Diabetes mellitus.pptx

Nursing Management · Monitor blood sugar and use a sliding scale to treat high levels of glucose · Educate patient about diabetes · Examine feet .
Diagnosis involves measuring blood glucose levels. Ongoing specialized assessment and evaluation for complications are essential for diabetes management.

1. Diabetes Mellitus Mr. Abhijit Bhoyar Assistant Professor Department of Child Health Nursing

2. Specific Learning Objectives At the end of the lecture, the students will be able to Define diabetes mellitus. Enumerate the types of diabetes mellitus . Describe the signs and symptoms of diabetes mellitus . Illustrate the complications of diabetes mellitus. Explain the management of diabetes mellitus .

3. Introduction It is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period.

4. Definition

5. Brief anatomy of Pancreas T he pancreas is a long, slender organ , most of which is located posterior to the bottom half of the stomach . The pancreas has an endocrine function. Its pancreatic islets—clusters of cells formerly known as the islets of langerhans — secrete the hormones glucagon, insulin, somatostatin, and pancreatic polypeptide (pp).

6. Pancreas

7. Functions of Insulin Transports and metabolizes glucose for energy Stimulates storage of glucose in the liver and muscle (in the form of glycogen ) Signals the liver to stop the release of glucose Enhances storage of dietary fat in adipose tissue Accelerates transport of amino acids (derived from dietary protein) into cells Inhibits breakdown of stored glucose, protein, and fat . It decreases the level of extracellular Potassium

8. Causes of diabetes include: Insulin resistance Autoimmune disease- Type 1 diabetes and LADA happen when your immune system attacks the insulin-producing cells in your pancreas Hormonal imbalances : During pregnancy, the placenta releases hormones that cause insulin resistance . Pancreatic damage Genetic mutations

9. Risk Factors Obesity Race- African-Americans tend to have less potassium in their bodies than whites. A potassium deficiency is linked to a higher risk for developing type 2 diabetes but African-Americans , on average, may be better than whites at making insulin. Hypertension , Physical activity Familial history , Gestational diabetes

10. PATHOPHYSIOLOGY OF DIABETIC MELLITUS

11. Types of diabetes mellitus There are three main types of diabetes mellitus

12. Type 1 Diabetes Mellitus (DM ) It results from the pancreas's failure to produce enough insulin. This form was previously referred to as "insulin- dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown.

13. Type 2 Diabetes Mellitus (DM ) It begins with insulin resistance, a condition in which cells fail to respond to insulin properly. This form was previously referred to as "non insulin- dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is excessive body weight and not enough exercise.

14. Gestational Diabetes Mellitus It is the third main form and occurs in pregnant women without a previous history of diabetes.

15. Symptoms of type 1 diabetes Need To Urinate Often Thirst Constant Hunger Weight Loss Vision Changes And Fatigue. These Symptoms May Occur Suddenly.

16. Symptoms for type 2 diabetes Generally similar to those of type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors. 

17. Cont.….. The classic symptoms of untreated diabetes are weight loss Polyuria (increased urination) Polydipsia (increased thirst) Polyphagia ( increased hunger). Symptoms may develop rapidly (weeks or months) in type 1 DM, while they usually develop much more slowly and may be subtle or absent in type 2 DM.

18. Cont.…. In addition they also include: Blurry vision , Headache Fatigue and Slow healing of cuts and Itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes

19. Diagnostic Evaluation Diabetes can be diagnosed in any of the following ways (and should be confirmed on a different day by any of these tests): FBS of greater than or equal to 126 mg/ dL Random blood glucose of greater than or equal to 200 mg/ dL with classic symptoms (polyuria, polydipsia, polyphagia, weight loss) OGTT greater than or equal to 200 mg/ dL on the 2-hour sample

20. Blood Glucose Description Fasting blood sugar (FBS), drawn after at least an 8-hour fast, to evaluate circulating amounts of glucose; postprandial test, drawn usually 2 hours after a well-balanced meal, to evaluate glucose metabolism; and random glucose, drawn at any time, nonfasting .

21. Nursing and Patient Care Considerations For fasting glucose, make sure that patient has maintained 8-hour fast overnight; sips of water are allowed. Advise patient to refrain from smoking before the glucose sampling because this affects the test results. For postprandial test, advise patient that no food should be eaten during the 2-hour interval. For random blood glucose, note the time and content of the last meal .

22. Interpret blood values as diagnostic for diabetes mellitus as follows: FBS greater than or equal to 126 mg/ dL on two occasions Random blood sugar greater than or equal to 200 mg/ dL and presence of classic symptoms of diabetes (polyuria, polydipsia, polyphagia, and weight loss) Fasting blood glucose result of greater than or equal to 100 mg/ dL demands close follow-up and repeat monitoring .

