Diabetes Mellitus

Diabetes is a disease in which the body doesn't produce or properly use insulin.
Insulin is a hormone produced in the pancreas, an organ near the stomach. Insulin is
needed to turn sugar and other food into energy. When you have diabetes, your body
either doesn’t make enough insulin or can’t use its own insulin as well as it should, or
both. This causes sugars to build up too high in your blood.

Diabetes mellitus is defined as fasting blood glucose of 126 milligrams per

deciliter (mg/dL) or more since normal blood glucose levels are about 90mg/100ml,
equivalent to 5mM (mmol/l).

• Incidence and Prevalence Rate

• The World Health Organization (WHO) estimates that more than 180 million
people worldwide have diabetes. This number is likely to more than double by
2030.
• In 2005, an estimated 1.1 million people died from diabetes.
• Almost 80% of diabetes deaths occur in low and middle-income countries.
• Almost half of diabetes deaths occur in people under the age of 70 years; 55% of
diabetes deaths are in women.

• Types

• Type 1 diabetes (previously known as insulin-dependent or childhood-onset) is

characterized by a lack of insulin production. Without daily administration of
insulin, Type 1 diabetes is rapidly fatal.
• Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results
from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of
people with diabetes around the world, and is largely the result of excess body
weight and physical inactivity.
• Gestational diabetes is hyperglycaemia which is first recognized during
pregnancy.
• “Pre-diabetes” is a condition in which blood glucose levels are higher than normal
but not yet diabetic. People with pre-diabetes are at increased risk for developing
type 2 diabetes, heart disease and stroke. This condition are as follows:
• Impaired Glucose Tolerance (IGT) and Impaired Fasting Glycaemia (IFG)
are intermediate conditions in the transition between normality and
diabetes. People with IGT or IFG are at high risk of progressing to type 2
diabetes, although this is not inevitable.
• Signs and Symptoms

• Cardinal Signs : 3 P’s

1. Polyuria – frequent urination
2. Polydipsia – displays of excessive thirst
3. Polyphagia – excessive hunger or eating
 • Weight loss
• Blurred Vision
• Slow wound healing
• Infections: pyorrhea (periodontal infections), urinary tract infection/, vasculitis,
cellulites, furuncle, carbuncles, vaginal infections
• Weakness and paresthesia
• Signs of inadequate circulation of the feet
• Signs of accelerated atherosclerosis (renal, cerebral, cardiac, peripheral)

 Type 1- Symptoms include excessive excretion of urine (polyuria), thirst

(polydipsia), constant hunger, weight loss, vision changes and fatigue. These
symptoms may occur suddenly.
 Type 2 symptoms
• Symptoms may be similar to those of Type 1 diabetes, but are often less
marked. As a result, the disease may be diagnosed several years after
onset, once complications have already arisen.
• Until recently, this type of diabetes was seen only in adults but it is now
also occurring in obese children.

 Gestational Diabetes

• Symptoms of gestational diabetes are similar to Type 2 diabetes.

Gestational diabetes is most often diagnosed through prenatal screening,
rather than reported symptoms.

• Laboratory Exam

Blood Glucose

Blood sugar tests measure how well your body processes sugar (glucose). Some
blood sugar tests are used to diagnose pre-diabetes or diabetes. Others determine how
well you're managing your diabetes.

 a blood glucose test measures the amount of a type of sugar called

glucose in your blood..
 Glucose comes from CHO foods; it is the main source of energy used
by the body.
 Insulin is a hormone that helps your body’s cells uses the glucose.
Insulin is produced in the pancreas and released into the blood when
the amount of glucose in the blood.
DIAGNOSTIC TEST:
Glaciated Hemoglobin Test
• Test used for diagnosing diabetes, it gauges how well you are managing
diabetes.

• the test reflects your average blood sugar level for the past 2-3 months

• test shows the result percentage of your hemoglobin

• normal range for people without diabetes is 4-6 percent

• level higher than 7 percent indicate the need for a change in your diabetes
treatment plan

Oral glucose tolerance test

• Oral glucose tolerance test measures your body's response to sugar.

• First your fasting blood sugar level is measured.

• If your blood sugar level rises more than expected to 200 mg/dL (11.1 mmol/L) or
more you may have diabetes.

