Diabetes mellitus

1. Diabetes

2. Definition:
• “A metabolic disease in which the body’s inability to produce any
or enough insulin causes elevated levels of glucose in the blood.”

3. How many types of

4. Types of diabetes:
• Type 1
• Type 2
• Gestational diabetes (GDM)
• Prediabetes

5. Type 1 diabetes:
• Is characterized by destruction of the pancreatic beta cells.
• Also known as juvenile diabetes
• Usually diagnosed in children and young adults
• When body’s own immune system destroys the insulin producing cells of the
pancreas – beta cells – which produce insulin
• Only 5% of people have this disease
• Body does not produce insulin
• Is not preventable
• No primary intervention
• Causes?
• Predisposition to diabetes – genetics - and something (i.e. weather, virus ... etc ) in
environment triggers the disease

6. Type 2 diabetes:
• Most common form of diabetes – about 90% of cases
• Used to be called adult onset, non insulin dependent diabetes
• Body produces insulin, but does not use it properly
• glucose doesn’t move into cells, they pile up in the bloodstream
• symptoms when they do occur are often ignored because they may not seem
serious

7. Gestational diabetes mellitus (GDM):
• Having diabetes during pregnancy
• Family Hx of diabetes, overweight prior to pregnancy?
• Having gestational diabetes puts you at risk for diabetes type 2
• Giving birth to a baby >9 lbs also puts you at risk for type 2
• 18 out of every 100 pregnant females will develop GDM

8. Prediabetes
• impaired glucose tolerance or impaired fasting glucose
It is a new classification of diabetes indicating a metabolic stage
between normal glucose homeostasis and diabetes.

9. Risk factors:
• Genetics
• Family pmHx
• Polycystic ovary syndrome (PCOS)
• Irregular menses
• Race
• African Americans, Hispanics and Asians > whites
• Age
• After age 45, but increases in younger adults and children
• Environmental factors
• Inactivity
• Weight gain

10. Symptoms of
Diabetes:

11. Complications for uncontrolled diabetes:

12. How to monitor your diabetes:

13. Treatment for Diabetic
1.Healthy eating
2.Regular exercise
3.Weight loss
4.Possibly, diabetes medication or insulin therapy
5.Blood sugar monitoring

14. Nursing Care Plan

15. Inadequatebloodglucose monitoring
Desired outcomes
Patient has a blood glucose reading of less than 11.1 mmol/L ; fasting blood
glucose levels of less than 7.0 mmol/L ; hemoglobin A1C level <7%.
Patient will achieve and maintain glucose in satisfactory range.
1. Assess for signs of hyperglycemia.
2. Assess blood glucose levels before meals and at bedtime.
3. Monitor the patient’s HbA1c-glycosylated hemoglobin.
4. Weight daily.

16. Risk for Impaired SkinIntegrity
Desired outcomes
Patient’s skin on legs and feet remains intact while the patient is hospitalized.
Patient will demonstrate proper foot care.
• 1. Conduct thorough baseline and ongoing assessment of the
following:
• (a) lesions, fissures, dryness, blisters, redness, cellulitis, or
gangrene of the lower extremities;
• (b) musculoskeletal assessment of the foot, ankle, joint of range
motion, bone abnormalities;
• (c) neurological assessment including sensations of touch, pain,
and temperature;
• (d) vascular examination of the lower extremities, the
temperature of the skin, lesions, capillary refill;
• (e) and hydration status.

17. Risk for ImpairedSkinIntegrity
• 2. Assess the integrity of the skin. Assess knee and deep tendon
reflexes and proprioception.
These are assessments for neuropathy. The skin on lower extremity
pressure points is at great risk for ulceration.
• 3. Inspect feet daily for erythema or trauma.
These are signs that the skin needs preventive care.

18. Risk for FluidVolume Deficit
• Desired Outcomes
Demonstrate adequate hydration as evidenced by stable vital signs,
palpable peripheral pulses, good skin turgor and capillary refill,
individually appropriate urinary output, and electrolyte levels within
normal range.
1. Assess the patient’s history related to duration or intensity of
symptoms such as vomiting, excessive urination.
2. Monitor vital signs:
• note orthostatic BP changes.
• respiratory pattern: Kussmaul’s respirations, acetone breath.

19. Risk for FluidVolume Deficit
• Temperature, skin color, moisture, and turgor.
3. Monitor I&O and note urine-specific gravity.
4. Weigh daily.

20. Risk for Infection
1. Teach and promote good hand hygiene.
2. Maintain asepsis during IV insertion, administration of
medications, and providing wound or site care. Rotate IV sites as
indicated.
3. Provide catheter or perineal care. Teach female patients to clean
from front to back after elimination.
4. Encourage an increase in fluid intake unless contraindicated.
Encourage intake of cranberry juice per day as appropriate.

21. Risk for Infection
5. Administer antibiotics as indicated.

22. •Questions?