23. Oral Glucose Tolerance Test Description The oral glucose tolerance test (OGTT) evaluates insulin response to glucose loading. FBS is obtained before the ingestion of a 50- to 200-g glucose load (usual amount is 75 g), and blood samples are drawn at ½, 1, 2, and 3 hours (may be 4- or 5-hour sampling).

24. Nursing and Patient Care Considerations Advise patient that for accuracy in results, certain instructions must be followed: Usual diet and exercise pattern must be followed for 3 days before OGTT. During OGTT, the patient must refrain from smoking and remain seated. Oral contraceptives, salicylates, diuretics, phenytoin, and nicotinic acid can impair results and may be withheld before testing based on the advice of the health care provider. Diagnostic for diabetes mellitus if 2-hour value is 200 mg/ dL or greater .

25. Glycated Hemoglobin ( Glycohemoglobin , Hb A 1c ) Description Measures glycemic control over a 60- to 120-day period by measuring the irreversible reaction of glucose to hemoglobin through freely permeable erythrocytes during their 120-day lifecycle

26. Nursing and Patient Care Considerations No prior preparation, such as fasting or withholding insulin, is necessary. Test results can be affected by red blood cell disorders ( eg , thalassemia, sickle cell anemia), room temperature, ionic charges, and ambient blood glucose values. Many methods exist for performing the test, making it necessary to consult the laboratory for normal values.

27. C-Peptide Assay (Connecting Peptide Assay ) Description Cleaved from the proinsulin molecule during its conversion to insulin, C-peptide acts as a marker for endogenous insulin production. Nursing and Patient Care Considerations Test can be performed after an overnight fast or after stimulation with Sustacal , I.V. glucose, or 1 mg of glucagon subcutaneously. Absence of C-peptide indicates no beta cell function, reflecting possible type 1 diabetes.

28. Fructosamine Assay Description Glycated protein with a much shorter half-life than glycated hemoglobin, reflecting control over a shorter period, approximately 14 to 21 days. May be advantageous in patients with hemoglobin variants that interfere with the accuracy of glycated hemoglobin tests. Nursing and Patient Care Conside rations Note if patient has hypoalbuminemia or elevated globulins because test may not be reliable. Should not be used as a diagnostic test for diabetes mellitus. No special preparation or fasting is n ecessary

29. Management Monitoring blood glucose levels Dietary management Maintaining physical activity Keeping weight and stress under control Monitoring oral medications and, if required, insulin use via injections or pump.

30. Dietary Management and Physical Activity Modifying Eating Habits Increasing Physical Activity Theses are the first steps toward reducing blood sugar levels.

31. Medication Type 1- Insulin Type 2 – Oral Hypoglycemic agents

32. Insulin Therapy People with type 1 diabetes require multiple insulin injections each day to maintain safe insulin levels. Insulin is often required to treat type 2 diabetes too. Using an insulin pump is an alternative to injections. The pump is about the size of a pager and is usually worn on your belt.

33. Cont.…. Insulin is delivered through a small tube (catheter) that is placed under the skin (usually in the abdomen ). There are four major types of insulin : Rapid-acting Short-acting Intermediate-acting Long-acting

34. Oral Medications Sometimes blood sugar levels remain high in people with type 2 diabetes even though they eat in a healthy manner and exercise. When this happens, medications taken in pill form may be prescribed . The medications work in several different ways.

35. Cont….. These include improve the effectiveness of the body's natural insulin, reduce blood sugar production, increase insulin production and inhibit blood sugar absorption. Oral diabetes medications are sometimes taken in combination with insulin.

36. FOR DIABETIC MELLITUS

37. Nursing Assessment Obtain a history of current problems, family history, and general health history. Has the patient experienced polyuria, polydipsia, polyphagia, and any other symptoms? Number of years since diagnosis of diabetes Family members diagnosed with diabetes, their subsequent treatment, and complications

38. Perform a review of systems and physical examination to assess for signs and symptoms of diabetes, general health of patient, and presence of complications. General: recent weight loss or gain, increased fatigue, tiredness, anxiety Skin: skin lesions, infections, dehydration, evidence of poor wound healing Eyes: changes in vision ”floaters , halos, blurred vision, dry or burning eyes, cataracts, glaucoma Mouth: gingivitis, periodontal disease

39. Cardiovascular: orthostatic hypotension, cold extremities, weak pedal pulses, leg claudication GI: diarrhea , constipation, early satiety, bloating, increased flatulence, hunger or thirst Genitourinary (GU): increased urination, nocturia , impotence, vaginal discharge Neurologic: numbness and tingling of the extremities, decreased pain and temperature perception, changes in gait and balance

40. Nursing Diagnoses Imbalanced Nutrition: More than Body Requirements related to intake in excess of activity expenditures Fear related to insulin injection Risk for Injury (hypoglycemia) related to effects of insulin, inability to eat Activity Intolerance related to poor glucose control