• A normal blood sugar level after an oral glucose tolerance test is lower than 140
mg/dL (7.8 mmol/L).

• If your blood sugar level is 140 to 199 mg/dL (7.8 to 11.0 mmol/L) after an oral
glucose tolerance test, you may have prediabetes.

• A blood sugar level of 200 mg/dL (11.1 mmol/L) or higher two hours after you
drink the sugary solution may indicate diabetes.

Random blood sugar test

• Measures your blood sugar at any point in time, not necessarily a certain amount
of time after a meal, snack or beverage.
• A normal random blood sugar level hasn't been clearly defined.
• Even if you've recently eaten and your blood sugar level is at its peak, your
random blood sugar level shouldn't be higher than 200 mg/dL (11.1 mmol/L).

Post Blood glucose Level

• post load or postprandial glucose level can be drawn to diagnosed DM

 • it is drawn 2 hours after standard meal
• 2 hour post load glucose level greater than 200 mg/dl during the OGTT is
confirmation of DM

Fasting Blood Sugar Test

• Measures the amount of sugar (glucose) in your blood after you fast for at least
eight hours or overnight.
• A normal range is 70 to 100 milligrams of glucose per deciliter of blood (mg/dL)
or 3.9 to 5.6 millimoles per liter (mmol/L).
• A level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) indicates impaired fasting
glucose

• Non- surgical Management

For Type 1 (IDDM)

Dietary therapy

o Match food intake with insulin therapy to avoid excessive swings in blood glucose
levels
o avoid hypoglycemia
- Meal planning should receive adequate emphasis in IDDM

o Food intake should meet the requirements for normal growth and development.
o Calories should be distributed into main meals and regular snacks, taking into
consideration local circumstances and the type of insulin therapy.
o Insulin therapy

• Treatment with insulin is one aspect of management in which adequate

education of the patient cannot be overemphasized.

For Type 2 (NIDDM)

Dietary treatment

o should aim at:

 ensuring weight control

 providing nutritional requirements
 allowing good glycemic control with blood glucose levels as close to normal
as possible
  correcting any associated blood lipid abnormalities
 Ensuring consistency and compatibility with other forms of treatment if
used, for example oral agents or insulin.

o Carbohydrates provide 50-60% of total caloric content of the diet.

o Dietary fat should provide 25-35% of total intake of calories but saturated fat
intake should not exceed 10% of total energy. Cholesterol consumption should
be restricted and limited to 300 mg or less daily.
o Protein intake can range between 10-15% total energy (0.8-1 g/kg of desirable
body weight). Requirements increase for children and during pregnancy. Protein
should be derived from both animal and vegetable sources.

o Exercise
• physical activity promotes weight reduction and improves insulin
sensitivity, thus lowering blood glucose levels.

o Drug Treatment
• Oral hypoglycemic drugs (OHD) are considered only after a regimen of
dietary treatment combined with exercise has failed to achieve the therapy
targets set.
• There are two major groups of OHD:
• SULPHONYLUREAS (SUs) - act by stimulating insulin release from
the beta cells and also by promoting its action through extra
pancreatic mechanisms
• BIGUANIDES (BGs) - exert action by decreasing gluconeogenesis
and by increasing the peripheral utilization of glucose.

For Gestational Diabetes

o Guidelines for the management of diabetes during pregnancy

• Frequent follow-up is needed to ensure that therapy targets are met
without significant hypoglycemia. Review every two to four weeks is
generally recommended but should be more frequent if required.
• Those well controlled on diet alone may continue on such therapy as long
as they are carefully monitored to assess the need for insulin.

o Screening for diabetes during pregnancy

• All pregnant women should be screened for diabetes during the first
antenatal visit by testing for glycosuria.
• A positive test is an indication for further assessment by a 75 g oral
glucose tolerance test.
• At 24-28 weeks of gestation, women at high risk of developing GDM or
IGT should be screened by means of an oral glucose tolerance test, using
75 g glucose load. Those at high risk include women with:
• previous GDM or IGT
• a family history of diabetes
 • obesity
• adverse obstetric history
• history of giving birth to a big baby
• history of a congenital malformation affecting the newborn in a
previous pregnancy.

