1. Diabetes Mellitus
Nursing Management

2. Diabetes Mellitus
A group of metabolic diseases characterized by inappropriate hyperglycemia resulting from defects in insulin secretion, insulin action or both
Chronic systemic disease
Abnormalities in carbohydrate, protein, fat and insulin metabolism
Abnormalities in the structure and function of blood vessels and nerves

3. Significance $245 billion dollars per year $176 in direct medical cost
$69 billion in lost productivity

4. Pathology Immune mediated response
Genetically determined beta cell dysfunction
Impaired insulin secretion
Acquired beta cell dysfunction (glucose toxicity)
Persistant hepatic glucose production
Diminished glucose disposal
Terms:
Glucagon
Gluconeogenesis
Glycogen
Glycogenolysis
Lactate

5. Diagnostic criteria All are confirmed on subsequent day testing
A1C 6.5% or greater (exception)
Acute symptoms plus casual blood glucose >200 mg/dL
Fasting glucose >126 mg/dL
2-hour plasma glucose >200 mg/dL during a 75 gram oral glucose load
Impaired fasting glucose: >100 mg/dL and <126 mg/dL (represents impaired glucose homeostasis)
Impaired glucose tolerance: 2-hour OGTT are >140 mg/dL but < 200 mg/dL

6. Characteristics of Type 1 and 2
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

7. 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

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

9. 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%

10. Metabolic Complications: Acute
DKA
HHS
Hypoglycemia

11. Chronic Complications
Hypertension
Dyslipidemia
Neuropathy
Foot ulcers
Skin and dental
Nephropathy
Retinopathy
Long term problems: cataracts, glaucoma, depression