Diabetes Mellitus Nursing Management

Characteristics of Type I and II Type II More common in youth Abrupt onset Absent or minimal insulin Thin, catabolic state Thirst, polyuria, polyphagia, fatigue, weight loss Prone to ketosis Nutritional therapy essential Insulin required for all Frequent vascular and neurologic complications 35 yoa or older Insidious Insulin resistance Obese or possibly normal Frequently none, fatigue, recurrent infections Ketosis resistant except during infection or stress Nutritional therapy essential Insulin required for some Frequent vascular and neurologic complications

Insulin Therapy Types of insulin Insulin regimens Mealtime insulin Long acting basal insulin Combination therapy Problems with insulin therapy Allergic reactions Lipodystrophy Somogyi effect and dawn phenomenon

Drug Therapy: Oral Agents Sulfonylureas Meglitindes Biguanides Alpha glucosidase inhibitors Thiazolidinediones (glitazones)

Nutrition Therapy Type I: Meal planning is based on usual food intake and balanced with insulin and exercise patterns Type II: Emphasis is based on achieving glucose, lipid and blood pressure Food composition Carbs: 50% Protein: 20% or less Fats: 30%

Metabolic Complications DKA HHNS Hypoglycemia