PATHOPHYSIOLOGY OF DIABETES MELLITUS TYPE II

Mandal, M. D. (2016, June 20). Diabetes Pathophysiology. Retrieved November 03, 2017, from https://www.news-medical.net/health/Diabetes-Pathophysiology.aspx

Modifiable factors Non Modifiable factors

 Physical inactivity  Family history

 Diet (High CHO)  Age ( >40 y/o)
 Race (Filipino)

Destruction of beta- cells in the pancreas

Failure to produce insulin Insulin resistance

Hct: 0.30 mg/dl

Hgb: 101 mg/dl

Continued hepatic glucose production
Decrease glucose utilization

hyperglycemia
Glucose
Increase fat metabolism Decreased transportation Protein utilization
of glucose across cell level: 333 Increase renal Decreased blood flow
membranes mg/dl threshold of glucose in the extremities
Amino acids converted
Increase body lipid levels into glucose
Increase glucose filtered in the urine
LDL: 167 leading to increase oncotic pressure.
Decreased ATP
mg/dl
Wasting of lean
body mass
Fatigue Polyphagi Polyuria
a Poor wound healing

Decrease blood flow

Weight loss Polydipsia
Impaired skin integrity
Production of glucose Pain r/t tissue trauma
Weight loss Risk for infection
Poor wound healing Fatigue
Dx: Imbalanced nutrition: less than
body requirements
 CUES EXPLANATION GOALS AND INTERVENTIONS RATIONALE EVALUATION ACTUAL
OF THE OBJECTIVES CRITERIA EVALUATION
PROBLEM
Disease Process: DM Type 2 diabetes is Long term: After 3 days Administer regular Regular insulin has a Fully met if: absence
type II characterized by a of nursing interventions, insulin by rapid onset and thus of edema on the hand
combination of patient will manifest intermittent or quickly helps move Partially met: still
Subjective data: peripheral insulin weight gain as evidenced continuous IV glucose into cells. with edema but
 “Hindi na sya resistance and Absence p method: IV bolus The IV route is the increase food intake.
ganon kalakas inadequate insulin followed by a initial route of choice Not met: gaining
kumain, pakonti secretion by continuous drip via because absorption weight everyday as
ng pakonti yung pancreatic beta cells. evidence by increase
pump of from subcutaneous
kinakain nya.” Insulin resistance, edema.
approximately 5–10 tissues may be
Claimed by the which has been
husband attributed to elevated U/hr so that glucose erratic. Many believe
 Weight loss as levels of free fatty is reduced by 50 the continuous
documented in acids and mg/dL/hr. method is the
the chart. proinflammatory optimal way to
cytokines in plasma, facilitate transition
leads to decreased to carbohydrate
Objective data: glucose transport into metabolism and
 Patient is seem muscle cells, elevated reduce incidence of
to have dry hepatic glucose hypoglycemia.
mucous production, and Short term: Administer glucose Glucose solutions Fully met: all mcous
membranes, increased breakdown  After 8 hrs of solutions: dextrose may be added after membranes are
poor capillary of fat. nursing intervention, and half-normal insulin and fluids moisten and well
refill, poor A role for excess the patient will saline. have brought the hydrated.
muscle tone, glucagon cannot be demonstrate blood glucose to Partially me: still
fatigability and underestimated; hydrated skin. with cracked skin but
approximately 400
slurring of indeed, type 2 diabetes some mucous
mg/dL. As
words, membranes are
carbohydrate
moistened.
NSG DX: metabolism
Not met: dehydration
Imbalanced approaches normal, occur
Nutrition: less than care must be taken
body requirements to avoid
hypoglycemia
related to insulin  After 8 hours of nsg Fully met: ngt is
insufficiency interventions patient removed as
will have an increase evidenced by food is
tolerance of food as tolerated by patient
manifested by when offered by
disconnecting the mouth.
ngt. Partially met: NGT is
still inserted but there
Administer other May be useful in is an increase intake
medications as treating symptoms through it.
indicated. related to autonomic Not met: Case worsen
neuropathies and increased
affecting GI tract, demand or need of
thus enhancing oral NGT.
intake and
absorption of
nutrients.
 After 8 hours of Observe for signs of Hypoglycemia can Fully met: Able to do
nursing hypoglycemia: occur once blood diet plan for diabetes
interventions, client changes in LOC, cold glucose level is and strictly follow it
will demonstrate and clammy skin, reduced and as evidenced by
lifestyle changes. rapid pulse, hunger, carbohydrate eating behaviors and
irritability, anxiety, metabolism resumes habits.
headache, and insulin is being Partially met: Still
demand for unhealthy
lightheadedness, given. If the patient
foods but strictly
shakiness. is comatose,
observing
hypoglycemia may moderation.
occur without Not me: didn’t made
notable change in any modification in
LOC. This potentially the diet and lifestyle.
life-threatening
emergency should
be assessed and
treated quickly per
protocol. Note: Type
 1 diabetics of long
standing may not
display usual signs of
hypoglycemia
because normal
response to low
blood sugar may be
diminished.
 After 8 hours of Auscultate bowel Hyperglycemia and Fully met: Blood
nursing sounds. Note reports fluid and electrolyte sugar level within
interventions, client of abdominal pain, disturbances can range of 80/120
will manifest bloating, nausea, decrease gastric mg/dl.
normalization of vomiting of motility and/or Partially met: Bloof
blood glucose level undigested food. function (due to sugar level is
within range of Maintain NPO status distention or ileus) moderately high
80/120 mg/dl within the range of
as indicated. affecting choice of
150-200 mg/dl.
interventions. Note:
Not met: Blood sugar
Chronic difficulties is very high. 200 and
with decreased above.
gastric emptying
time and poor
intestinal motility
may suggest
autonomic
neuropathies
affecting the GI tract
and requiring
symptomatic
treatment.
Weigh daily or as Weighing serves as
ordered. an assessment tool
to determine the
adequacy of
nutritional intake.
Ascertain patient’s Identifies deficits
dietary program and and deviations from
usual pattern then therapeutic needs.
compare with the
recent intake.
Provide liquids Oral route is
containing nutrients preferred when
and electrolytes as patient is alert and
soon as patient can bowel function is
tolerate oral fluids restored.
then progress to a
more solid food as
tolerated.
Provide diet of Complex
approximately 60% carbohydrates
carbohydrates, 20% (apples, broccoli,
proteins, 20% fats in peas, dried beads,
designated number carrots, peas, oats)
of meals and snacks. decrease glucose
levels/insulin needs,
reduce serum
cholesterol levels,
and promote
satiation. Food
intake is scheduled
according to specific
insulin
characteristics and
individual patient
 response. Note: A
snack at bedtime of
complex
carbohydrates is
especially important
(if insulin is given in
divided doses) to
prevent
hypoglycemia during
sleep and potential
Somogyi response.
Identify food If patient’s food
preferences, preferences can be
including ethnic and incorporated into
cultural needs. the meal plan,
cooperation with
dietary requirements
may be facilitated
after discharge.
Include SO in meal To promote sense of
planning as involvement and
indicated. provide information
to the SO to
understand the
nutritional needs of
the patient. Note:
Various methods
available or dietary
planning include
exchange list, point
system, glycemic
index, or pre
selected menus.
Consult dietician To reveal changes
and/or physician for that should be made
further assessment in the client’s dietary
and intake. For greater
recommendation understanding and
regarding food further assessment
preferences and of specific foods.
nutritional support.
 CUES EXPLANATION OF GOALS AND INTERVENTIONS RATIONALE EVALUATION ACTUAL
THE PROBLEM OBJECTIVES CRITERIA EVALUATION

