DIABETES
MELLITUS
Types
DM 1:
INSULIN DEPENDENT
-
Characterized by destruction of the pancreatic
beta cells. It is thought that combined genetic, immunologic, and possible
environmental (e.g. viral) factors contribute to beta cells destruction
DM 2:
NON-INSULIN DEPENDENT
-
The two main problems related to insulin in type
2 DM are insulin resistance and impaired insulin secretion. Insulin resistance
refers to decreased tissue sensitivity to insulin. The exact mechanisms that
lead to insulin resistance and impaired insulin secretion in type 2 are
unknown, although genetic factors are thought to play role.
Clinical
Manifestations
- Classic 3 P’s
- Fatigue
- Body weakness
- Visual changes
- Slow wound healing
- Recurrent skin and mucus membrane infections
Diagnostic
Evaluations
- FBS equal to or greater than 126 mg/dL (7.0 mmol/L)
Normal: 60 – 100 mg/dl (Somogyi )
80 – 120 mg/dl (Folin and Lou’s)
- OGTT value 1 and 2 hours post-prandial equal to or greater than 200 mg/dL
> Blood Sugar increased to 150 mg within 30 min and returns
to fasting level 60-120 mg in 2 hrs.
- RBS of equal to or greater than 200 mg/dL PLUS the 3 P’s
- Glycosylated Hemoglobin
- Urine test
·
Copper reducing tests (clinitest, benedict’s
test)
·
Glucose oxidase enzyme strips (testape, diastix)
·
Test for ketones
a. Acetest,
ketodiastix
b. protect
from moisture, direct sunlight and heat
c. Freshly
voided specimen must be used
Management
1. Diet (combined with exercise if possible)
2. Oral hypoglycemic therapy
3. Insulin treatment
Complications
- Acute
- Diabetic
Ketoacidosis
- Hyperglycemic
Hyperosmolar Non-Ketotic Coma
- Chronic
- Macroangiopathy
(Cerebrovascular disease, Coronary Arterty disease, and peripheral
vascular disease)
- Microangiopathy
( Retinopathy, nephropathy, peripheral neuropathy, and autonomic
neuropathy)
Nursing
Diagnoses
- Deficient Fluid Volume related to hyperglycemia
·
Assess BO and heart rate frequently, depending
on a patient’s condition; assess skin turgor and temperature
·
Monitor intake and output every hour
·
Replace fluids as ordered through peripheral
I.V. line
·
Monitor urine specific gravity to assess fluid
changes
·
Monitor blood glucose frequently
·
Assess for symptoms of hypokalemia: fatigue,
anorexia, nausea, vomiting, muscle weakness, decreased bowel sounds,
paresthesia, arrhythmias, flat T waves, ST segment depression
·
Administer replacement electrolytes and insulin
as ordered
·
Monitor serum glucose, bicarbonate, and pH
levels periodically
·
Provide reassurance about improvement of
condition and that correction of fluid imbalance will help reduce discomfort
- Imbalanced Nutrition: More Than Body Requirements related to
intake in excess of activity expenditures
·
Assess current timing and content of meals
·
Advise patient on the importance of
individualized meal plan
·
Discuss the goals of dietary therapy for the
patient
·
Explain the importance of exercise in
maintaining/reducing body weight
- Fear related to insulin injection
Nursing
Interventions
·
Assist patient to reduce fear of injection by
encouraging verbalization of fears regarding insulin injection
·
Demonstrate and explain thoroughly the procedure
for insulin self-injection
·
Help patient to master technique by taking a
step-by-step approach
- Risk for Impaired Skin Integrity related to decreased sensation and circulation to lower extremities
Nursing
Interventions
·
Assess feet and legs for skin temperature,
sensation, soft tissue injuries, corns, calluses, and dryness
·
Maintain skin integrity by protecting feet from
breakdown
·
Instruct patient in foot care guidelines
·
Advise patient who smokes to stop smoking or
reduce, if possible
No comments:
Post a Comment