Management:- The main management or goal is to normalise insulin activity and blood glucose level to reduce the vascular and nephropathic complications. 5 main components of management of diabetes mellitus patient’s are:-

20. Cont.. 1) Diet 2) Exercise 3) Monitoring 4) Education 5) Medication

21. Pharmacological t/t:- (A) Insulin therapy:- Insulin may be grouped into several categories based on the onset, peak and duration of action……. 1) Rapid acting:- Eg. Lispro, Aspart onset- 10-15min. duration- 8hrs. 2) Short acting:- Eg. Humalog R, Novolin R onset- ½-1hr duration- 4-6 hrs

22. 3) Intermediate acting :- Eg. ProtamineHagedorn, Novolin L onset- 2-4 hrs duration- 16-24hrs. 4) Long acting :-Eg. Ultralenate onset-6-8 hrs. duration-20-30hrs. 5) Very long acting:- Eg. Glargine onset- 1hr. duration- 24hrs

23. (B) Oral diabetic agent:- -Sulfonylureas (stimulate pancreas to stimulate insulin) -Biguanides- (helps to decrease the glucose level) -Alpha glucosidase inhibitors (delaying absorption of glucose) -Thiazolidinediones (promote insulin action) -Meglitinides- ( decrease glucose level) Surgical Management:- Pancreas transplantation

24. Nursing Management:- Assessment:- - Assess the general condition of the patient. - Assess the past and medical history of the patient. - Assess for the etiological factors responsible in client. - Assess for signs and symptoms in the client. - Assess for the type of diabetes and type of insulin used foe the patient. -Assess for the investigation for the patient.

25. Nursing Diagnosis:- Risk for fluid volume deficit related to polyuria and dehydration. Imbalance nutrition related to imbalance of insulin, food and physical activity. Deficient knowledge about diabetes self care skills/ information. Potential self-care deficit related to physical impairments or social factors. Anxiety related to loss of control, fear of inability to manage diabetes, misinformation related to diabetes, fear of diabetes complications.

26. Intervention:- 1) Maintaining fluid and electrolyte balance Intake and output are measured. I/V fluids and electrolytes are administered as prescribed. Oral intake is encouraged when it is permitted. Vital signs are monitored hourly for signs of dehydration. 2) Improving nutritional intake… Meal planning is implemented, with the control of glucose as the primary goal. An appropriate caloric intake allows the patient to achieve and maintain desired body weight.

27. 3) Reducing anxiety.. Provide emotional support and sets aside time to talk with the patient. Any misconception the or family may have regarding diabetes are dispelled. Positive reinforcement is given for the self care behaviours. 4) Improving self care..

28. Assignment:- M.M-10 Time-10mins 1) Define diabetes mellitus. 2) Enlist the types of diabetes mellitus. 3) Write down the clinical manifestations of diabetes mellitus. (Write your name and roll no. on the top of the answer sheet.)