1. Care of Patients with Diabetes Mellitus
Chapter 67
Care of Patients with Diabetes Mellitus
Glucometer for measuring serum glucose levels.

2. Insulin Physiology
Proinsulin, secreted by and stored in the beta cells of the islets of Langerhans in the pancreas, is transformed by the liver into active insulin. Insulin attaches to receptors on target cells, where it promotes glucose transport into the cells through the cell membranes.

3. Types of Diabetes Type 1 Type 2 Gestational (GDM)
Other specific conditions resulting in hyperglycemia

4. Absence of Insulin Hyperglycemia Polyuria Polydipsia Polyphagia
Ketone bodies
Hemoconcentration, hypovolemia, hyperviscosity, hypoperfusion, and hypoxia
Acidosis, Kussmaul respiration
Hypokalemia, hyperkalemia, or normal serum potassium levels

5. Acute Complications of Diabetes
Diabetic ketoacidosis
Hyperglycemic-hyperosmolar state (HHS)
Hypoglycemia from too much insulin or too little glucose

6. Chronic Complications of Diabetes
Macrovascular/microvascular disease
Retinopathy (vision problems)
Nephropathy (kidney dysfunction)
Neuropathy (nerve dysfunction)

7. Macrovascular Complications
Cardiovascular disease
Cerebrovascular disease

8. Microvascular Complications
Eye and vision complications
Diabetic neuropathy
Diabetic nephropathy
Male erectile dysfunction

9. Metabolic Syndrome Also called syndrome X
Classified as simultaneous presence of metabolic factors known to increase risk for developing type 2 diabetes and cardiovascular disease

10. Health Promotion and Maintenance
Control of diabetes and its complications is major focus for health promotion activities

11. Assessment History Blood tests Fasting plasma glucose (FPG)
Oral glucose tolerance test (OGTT)
Other blood tests
Screening
Ongoing assessment—glycosylated hemoglobin assays, glycosylated serum proteins and albumin, urine tests, tests for kidney function

12. Testing Sensation
Placement sites of monofilaments for testing of protective sensation.

13. Treatment Options Oral therapies Insulin therapies
Nutritional considerations
Exercise
Surgical intervention
Foot care
Wound care

14. Patient Education Insulin storage Dose preparation Syringes
Blood glucose monitoring
Infection control measures
Diet therapy

15. Activity: Patient with a Diabetic Condition
Etiologies, risk factors, comorbidities
Assessment findings
Diagnostic tests
Nurse’s role
Interdisciplinary team’s role
Treatment/intervention priorities
Teaching/health promotion information
Community resources

16. Audience Response System Questions
Chapter 67
Audience Response System Questions 16

17. Question 1 What percent of the United States population has diabetes?
3.2%
5.6%
8.3%
10.1%
Answer: C
Rationale: An estimated 25.8 million children and adults in the United States—8.3% of the population—have diabetes; 18.8 million people are diagnosed, 7.0 million are undiagnosed, 79 million have pre-diabetes, and 1.9 million new cases were diagnosed in people aged 20 and older in 2010.
(Source: Accessed August 15, 2011, from

18. Question 2
Which symptom requires immediate intervention during a hypoglycemic episode?
Confusion
Hunger
Headache
Tachycardia
Answer: A
Rationale: Glucose is necessary for brain function. Confusion is a marker of severe hypoglycemia requiring immediate intervention. Irritability/anxiety, hunger, tachycardia, headache, sweating, and seizures are additional signs of hypoglycemia.

19. Question 3 When should a patient with type 1 diabetes avoid exercise?
When serum glucose is less than 150
During colder months
When ketones are present in the urine
When emotional stressors are high for the patient
Answer: C
Rationale: Exercise should be avoided if ketones are present in the urine. Ketones indicate that current insulin levels are not adequate and that exercise would elevate blood glucose levels.
(Source: Accessed August 15, 2011, from