Interventions for Clients with Diabetes Mellitus

PANCREAS Function: pancreas is not only and exocrine gland for digestion. GLUCAGON – from alpha cells of pancreatic islets, raises blood glucose level. INSULIN – from beta cells of pancreatic islets, lowers blood glucose level.

Types of Diabetes Type I Type 2 Gestational Other types include: Genetic defect beta cell or insulin Disease of exocrine pancreas Drug or chemical induced Infections Others

Absence of Insulin Hyperglycemia Polyuria Polydipsia Polyphagia Hemoconcentration, hypervolemia, hyperviscosity, hypoperfusion, and hypoxia Acidosis, Kussmaul respiration Hypokalemia, hyperkalemia, or normal serum potassium levels

Acute Complications of Diabetes Diabetic ketoacidosis Hyperglycemic-hyperosmolar-nonketotic syndrome Hypoglycemia from too much insulin or too little glucose

Chronic Complications of Diabetes Cardiovascular disease Cerebrovascular disease Retinopathy (vision) problems Diabetic neuropathy Diabetic nephropathy Male erectile dysfunction

Assessment History Blood tests Fasting blood glucose test: two tests > 126 mg/dL Oral glucose tolerance test: blood glucose > 200 mg/dL at 120 minutes Glycosylated hemoglobin assays Glucosylated serum proteins and albumin

Urine Tests Urine testing for ketones Urine testing for renal function Urine testing for glucose

Risk for Injury Related to Hyperglycemia Interventions include: Dietary interventions, blood glucose monitoring, medications Oral therapy Sulfonylurea agents Meglitinide analogues Biguanides Alpha-glucosidase inhibitors Thiazolinedione antidiabetic agents

Drug Therapy Drug administration Drug selection Insulin therapy: Insulin analogue Short-acting insulin Concentrated insulin Intermediate Fixed-combination Long-acting Buffered insulins

Insulin Regimens Single daily injection protocol Two-dose protocol Three-dose protocol Four-dose protocol Combination therapy Intensified therapy regimens

Pharmacokinetics of Insulin Injection site Absorption rate Injection depth Time of injection Mixing insulins

Complications of Insulin Therapy Hypoglycemia Lipoatrophy Dawn phenomenon Somagyi's phenomenon

Alternative Methods of Insulin Administration Continuous subcutaneous infusion of insulin Implanted insulin pumps Injection devices New technology includes: Inhaled insulin Transdermal patch (being tested)

Client Education Storage and dose preparation Syringes Blood glucose monitoring Interpretation of results Frequency of testing Blood glucose therapy goals

Diet Therapy Goals of diet therapy Principles of nutrition in diabetes Protein, fats and carbohydrates, fiber, sweeteners, fat replacers Alcohol Food labeling Exchange system, carbohydrate counting Special considerations for type 1 and type 2 diabetes

Whole-Pancreas Transplantation Operative procedure Rejection management Long-term effects Complications Islet cell transplantation hindered by limited supply of beta cells and problems caused by antirejection drugs S&P

Health Teaching Assessing learning needs Assessing physical, cognitive, and emotional limitations Explaining survival skills Counseling Psychosocial preparation Home care management Health care resources