Diabetes mellitus
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Transcript of Diabetes mellitus
Diabetes Mellitus
Definition:-Diabetes mellitus is a chronic systemic disease
characterized by either a deficiency of insulin or a
decrease ability of the body to use insulin.
Anatomy & Physiology:-
Classification of D.M.:-
Type-I Diabetes mellitus:-In this form of diabetes mellitus the Beta cells of
pancreas that normally produce insulin which are
destroy by an auto-immune response.
As a result insulin injection are needed to control the
elevated blood sugar level.
Causes:-1) Genetic factors.(HLA)
2) Immunological factors.
3) Environmental factors.
Patho-physiology:-
Type-2 Diabetes mellitus:-It refers from decreased sensitivity to insulin
or decrease production of insulin.
This type of patient firstly treated by diet and
exercise and secondary by oral hypoglycemic
drug.
Causes:-1) Age- > 65yrs.
2) Obesity
3) Family history.
Gestational D.M. :-Onset is during pregnancy
usually 2nd & 3rd trimester.
It may be due to hormonal
secretion by the placenta
which inhibit the action of
insulin.
4) Associated with other conditions:-It is a form of non- insulin dependent diabetes
mellitus, in which the disease is associated with other
disease, hormonal abnormalities, drugs such as gluco-
corticoids and oestrogen containing preparation.
5) Impaired Glucose Tolerance:-Most common in people
who are susceptible to
artherosclerosis disease,
obese or non-obese
patient , previous history
of hyperglycemia,
Clinical Manifestation:-Polydypsia.Polyphasia.Polyuria.Hyperglycemia.Blurred vision.Diabetic ketosis.Diabetic ketoacidosis.Dry skin.Slow healing wound.Weakness.
Investigations:-1) Fasting blood glucose.
2) Random blood glucose.
3) Postprandial blood glucose
level.
4) Oral glucose tolerance test.
5) Urine test for ketonuria.
6) Urine test for proteinuria.
Complications:-1) Chronic complications:-
-Macrovascular complication.
(coronary artery d/s, cerebrovascular d/s, Hypertension etc.)
-Microvascular complications.
(Retinopathy, nephropathy)
-Neuropathic complications:-
(Sensorimotor neuropathy, autonomic neuropathy)
-Mixed:-
(Foot ulcer)
Acute Complications:- -Hypoglycemia. -Hyperglycemia. -Diabetic ketoacidosis. -Diabetic retinopathy. -Diabetic nephropathy. -Diabetic neuropathy.
Management:-The main management or goal is to normalise insulin
activity and blood glucose level to reduce the vascular and nephropathic complications.
5 main components of management of diabetes mellitus patient’s are:-
Cont..1) Diet
2) Exercise
3) Monitoring
4) Education
5) Medication
Pharmacological t/t:-
(A) Insulin therapy:-Insulin may be grouped into several categories based on
the onset, peak and duration of action……. 1) Rapid acting:- Eg. Lispro, Aspart onset- 10-15min. duration- 8hrs.2) Short acting:- Eg. Humalog R, Novolin R onset- ½-1hr duration- 4-6 hrs
3) Intermediate acting :- Eg. Protamine Hagedorn, Novolin
L onset- 2-4 hrs duration- 16-24hrs.4) Long acting :-
Eg. Ultralenate onset-6-8 hrs. duration-20-30hrs.5) Very long acting:- Eg. Glargine onset- 1hr. duration- 24hrs
(B) Oral diabetic agent:- -Sulfonylureas (stimulate pancreas to stimulate insulin) -Biguanides- (helps to decrease the glucose level) -Alpha glucosidase inhibitors (delaying absorption of glucose) -Thiazolidinediones (promote insulin action) -Meglitinides- ( decrease glucose level)Surgical Management:- Pancreas transplantation
Nursing Management:-Assessment:- - Assess the general condition of the patient. - Assess the past and medical history of the
patient. - Assess for the etiological factors responsible
in client. - Assess for signs and symptoms in the client. - Assess for the type of diabetes and type of
insulin used foe the patient. -Assess for the investigation for the patient.
Nursing Diagnosis:-1) Risk for fluid volume deficit related to
polyuria and dehydration.2) Imbalance nutrition related to imbalance of
insulin, food and physical activity.3) Deficient knowledge about diabetes self
care skills/ information.4) Potential self-care deficit related to physical
impairments or social factors.5) Anxiety related to loss of control, fear of
inability to manage diabetes, misinformation related to diabetes, fear of diabetes complications.
Intervention:-1) Maintaining fluid and electrolyte balanceIntake and output are measured.I/V fluids and electrolytes are administered as
prescribed.Oral intake is encouraged when it is permitted.Vital signs are monitored hourly for signs of
dehydration.2) Improving nutritional intake…Meal planning is implemented, with the control of
glucose as the primary goal.An appropriate caloric intake allows the patient to
achieve and maintain desired body weight.
3) Reducing anxiety..Provide emotional support and sets aside
time to talk with the patient.Any misconception the or family may have
regarding diabetes are dispelled.Positive reinforcement is given for the self
care behaviours.4) Improving self care..
Assignment:-M.M-10 Time-
10mins
1) Define diabetes mellitus.
2) Enlist the types of diabetes mellitus.
3) Write down the clinical manifestations of diabetes mellitus.
(Write your name and roll no. on the top of the answer sheet.)