diabetes

• Diabetes Mellitus


  A group of metabolic disorders characterized by high blood glucose levels resulting from the body's inability to produce or use insulin effectively
• Classifications of Diabetes Mellitus

  • Type 1
  • Type 2
  • Gestational Diabetes
  • Latent Autoimmune Diabetes of Adult
  • Diabetes Associated with other conditions (Pre-diabetes)
  • Drug-Induced Diabetes
• Type 1 Diabetes Mellitus


  • Autoimmune response
  • Insulin-dependent diabetes
  • Characterized by the destruction of Pancreatic Beta cells
  • Combined genetic, immunologic, and environmental factors contribute to beta-cell destruction
  • Genetic susceptibility is a common underlying factor, found in people with certain Human Leukocyte Antigen (HLA) type
• Clinical Manifestations of Diabetes Mellitus

  • Polyuria
  • Polydipsia
  • Polyphagia
  • Fatigue
  • Weakness
  • Vision changes
  • Wounds slow to heal
  • Paresthesia
• Acute Complications of Diabetes Mellitus

  • Hypoglycemia
  • Diabetic Ketoacidosis
• Risk Factors for Type 1 Diabetes Mellitus


  • Family history
  • Certain human leukocyte antigen (HLA) genes: HLA-DR3 and HLA-DR4
  • Viral infections
  • Dietary factors
  • Geographical factors
  • Autoimmunity
  • Autoantibodies
  • Age: children and adolescents
  • Ethnicity: European descent
• Methods of Insulin Delivery

  • Traditional subcutaneous injections
  • Insulin pens
  • Insulin pumps
• Rapid Acting Insulin


  • Onset: 15 - 30 min, Peak: 15 min, Duration: 30 - 90 min
  • Used for rapid reduction of glucose level, to treat postprandial hyperglycemia, or to prevent nocturnal hyperglycemia
• Short Acting Insulin


  • Onset: 3 - 60 min, Peak: 2 - 3 hrs, Duration: 4 - 6 hrs
  • Usually given 15 min before meal, may be taken alone or in combination with longer-acting insulin
• Intermediate Acting Insulin


  • Onset: 1 - 1.5 hrs, Peak: 4 - 12 hrs, Duration: Up to 24 hrs
  • Food should be taken around the time of onset and peak
• Long Acting Insulin


  • Onset: 3 - 6 hrs, Duration: 24 hrs
  • Used for basal dose
• Rapid-Acting Inhalation Powder Insulin

  • Onset: 2 - 3 hrs
  • Administer at the beginning of a meal
• Nursing Management of Diabetes Mellitus

  • Glucose control is important
  • Developing diabetes educational plan
  • Educating patients to self-administer Insulin
  • Proper storage of insulin: refrigerated when not in use, avoid extreme temperatures, keep at room temperature when in use, always have a spare vial, mix cloudy insulin thoroughly
• Selecting Syringes


  Currently, three sizes of U-100 Insulin syringes are available: 1-mL (100-unit capacity), 0.5-mL (50-unit capacity), 0.3-mL (30-unit capacity)
• Selecting and Rotating Injection Site

  • Four main areas for injection: abdomen, upper arm, thighs, and hips
  • Speed of absorption is greatest in the abdomen and decreases progressively in the arm, thigh, and hip
  • Rotate injection site to prevent lipodystrophy
• Type 2 Diabetes Mellitus


  • Metabolic condition
  • Non-insulin dependent
  • Insulin resistance is when cells in muscle, fat, or liver don't respond well to insulin
  • Two main problems: insulin resistance and impaired insulin secretion
• Clinical Manifestations of Type 2 Diabetes Mellitus

  • Polyuria
  • Polydipsia
  • Polyphagia
  • Fatigue
  • Weakness
  • Vision changes
  • Wounds slow to heal
  • Paresthesia
• Assessment and Diagnostic Findings for Diabetes Mellitus

  • Fasting Plasma Glucose: 70 mg/dL - 100 mg/dL
  • Random Plasma Glucose: 80 mg/dL - 120 mg/dL
  • 2-Hour Postprandial Load: less than 140 mg/dL (without DM), less than 180 mg/dL (with DM)
  • Hemoglobin A1C: less than or equal to 5.6
• Acute Complications of Type 2 Diabetes Mellitus

  • Hyperglycemic hyperosmolar syndrome: life-threatening condition, mainly in type 2 DM, characterized by body making insulin but insulin not working properly, leading to hypotension, profound dehydration, tachycardia, and variable neurologic signs
• Chronic Complications of Diabetes Mellitus

