This document provides information on diabetes mellitus including: - It defines diabetes as a metabolic disorder causing high blood sugar levels over time due to the body's inability to respond to or produce insulin. - There are two main types of diabetes - type 1 usually occurs at a young age and type 2 which is more common in obese adults over 30. - Symptoms include frequent urination, thirst, and hunger as the body turns to other energy sources without enough insulin. - Treatment involves nutritional therapy, insulin administration, oral medications, education, and managing acute complications like hypoglycemia and ketoacidosis. - Long term complications can impact the cardiovascular, ocular, renal, and neurological systems if blood sugar

1. NURSING CARE
DIABETES MELLITUS

2. Diabetes
What is diabetes?
What population of patients would
be
at risk for developing diabetes?

3. Diabetes Mellitus
 Commonly referred to as diabetes.
 Diabetes “Greek word”- Siphon implies a lot of
urine.
 Mel “Latin word”- Honey.
 Metabolic disorder in which there are High
blood sugar levels over a prolonged period.

4. Anatomy

5. Diabetes
 Normal Pathophysiology
 Need to consider how insulin works
 insulin continuously released: during “fasting
periods”, the pancreas continuously releases a
small amount of insulin along with glucagon.
Together a constant level of glucose in the blood
is maintained by stimulating the release of
glucose from the liver.

6. Diabetes
 In diabetes
 the body’s ability to respond to insulin may
decrease
 the pancreas may stop producing insulin. This in
turn leads to hyperglycemia leads to other
acute metabolic complications
 Diabetes is a heterogeneous group of diseases
involving disruption of metabolism of
carbohydrates, fats, and protein.

7. Diabetes
 Classification of diabetes mellitus
Type I
 may occur at any age
 usually thin
 abrupt onset
 family history?

8. Diabetes
 Type II
 >age 30
 often obese
 few classic symptoms
 insulin resistant
 Impaired glucose tolerance
 plasma glucose levels higher than normal, but not
diagnostic for diabetes 2 hr plasma glucose >140
mg/dl & < 200 mg/dl

9. Diabetes
 Impaired fasting glucose
 fasting plasma glucose > 110 mg/dl & < 126 mg/dl
 Gestational diabetes
 has onset or discovery of glucose tolerance during
pregnancy

10. Diabetes
 Clinical Manifestations
 Insulin deficiency or decreased insulin activity glucose not
used properly
 results in frequent urination (polyuria), and thirst
(polydipsia)
 without insulin the patient may experience hunger
(polyphagia)
 the body will turn to other energy sources besides glucose:
first fat and then protein

11. Diabetes
 Diagnostic studies
 normal blood glucose range: 70-110 mg/dl
 urine tests not sufficient for a dx of diabetes
 fasting blood glucose of > 126 mg/dl
 glycosylated hemolobin

12. Diabetes
 Nutritional therapy
 Goals of nutritional therapy
 maintenance of as near-normal blood glucose levels
 achievement of optimal serum lipid levels
 provision of adequate calories for maintaining or
attaining reasonable weights, normal growth &
development rates
 prevention and treatment of acute complications
 improvement of overall health through optimal nutrition

13. Diabetes
 Nutritional therapy
 Type I
 based on patient’s usual food intake with insulin
therapy
 eat at consistent times, synchronized with the action of
their insulin
 monitor blood glucose levels and adjust as needed

14. Diabetes
 Nutritional therapy
 Type II
 achieving glucose, lipid, and blood pressure goals
 weight loss is desirable
 regular exercise
 monitor blood glucose level

15. Diabetes
 Drug therapy
4 types of insulin; things to consider
 how soon the insulin starts working (onset)
 when it works the hardest (peak time)
 how long it lasts in your body (duration)

16. Insulin
 Rapid-acting insulin:
 onset: 15 minutes after injection
 peak: 30-90 minutes later
 duration: may last as long as 5 hours
 Short-acting:
 onset: 30 minutes after injection
 peak:2 to 4 hours
 duration: 4 to 8 hours

17. Insulin
 Intermediate-acting
 onset: 2 to 6 hours
 peak: 4 to 14 hours
 duration: 14 to 20 hours
 Long-acting
 onset: 6 to 14 hours
 peak: 10 to 16 hours
 duration: 20 to 24 hours

18. Insulin and Oral Agents
 Problems with insulin therapy
 allergic reactions
 lipodystrophy
 Somogyi effect and dawn phenomenon
 Oral medications
 Other drugs affecting blood glucose levels

19. Nursing Management: Diabetes
 Assessment:
 Subjective data
 past health information
 family history
 medications
 surgery and other treatments
 Health-perception-health management
 + family history, malaise

20. Nursing Management: Diabetes
 Nutritional-metabolic
 weight
 thirst and hunger
 Nausea and vomiting
 poor healing compliance with diet
 Elimination
 constipation or diarrhea
 frequent urination, incontinence, nocturia
 skin infections

21. Nursing Management: Diabetes
 Activity-exercise
 muscle weakness, fatigue
 Cognitive-perceptual
 abdominal pain, headache, blurred vision,
numbness or tingling of extremities, pruritis
 Sexuality-reproductive
 impotence, frequent vaginal infections, decreased
libido