• Surgical Management

Pancreas Transplant
Indication:
Some client with type 1 diabetes mellitus receive pancreas transplant. Clients own
pancreas is left intact (98% of its function is exocrine in nature) and the new pancreas is
anastomosed (attached) to the iliac artery and veins through which insulin can enter the
systemic pathway. The new pancreas is placed in the lower pelvic cavity and the duct is
connected to the urinary bladder. The exocrine secretions of the pancreas drain into the
bladder and are not absorbed. The general procedure lasts for 4 to 6 hours.
Contraindication:
Clients with type 1 diabetes mellitus must have a well functioning kidney to receive
pancreas transplant. Other contraindication includes problems that make the client
unable to withstand the stress of surgery.
Implication:
Major complication of pancreas transplant includes vessel thrombosis, rejection and
infection.
Islet cell Transplant
Islet cell transplant is also being investigated as treatment for type 1 diabetes mellitus.
Less toxic antirejection drugs are required for this procedure but the desired outcome
has been limited.
Preoperative and Intraoperative Management of Diabetic Patients:

• If the serum glucose level is below 250 mg/dL on the morning of surgery,
sulfonylureas should be withheld (glipizide, glyburide, and chlorpropamide)
• 5% glucose solution should be administered intravenously at a rate of about 100
mL/h.
• If the fasting glucose level is above 250-300 mg/dL, an alternative approach is to
add 5 units of insulin directly to each liter of 5% glucose solution being given at
100 mL/h.
 • If the operation is lengthy, blood glucose levels should be measured every 3-4
hours during surgery.
Postoperative Management of diabetic patients:

• It is best to continue the glucose-insulin infusion until the patient is eating.

• Hypoglycemia, the most common postoperative complication.
• Blood glucose levels should be measured every 2-4 hours and the patient
monitored for signs and symptoms of hypoglycemia.
• When hypoglycemia is detected, the amount of glucose infused should be
promptly increased and the insulin decreased.
• A marked increased in glucose and insulin requirements postoperatively suggest
the presence of occult infection.
• Adjustments in the rate of glucose or insulin administration must be based on
blood glucose levels.

• Health Teaching

• Blood glucose monitoring

 Blood glucose monitoring is a way of testing the concentration of glucose

in the blood (glycemia).
 It is important in the care of diabetes mellitus. A blood glucose test is
performed by piercing the skin (typically, on the finger tip) to draw blood,
then placing the blood on a chemically active disposable strip which
indicates the result either by changing colour, or changing an electrical
characteristic, the latter being measured by an electronic meter.
 Most people with Type 2 diabetes test at least once per day (usually
before breakfast) to assess the effectiveness of their diet and exercise

• Administration of medications (insulin, oral agents)

• Dietary management

 improving blood glucose and lipid levels

 providing consistency for day to day food intake

 fascinating weight management

 providing nutrition for all stages of life

• Exercise

 Exercise is extremely important in managing diabetes because of its effects

on lowering blood glucose and reducing cardiovascular risk factors.
  It also improves circulation and muscle tone.

 Precaution: exercising with elevated blood glucose levels increases the

secretion of glucagon which increases the blood glucose level

• Avoid intake of alcohol

• Can use artificial sweeteners to achieve caloric intake restrictions

• Follow up visits to assess for complications od diabetes mellitus and reinforce

learning needs

• Yearly fundoscopic examination by an opthalmologist with treatment as needed

• Control of angina and peripheral vascular disease

• Performing daily foot care

• Insulin Administration

 Insulin is a hormone necessary to process glucose (blood sugar), the

body’s main source of energy.

Far Eastern University

Institute of Nursing

Report on
Diabetes Mellitus

Submitted to:

Prof. Acosta

Submitted by:

GROUP 85-BSN022
Adap, Maria Katrina Erica A.
Ayonayon, Manuel Jr., M.
Bonoan, Princess Dulce Y.
Bricia, Jan Karlo V.
Brillantes, Adrian Jr., S.
Bughao, Merrielle A.
Caban, Harold O.
Catabay, Ma. Jovel Cassandra G.
Dano, Phoebe S.
Dayao, Raymundo Jr., M.
de Castro, Lorebell C.
de Leon, Christian Arthur C.