Assessment and Management of Patients With Diabetes Mellitus

Assessment and Management of Patients With Diabetes Mellitus Prepared by Dr. Iman. Abdullah

Out Line Ø Definition of diabetes mellitus Ø Risk factors for diabetes mellitus Ø Diabetes and its classification Ø Overview in type I and 2 diabetes Ø Pathophysiology of diabetes Ø Clinical manifestations of diabetes Ø Diagnostic findings of diabetes Ø Management of diabetes Ø Monitoring glucose levels and ketones Ø Pharmacologic therapy Ø Insulin therapy

Out Line Ø Complications of insulin Ø Oral antidiabetic agents Ø Nursing management Ø Patient education Ø Acute complications of diabetes Ø Nursing process for patient newly diagnosed with diabetes mellitus Ø Patient education (foot care) Ø Long-term complications of diabetes Ø Special issues in diabetes care

Learning Objectives On completion of this lecture, the student will be able to: Ø Differentiate between type I and type 2. Ø Describe etiologic factors associated with diabetes. Ø Relate the clinical manifestations of diabetes to the associated pathophysiologic alterations. Ø Explain the dietary modifications used for management of people with diabetes. Ø Describe the relationships among diet, exercise, and medication. Ø Differentiate between hyperglycemia with DKA and HHNS

Cont. Ø Describe management strategies for a person with diabetes to use during “sick days”. Ø Describe the major macrovascular, microvascular, and neuropathic complications of diabetes. Ø Use the nursing process as a framework for care of patients with diabetes.

Diabetes Mellitus Definition: Ø Is a group of metabolic diseases characterized by increased levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. Risk Factors for Diabetes Mellitus

Diabetes and its Classification Type I diabetes: Insulin-dependant diabetes (IDDM). Type II diabetes: non Insulin-dependant diabetes (NIDDM). Gestational diabetes mellitus. Diabetes mellitus associated with other conditions or syndrome.

Overview q. In type I diabetes q In type 2 diabetes

Pathophysiology of Diabetes q Type I diabetes q Type 2 diabetes q Gestational Diabetes

Clinical Manifestations Clinical manifestations of all types of include: Ø “Three Ps”: polyuria, polydipsia, and polyphagia Ø Fatigue and weakness Ø Sudden vision changes Ø Tingling or numbness in hands or feet Ø Dry skin Ø Skin lesions or wounds that are slow to heal Ø Recurrent infections

Diagnostic Findings Criteria for the diagnosis of diabetes mellitus: Ø Symptoms of diabetes plus casual plasma glucose concentration equal to or greater than 200 mg/dl. Ø Fasting plasma glucose greater than or equal to 126 mg/dl (7. 0 mmol/L). Ø Two-hour postload glucose equal to or greater than 200 mg/dl during an oral glucose tolerance test. Ø If fasting glucose level are normal, the diagnosis must be based on a Glucose Tolerance test.

Management Nutritional therapy Education Pharmacologic therapy Exercise Monitoring

Monitoring Glucose levels and Ketones Ø Self-Monitoring Blood Glucose (SMBG) Ø Continuous Glucose Monitoring System (CGMS) Ø Glycated Hemoglobin Ø Urine Glucose Testing Ø Testing for Ketones

Pharmacologic Therapy § Insulin Therapy and Insulin Preparations § Insulin preparations vary according to three main characteristics: Ø Time course of action Ø Species ( source) Ø Manufacturer

Insulin Regimens Ø There are two general approaches to insulin therapy: § Conventional § And intensive

Complications of Insulin Ø Local Allergic Reactions Ø Systemic Allergic Reactions Ø Insulin Lipodystrophy Ø Resistance to Injected Insulin Ø Morning Hyperglycemia

Alternative methods of Insulin Delivery Ø Insulin Pens Ø Jet injectors

Ø Insulin Pumps Ø Implantable and inhalant insulin delivery Ø Transplantation of pancreatic cells

Oral Antidiabetic Agents Ø Sulfonylureas Ø Biguanides Nursing Management Patient Education

Acute Complications of Diabetes There are three major acute complications of diabetes related to short-term imbalances in blood glucose levels: Hypoglycemia Diabetic ketoacidosis (DKA) Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

Gerontologic Considerations Ø In elderly patients with diabetes, hypoglycemia is a particular concern for many reasons: § Elderly people frequently live alone and may not recognize the symptoms of hypoglycemia. § With decreasing renal function, it takes longer for oral hypoglycemic agents to be excreted by the kidneys. § Skipping meals may occur because of decreased appetite or financial limitations. § Decreased visual acuity may lead to errors in insulin administration.

Nursing Process The patient newly diagnosed with diabetes mellitus: ØAssessment Ø Nursing Diagnosis. ØPotential Complications ØPlanning and Goals ØNursing Intervention ØEvaluation

Patient education (foot care) Ø Take care of your diabetes

Cont. Ø Inspect your feet every day Ø Wash your feet every day

Cont. Ø Keep the skin soft & smooth

Cont. Ø Smooth corns and calluses gently Ø Trim your toenails each week or when needed

Cont. Ø Wear shoes and socks at all times Ø Protect your feet from hot and cool Ø Keep the blood flowing to your feet Ø Check with your health care provider.

Long-Term Complications of Diabetes ØThe general categories of longterm diabetic complications are: §Macro vascular §Micro vascular §Neuropathy

Foot and Leg Problem Three diabetic complications contribute to the increased risk of foot problems and infections include: Ø Neuropathy Ø Peripheral vascular disease Ø Immunocompromise Ø Management (teaching proper foot care )

Special Issues in Diabetes Care Ø Patient with diabetes who are undergoing surgery Ø Management of Hospitalized Patients With Diabetes Ø Hyperglycemia During Hospitalization Ø Hypoglycemia During Hospitalization Ø Common Alteration in Diet Ø Hygiene Ø Stress

Nursing Process The Patient With Diabetes as a Secondary Diagnosis ØAssessment ØNursing Diagnosis ØPotential Complications ØPlanning and Goals ØNursing Intervention ØEvaluation

Reference Brunner, L. and Suddarath, D. (2014). Text Book of Medical Surgical Nursing. 13 th Edition. J. B. Lippincott Williams & Wilikins, Library of Congress Catalging-in. Publication Date: 2013 ISBN/ISSN: 9781451130607

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