NU RS I N G MANAGE M ENT:

1/16 GROUP 1(A)

LUQMAN HAKIM TING PEI YIN
YOTHINI THERESA CHAN

D IA BET E S ME LLIT US BONG SUK CHIN

NUR AIDATUSHEELA


SHARATHA
CHIANG TZE SEN
REVI EW OF ANATO MY &
PHYSIOLOGY

Hormones:
INSULIN by beta cells
GLUCAGON by alpha cells
INSULIN
Insulin promotes the absorption of glucose from
blood into cells for energy
Secreted at low levels during fasting
Increased levels after eating
PHYSIOLOGY
DI ABETES MELLITUS

A chronic disorder of altered

carbohydrate, protein & fat
metabolism caused either by an
insulin deficiency or insulin
resistance
 TYPES
TYPE 1 DM TYPE 2 DM
Auto-immune Insulin resistance b-cells
Destruction of b-cells of pancreas produce insulin but insulin does
little or no insulin production not bind to receptor site
Requires daily insulin injections 90%
Familial Common in obese/overweight
10%, usually appears below age 15
CLIN ICAL MANIFE STATIONS
Hyperglycaemia Changes in LOC (sleepiness,
3Ps: polyuria, polydipsia, drowsiness coma)
polyphagia Prolonged wound healing
Glycosuria Recurrent infection (glucose
Ketonuria inhibits the phagocytic action of
WBC)
Nausea/vomiting
Weakness
Fatigue
DI AGNOSTIC TESTS
Blood tests
a) HbA1C (Glycated Haemoglobin)
b) Fasting blood glucose test
Urinalysis
a) Ketonuria
b) Glycosuria
NU RSING MANAGE MENT
Nurses role:
1. Educating
2. Administering medication DIET EXERCISE
3. Assessing MONITOR
4. Monitoring
MEDICATIONS
NU RSING MANAGE MENT: DIET
Follow individualised diet based on activity level
Do not skip meals
Eat at regularly spaced intervals
Recognise appropriate food portions
Avoid food with added sugars
Advise use of complex carbohydrates to help stabilise BS
Routine HGT before & after meal may be necessary during initial
control, illness, in unstable pts.
 NU RSING MANAGE MENT:
EXERCISE
Benefits:
BS
need for insulin
no. of functioning receptor sites for insulin
Aerobic exercise (e.g.: cardio, walking, running, swimming)
Health education:
- check BS prior to exercising if lower than normal, eat a small snack
- carry simple carbs at all times (juice, sugar)
- S&S of hypo: sweating, tremors, clammy, confusion, headache
NU RSING MANAGE MENT:
MED I CATI ONS

1. Oral hypoglycaemic agents (for Type 2 when diet & exercise

dont work)
2. Insulin (for Type 1)
 ORAL HYPOGLYCAEM IC AGENTS
1. Sulfonylureas (glipizide, glimepide)
stimulate b-cells to make insulin
2. Meglitinides (repaglinide, nateglinide)
stimulate b-cells to make insulin
3. Biguanides (metformin)
decrease glucose production by liver
4. Thiazolidinedione (glitazone)
decrease glucose production by liver
5. Alpha-glucosidase inhibitors (miglitol, acarbose)
delay glucose absorption in intestine
ORAL HYPOGLYCAEM IC AGENTS
Monitor serum glucose levels
Teach patient signs & symptoms of hyper/hypoglycaemia
Assess liver & kidney function before initiating therapy
Know appropriatete time to administerr oral med
INSULIN
Route: Subcutaneous
Rotate sites. Failure to rotate sites may lead to lipodystrophy
Lipodystrophy: localised disturbance of fat metabolism
Common sites: Abdomen, Arms, Thighs
Press (do not rub!) site after injection
Mixing insulin: clear to cloudy
Complications: hypoglycaemia
HEALTH E DUCATION TO AVOID
DI ABETIC COMPLICATIONS
Teach pt. about diabetic foot care
Encourage good daily hygiene
Advise regular eye exams
Maintain fluid intake