  • Macrovascular Complications: Coronary Artery Disease, Peripheral Vascular Disease
  • Microvascular Complications (microangioedema): Diabetic Retinopathy, Diabetic Nephropathy
  • Diabetic Neuropathies: Peripheral Neuropathy, Autonomic Neuropathy
• Diabetic Neuropathies


  • Group of diseases that affect all types of nerves, including peripheral (sensorimotor), autonomic, and spinal nerves
  • May be attributed to vascular or metabolic mechanism or both
  • Characterized by capillary basement membrane thickening and capillary closure, as well as demyelination of the nerves
• Peripheral Neuropathy


  Most commonly affects the distal portions of the nerves, especially the nerves of the lower extremities
• Autonomic Neuropathy


  Results in a broad range of dysfunctions affecting almost every organ system of the body
• Type 2 Diabetes Mellitus Medical Management: Nutritional Therapy


  • Control of total calorie intake to attain and maintain reasonable body weight, control of blood glucose levels, normalization of lipids and blood pressure to prevent heart disease
  • For patients with obesity, weight loss of 5% to 10% of total weight may significantly improve blood glucose levels
  • Meal Planning involves calorie-controlled diets based on person's age, gender, height, and weight, focusing on percentages of calories from carbohydrates, proteins, and fat
• Macronutrient Recommendations for Type 2 Diabetes Mellitus

  • Carbohydrates: 50% - 60% of calories, majority from whole grains, low glycemic index diet
  • Protein: 10% - 20% of calories, use of nonanimal sources to reduce saturated fat and cholesterol
  • Fats: Moderate intake
  • Fiber: Adequate intake
• Autonomic Neuropathy affects the nerves of the lower extremities
• Nutritional Therapy


  • Control of total calorie intake to attain and maintain reasonable body weight
  • Control of blood glucose levels
  • Normalization of lipids and blood pressure to prevent heart disease
• For patients who have obesity, weight loss of 5% to 10% of total weight may significantly improve blood glucose levels
• Meal Planning


  • Calorie-controlled diets based on person's age, gender, height, and weight
  • Focuses on the percentages of calories that come from carbohydrates, proteins, and fat
• Macronutrient composition


  • Carbohydrates: 50% - 60% of calories
  • Protein: 10% - 20% of calories
  • Fats: 20% - 30% of calories
• Carbohydrates


  • Majority of selection should come from whole grains
  • Low glycemic index diet
  • All carbohydrates must be eaten in moderation to avoid high postprandial blood glucose levels
• Protein


  • Use of nonanimal sources of protein may be included to help reduce saturated fat and cholesterol intake
  • May be reduced in patients with early signs of kidney disease
• Fats


  • Reducing the total percentage of calories from fat sources to less than 30% of total calories
  • Limiting the amount of saturated fats to 10% of total calories
  • Limiting total intake of dietary cholesterol to less than 300 mg/day
• Fiber


  • At least 28 g/day
  • Lowers total cholesterol and low-density lipoprotein levels in the blood
  • Increases satiety, which is helpful for weight loss
• Exercise


  Alters blood lipid concentrations, increasing levels of HDL and decreasing total cholesterol and triglyceride levels reducing risk of cardiovascular disease
• Exercise recommendations must be altered as necessary for patients especially in patients with diabetic complications
• Oral Antidiabetic Agents


  • Biguanides (Metformin, Metformin with glyburide)
  • Alpha-Glucosidase Inhibitors (Acarbose, Miglitol)
  • Dipeptide Peptidase-4 (DPP-4) Inhibitors (Alogliptin, Saxagliptin, Sitagliptin, Vildagliptin)
  • Glucagonlike Peptide-1 Agonist (GLP-1) (Dulaglutide, liraglutide)
  • Non-Sulfonylurea Insulin Secretagogues (Nateglinide, repaglinide)
  • Second-Generation Sulfonylureas (Glimepiride, glipizide, Glyburide)
  • Sodium-Glucose co-transporter 2 (SGL-2) Inhibitors (Dapagliflozin, Empagliflozin)
  • Thiazolidinediones (Pioglitazone, Rosiglitazone)
• Biguanides


  • Inhibit production of glucose by the liver
  • Increase body tissue sensitivity to insulin
  • Decrease hepatic synthesis of cholesterol
• Alpha-Glucosidase Inhibitors


  • Delay absorption of complex carbohydrates in the intestine and slow entry of glucose into systemic circulation
  • Do not increase insulin secretion
  • Can be used alone or in combination with sulfonylureas, metformin, or insulin to improve glucose control
• Dipeptide Peptidase-4 (DPP-4) Inhibitors

  Increase and prolong the action of incretin, a hormone that increases insulin release and decreases glucagon levels, with the result of improved glucose control