41. Deficient Knowledge related to use of oral hypoglycemic agents Risk for Impaired Skin Integrity related to decreased sensation and circulation to lower extremities Ineffective Coping related to chronic disease and complex self-care regimen

42. Improving Nutrition Assess current timing and content of meals. Advise patient on the importance of an individualized meal plan in meeting weight-loss goals. Discuss the goals of dietary therapy for the patient. Assist patient to identify problems that may have an impact on dietary adherence and possible solutions to these problems . Emphasize that lifestyle changes should be maintainable for life Nursing Interventions

43. Explain the importance of exercise in maintaining/reducing body weight. Caloric expenditure for energy in exercise Carryover of enhanced metabolic rate and efficient food utilization Assist patient to establish goals for weekly weight loss and incentives to assist in achieving them. Strategize with patient to address the potential social pitfalls of weight reduction.

44. Teaching About Insulin Assist patient to reduce fear of injection by encouraging verbalization of fears regarding insulin injection, conveying a sense of empathy, and identifying supportive coping techniques. Demonstrate and explain thoroughly the procedure for insulin self-injection. Help patient to master technique by taking a step-by-step approach. Allow patient time to handle insulin and syringe to become familiar with the equipment. Teach self-injection first to alleviate fear of pain from injection. Instruct patient in filling syringe when he or she expresses confidence in self-injection procedure. Review dosage and time of injections in relation to meals, activity, and bedtime based on patient's individualized insulin regimen.

45. Preventing Injury Secondary to Hypoglycemia Closely monitor blood glucose levels to detect hypoglycemia . Instruct patient in the importance of accuracy in insulin preparation and meal timing to avoid hypoglycemia . Assess patient for the signs and symptoms of hypoglycemia . Adrenergic (early symptoms) sweating , tremor, pallor, tachycardia, palpitations, nervousness from the release of adrenalin when blood glucose falls rapidly Neurologic (later symptoms) light-headedness , headache, confusion, irritability, slurred speech, lack of coordination, staggering gait from depression of central nervous system as glucose level progressively falls

46. Treat hypoglycemia promptly with 15 to 20 g of fast-acting carbohydrates. Half cup (4 oz ) juice, 1 cup skim milk, three glucose tablets, four sugar cubes, five to six pieces of hard candy may be taken orally. Nutrition bar specially designed for diabetics supplies glucose from sucrose, starch, and protein sources with some fat to delay gastric emptying and prolong effect; may prevent relapse. Used after hypoglycemia treated with fact-acting carbohydrate. Glucagon 1 mg (subcutaneously or I.M.) is given if the patient cannot ingest a sugar treatment. Family member or staff must administer injection. I.V. bolus of 50 mL of 50% dextrose solution can be given if the patient fails to respond to glucagon within 15 minutes.

47. Maintaining Skin Integrity Assess feet and legs for skin temperature, sensation, soft tissue injuries, corns, calluses, dryness, hammer toe or bunion deformation, hair distribution, pulses, deep tendon reflexes Maintain skin integrity by protecting feet from breakdown. Use heel protectors, special mattresses, foot cradles for patients on bed rest. Avoid applying drying agents to skin ( eg , alcohol). Apply skin moisturizers to maintain suppleness and prevent cracking and fissures. Instruct patient in foot care guidelines Advise the patient who smokes to stop smoking or reduce.

48. All forms of diabetes increase the risk of long-term complications . Develop after many years (10–20) The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease, About 75% of deaths in diabetics are due to coronary artery disease. Other "macrovascular" diseases (stroke) P eripheral vascular disease . Complications

49. Cont.… The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves. Diabetic Retinopathy- Damage to the eyes, known as diabetic retinopathy , is caused by damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and blindness.

50. Cont.… Diabetic Nephropathy - Damage to the kidneys , known as diabetic nephropathy , can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplant. Diabetic Neuropathy - Damage to the nerves of the body, known as diabetic neuropathy , is the most common complication of diabetes.

51. Cont.…. The symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetes-related foot problems ( such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness – Diabetic Amyotrophy.

52. Cont…. Prevention - For obese patients especially those with type 2 Diabetes: weight loss is the key to treatment and the major preventive factor the development of Diabetes.   Health Education - Assess learning needs, Explain surviving skills, Counseling and Home care management

53. Expected Questions Short Explain the Clinical features of Diabetes Mellitus. Describe the management of Diabetes Mellitus.

54. References Jacob Anthikad, Biochemistry for nurses 3 rd ed. Pankaja Naik, Essentials of Biochemistry, 1 st ed. Satyanarayan, Essentials of Biochemistry, 2 nd ed. A. C. Deb, Biochemistry, 4 th ed . Brunner & Suddarth’s Textbook Of Medical Surgical Nursing, (South Asian Edition)- 2 Volume.

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