NUR 149 2nd SEMESTER

A.Y. 2022-2023 C,D,&FI

DIABETES MELLITUS

DIABETES MELLITUS - Other symptoms: fatigue and weakness,

sudden vision changes, tingling or numbness
- Diabetes mellitus is a group of metabolic in hands or feet, dry skin, skin lesions or
diseases characterized by increased levels of wounds that are slow to heal, and recurrent
glucose in the blood (hyperglycemia) resulting infections (vaginal).
from defects in insulin secretion, insulin action, - DKA: sudden weight loss, nausea, vomiting,
or both. abdominal pains, hyperventilation, and a
fruity breath odor,
CLASSIFICATIONS
ASSESSMENT AND DIAGNOSTIC FINDINGS
Type I • Fasting Plasma Glucose (FBS)
- 5% to 10% of people with the disease • Random Plasma Glucose (RBS)
- Acute onset • 2-hour Postload Glucose (2-Hour
- Little or no endogenous insulin Postprandial)
- Previously known as juvenile diabetes,
juvenile-onset diabetes, ketosis-prone
diabetes, brittle diabetes, and insulin-
MEDICAL MANAGEMENT
dependent diabetes mellitus (IDDM) • Goal: To normalize insulin activity and blood
- Usually thin at diagnosis (recent weight glucose levels to reduce the development of
loss) vascular and neuropathic complications.
- Needs insulin • Nutritional Therapy
- Ketosis common • Exercise
- Diabetic ketoacidosis (DKA) as acute • Monitoring Glucose Levels and Ketones
complication a) Self-Monitoring of Blood Glucose
b) Testing for Glycated Hemoglobin
Type 2 c) Testing for Ketones
- 90–95% of all diabetes • Pharmacologic Therapy
- Slow, progressive glucose intolerance a) Insulin Therapy
- Obese: 80% of type 2; Nonobese: 20% of b) Oral Antidiabetic Agents
type 2
- Previously classified as adult-onset
diabetes, maturity-onset diabetes, ketosis- INSULIN THERAPY
resistant diabetes, stable diabetes, and - In type 1 diabetes, must be administered for life.
non–insulin-dependent diabetes (NIDDM) In type 2 diabetes, may be necessary on a long-
- Usually obese at diagnosis term basis to control glucose levels if meal
- Decrease in endogenous insulin, or planning and oral agents are ineffective.
increased with insulin resistance - Insulin may be increased temporarily during
- Most patients can control blood glucose illness, infection, pregnancy, surgery, or some
through weight loss if obese; other stressful event. In many cases,
- Needs oral antidiabetic agents to improve - Administered two or more times daily after an
blood glucose levels if dietary modification accurate monitoring of blood glucose levels
and exercise are unsuccessful
- May need insulin on a short-term or long-
term basis to prevent hyperglycemia
- Ketosis uncommon, except in stress or
infection
- Acute complication: hyperglycemic
hyperosmolar nonketotic syndrome
(HHNKS)

Clinical Manifestations
- “Three Ps”: Polyuria; Polydipsia;
Polyphagia
- Weight loss

MS LEC GI, TCGGUILLERMO

1
 COMPLICATIONS OF INSULIN THERAPY NURSING MANAGEMENT

• Local Allergic Reactions • Provide Patient Education: Teaching

• Systemic Allergic Reactions - rare • Patients to Self-Administer Insulin
• Insulin Lipodystrophy - in the form of either • Should be administered subcutaneously.
lipoatrophy or lipohypertrophy • When not in use: vials should be refrigerated.
✓ Lipoatrophy is loss of subcutaneous fat; • Insulin vial in use should be kept at room
it appears as slight dimpling temperature
✓ Lipohypertrophy, the development of • Cloudy insulins should be thoroughly mixed
fibrofatty masses at the injection site, is by gently inverting the vial or rolling it
caused by the repeated use of an between the hands before drawing the
injection site (rotation of injection sites is solution into a syringe or a pen.
so important)
• Resistance to Injected Insulin NURSING MANAGEMENT
• Morning Hyperglycemia - caused by an
insufficient level of insulin, which may be 1. When mixed in one syringe: regular insulin
caused by several factors: the dawn be drawn up first before long-acting (clear
phenomenon, the Somogyi effect, or insulin insulin first before cloudy insulin).
waning. 2. Prefilled syringes should be stored with the
needle in an upright position to avoid
clogging of the needle.
3. Select and rotate injection sites: abdomen
(great absorption), upper arms (posterior
surface), thighs (anterior surface), and hips.
4. Allow the skin to dry after cleansing with
alcohol before injection
5. A 90-degree angle is the best insertion
angle; aspiration (inserting the needle and
METHODS OF INSULIN DELIVERY then pulling back on the plunger to assess for
blood being drawn into the syringe) is
generally not recommended with self-
injection of insulin.

Acute Complications of Diabetes

• Hypoglycemia (< 50-60mg/dL)
• Diabetic Ketoacidosis (DKA)
• Hyperglycemic Hyperosmolar
• Nonketotic Syndrome (HHNS)

DKA ASSESSMENT and DIAGNOSTIC FINDINGS

• Blood glucose levels: between 300 and 800
mg/dL up to 1000 mg/dL
• Serum bicarbonate (0 to 15 mEq/L) and low
pH (6.8 to 7.3)
ORAL DIABETIC AGENTS • Metabolic acidosis. Accumulation of ketone
• Sulfonylureas Hypokalemia; Hyponatremia
• Non-Sulfonylurea Insulin Secretagogues • Increased levels of creatinine, blood urea
• Biguanides nitrogen (BUN), and hematocrit
• Alpha-Glucosidase Inhibitors
• Thiazolidinediones (or glitazones) HHNS ASSESSMENT and DIAGNOSTIC FINDINGS
1. Blood glucose level: 600 to 1200 mg/dL,
2. Increased Electrolyte and BUN
3. Osmolality exceeds 350 mOsm/kg

MS LEC GI, TCGGUILLERMO

2
 LONG TERM COMPLICATIONS OF DIABETES
1. Macrovascular- Atherosclerosis
2. Microvascular
✓ Retinopathy
✓ Nephropathy
3. Diabetic Neuropathies
✓ Peripheral Neuropathy
✓ Autonomic Neuropathy
o Erectile Dysfunction
o Decreased VAginal Lubrication

SURGICAL MANAGEMENT
• Debridement
• Amputation

MS LEC GI, TCGGUILLERMO