Diabetes Mellitus

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.

Anatomy & Physiology:-

Classification of D.M.:-

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.

Causes:-1) Genetic factors.(HLA)

2) Immunological factors.

3) Environmental factors.

Patho-physiology:-

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.

Causes:-1) Age- > 65yrs.

2) Obesity

3) Family history.

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.

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.

5) Impaired Glucose Tolerance:-Most common in people

who are susceptible to

artherosclerosis disease,

obese or non-obese

patient , previous history

of hyperglycemia,

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

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.

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)

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

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:-

Cont..1) Diet

2) Exercise

3) Monitoring

4) Education

5) Medication

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

3) Intermediate acting :- Eg. Protamine Hagedorn, 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

(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

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.

Nursing Diagnosis:-1) Risk for fluid volume deficit related to

polyuria and dehydration.2) Imbalance nutrition related to imbalance of

insulin, food and physical activity.3) Deficient knowledge about diabetes self

care skills/ information.4) Potential self-care deficit related to physical

impairments or social factors.5) Anxiety related to loss of control, fear of

inability to manage diabetes, misinformation related to diabetes, fear of diabetes complications.

Intervention:-1) Maintaining fluid and electrolyte balanceIntake 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.

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..

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.)