22. Nursing Management: Diabetes
 Coping-stress
 depression
 apathy
 irritability
 Value-belief
 commitment to lifestyle changes involving diet,
medication, and activity patterns

23. Nursing Management: Diabetes
 Insulin therapy
 assessment of patient’s use of and response to
insulin therapy
 education of the patient regarding administration,
adjustment to, and side effects of insulin

24. Nursing Management: Diabetes
 Oral agents
 nursing responsibilities similar to those taking
insulin
 Personal hygiene
 dental
 skin care
 Medical identification and travel
 Follow-up nursing management

25. Methods of Insulin Delivery
 Pens
 Jet injectors
 Insulin pumps—insulin is delivered at .5-2
units/hour. Most common risk of insulin pump
therapy is ketoacidosis.
 Implantable devices
 Transplantation of pancreatic cells

26. Complications of Diabetes
 Diabetic Ketoacidosis
 Etiology
 undiagnosed diabetes
 inadequate treatment of existing diabetes
 insulin not taken as prescribed
 change in diet, insulin, or exercise regimen

27. Complications of Diabetes
 Diabetic Ketoacidosis
 Assessment
 dry mouth, thirst, abdominal pain, N & V, confusion,
lethargy, flushed dry skin, eyes appear sunken, breath
odor of ketones, rapid, weak pulse, labored breathing,
fever, urinary frequency, serum glucose > 300 mg/dl,
glucosuria and ketonuria

28. Complications of Diabetes
 Diabetic Ketoacidosis
 Nursing interventions
 Initial
 ensure patent airway
 O2
 establish IV access and begin fluid resuscitation
begin continuous IV insulin
 identify history of diabetes, time of last food, and
time/amount of last insulin injection

29. Complications of Diabetes
 Diabetic Ketoacidosis
 Nursing interventions
 ongoing monitoring
 monitor VS, LOC, cardiac rhythm, O2 saturation, and urine
output
 assess breath sounds
 monitor serum glucose and serum potassium
 anticipate possible administration of sodium bicarbonate
with severe acidosis (pH < 7.0)

30. Complications of Diabetes
 Hyperglycemic Hyperosmolar Nonketosis
 occurs in a patient who has some insulin to
prevent DKA but not enough to prevent severe
hyperglycemia, osmotic diuresis, and extracellular
fluid depletion
 usually is a history of inadequate fluid intake,
increasing mental depression and polyuria
 HHNK constitutes a medical emergency

31. Complications of Diabetes
 Hyperglycemic Hyperosmolar Nonketosis
 Nursing management
 administration of a rapid-acting insulin
 administration of IV fluid
 assessment of mental status
 I & O
 assessment of blood glucose levels
 assessment of blood and urine for ketones
 electrocardiogram monitoring

32. Complications of Diabetes
 Hypoglycemia
 clinical manifestations
 blood glucose <50 mg/dl
 cold, clammy skin
 numbness of fingers , toes, mouth
 emotional changes, HA, nervousness, seizures, coma,
faintness, dizziness
 changes in vision
 hunger
 unsteady gait, slurred speech

33. Complications of Diabetes
 Hypoglycemia
 causes
 alcohol intake with food
 too little food - delayed, omitted, inadequate intake
 diabetic medication or food taken at wrong time
 loss of weight with change of medication
 use of B-blockers

34. Complications of Diabetes
 Hypoglycemia
 nursing management
 immediate ingestion of 5-20 g of simple carbohydrates
 ingestion of another 5-20 g of simple carbohydrates in
15 min if no relief obtained
 contact physician if no relief obtained
 collaborate with physician
 prevention is the key

35. Complications of Diabetes
 Hyperglycemia
 clinical manifestations
 elevated blood sugar
 increase urination
 increase in appetite followed by lack of appetite
 weakness, fatigue
 blurred vision, HA
 nausea and vomiting, abdominal cramps
 glycosuria
 progression to DKA or HHNK

36. Complications of Diabetes
 Hyperglycemia
 causes
 too much food
 too little or no diabetes medication
 inactivity
 emotional, physical stress
 poor absorption of insulin

37. Complications of Diabetes
 Hyperglycemia
 nursing management
 notify physician
 continuance of diabetes medication as ordered
 frequent checking of blood and urine specimens and
recording of results
 prevention is key

38. Chronic Complications
 Macroangiopathy
 Microangiopathy
 Peripheral Vascular Disease
 Diabetic Retinopathy
 Nephropathy
 Neuropathy
 Skin changes

39. Teaching Plan
 Education is critical
 Simple Pathophysiology
 Treatment modalities
 Recognition, treatment and prevention of acute complications
 When to call the doctor
 Foot care, eye care, general hygiene, risk factor management

40. Teaching patients to
administer insulin
 Storing insulin (may not refrigerate if used within
one month). Prefilled syringes should be stored
standing up.
 Syringes
 Concentrations of insulin
 Mixing insulins
 Do not rotate area to area, use same anatomic area
 No need to aspirate

41. THANK YOU ! 