Disease condition: Type 2 diabetes is Long term: Patient’s Review patient’s history to Such information can Fully met: patient is
Diabetes Mellitus type characterized by a fluid and electrolyte determine the probable assist to direct able to reach the
II combination of balance will be cause of the fluid management. History target input and
peripheral insulin stabilized and intake imbalance. may include increased output, absence of
resistance and and output will reach fluids edema and regular
Subjective data: inadequate insulin an approximate or sodium intake. breathing.
 Patient diagnosed secretion by pancreatic balance over a span of Partially met: she is
with dm type II beta cells. Insulin 72 hours as evidenced back to feeling of
and chronic renal resistance, which has by decreased normal, which
insufficiency. been attributed to peripheral edema, includes feeling
 Significant other elevated levels of free decreased signs of short of air, deep
report a decreased fatty acids and dyspnea, and patient breathing, and use
verbal output. proinflammatory verbalizing doesn’t of accessory
 Hgb: 101 mg/dl, cytokines in plasma, feel breathlessness. muscles and belly
hct: 0.30 mg/dl, leads to decreased to breathe, however
LDL: 163 mg/dl glucose transport into is still retaining
 Patient received muscle cells, elevated large volumes of
whole packed of hepatic glucose fluid.
blood last production, and Not met: conditions
October 31. increased breakdown of didn’t get any
Objective data: fat. better.
 Patient is with A role for excess Short term: Monitor weight regularly Sudden weight gain Fully met: olume
pitting edema glucagon cannot be using the same scale and may mean fluid as evidenced by
grade 1+ on both underestimated;  After 8 hours of preferably at the same time retention. Different weight loss,
hands. nursing of day wearing the same scales and clothing decreased
 With wound on interventions, amount of clothing. may show false weight peripheral edema,
theright foot patient will inconsistencies. clear lung sounds,
draining with demonstrate and normal heart
 purulent reduced Monitor input and output Dehydration may be sounds each day
discharges. extracellular fluid closely. the result of fluid until discharge was
 Seen to have dry volume as shifting even if overall partially met. The
mucous evidenced weight fluid intake is patients lung
membranes loss, decreased adequate. sounds were clear,
peripheral edema, and heart regular
Nursing dx: Excess clear lung rhythm despite rate
fluid volume related to sounds, and being high at times
compromised normal heart Partially met: Still
regulatory mechanism sounds each day with edema.
until discharge. Not met: edema
worsen.

