1. Interventions for Clients with Diabetes Mellitus

2. 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.

5. 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

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

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

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

16. 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

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

18. 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

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

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

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

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

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

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

27. 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

29. 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

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