 After 2 days of Assess weight in relation to In some patient Fully met: patient
NSG nutritional status. with heart failure, the is discharged with
interventions, weight may be a poor normal and
patient’s indicator of fluid stabilized glucose
complication will volume status. Poor level and without
be prevented or nutrition and any complications
minimized by decreased appetite such as infection.
discharge date over time result in a Partially met: With
was met. decrease in weight, risk for
which may be complication but
accompanied by fluid can be prevented
retention even though with drugs and
the net weight remains interventions.
unchanged. Not met:
Complication
Record intake if patient is Patients should be cannot be
on fluid restriction. reminded to include prevented, arised
items that are liquid at as a new problem
room temperature such thereby causing an
as gelatin, sherbet, extension to ward
soup, and frozen juice confinement.
pops.
Monitor and note BP and
HR.
Review chest x-ray reports.
Assess urine output in
response to diuretic
therapy.
Note for presence of edema
by palpating over the tibia,
ankles, feet, and sacrum.
Sinus tachycardia and
increased BP are
evident in early stages.
The x-ray studies
show cloudy white
lung fields as
interstitial edema
accumulates.
Recording two voids
versus six voids after a
diuretic
medication may
provide more useful
information.
Medications may be
given intravenously
because FVE in the
abdomen may
interfere with
absorption of oral
diuretic medications.
Edema occurs when
fluid accumulates in
the extravascular
spaces. Dependent
areas more readily
exhibit signs of edema
formation. Edema is
graded from trace
(indicating barely
perceptible) to 4
(severe edema).
Pitting edema is

Assess for crackles in
the lungs, changes in
respiratory pattern,
shortness of breath, and
orthopnea.
Assess for bounding
peripheral pulses and S3.
Check for distended neck
veins and ascites. Monitor
abdominal girth to follow
any ascites accurately.
Review
serum electrolytes, urineos
molality, and urine specific
gravity.
manifested by
a depression that
remains after one’s
finger is pressed over
an edematous area and
then removed.
Measurement of an
extremity with a
measuring tape is
another method of the
following edema.
These signs are caused
by an accumulation of
fluid in the lungs.
These assessment
findings are signs of
fluid overload.
Distended neck veins
are caused by elevated
CVP. Ascites occurs
when fluid
accumulates in
extravascular spaces.
All are indicators of
fluid status and guide
therapy.
Consider the need for an
external or indwelling
urinary catheter.
Check for excessive
response to diuretics.
Instruct patient, caregiver,
and family members
regarding fluid restrictions,
as appropriate.
Limit sodium intake as
prescribed.
Monitor fluid intake.
Take diuretics as
prescribed.
Treatment focuses on
diuresis of excess
fluid. Urinary
catheters provide a
more accurate
measurement of the
response to diuretics.
Significantly increased
response
to diuretics may lead
to the fluid deficit.
Information and
knowledge about
condition are vital to
patients who will be
co-managing fluids.
Restriction
of sodium aids in
decreasing fluid
retention
This enhances
compliance with the
regimen.
Diuretics aids in the
excretion of excess
body fluids.
Elevate edematous
extremities, and handle
with care.
Consider interventions
related to specific
etiological factors (e.g.,
inotropic medications
for heart failure,
paracentesis
for liver disease).
Educate patient and family
members regarding fluid
volume excess and its
causes.
Explain rationale and
intended effect of the
treatment program.
Educate patient and family
members the importance of
proper nutrition, hydration,
and diet modification.
Elevation increases
venous return to the
heart and, in turn,
decreases edema.
Edematous skin is
more susceptible to
injury.
Knowledge of
etiological factors
gives direction for
subsequent
interventions.
Information is key to
managing problems.
Follow-up care will be
the patient’s or
caregiver’s
responsibility.
Information is
necessary to make
correct choices in the
future.
Knowledge heightens
compliance with the
treatment plan.