Diabetes mellitus-Types, sign and symptoms and management of Diabetes mellitus

• Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia resulting from impaired insulin secretion

Classification of Diabetes

I. Type 1 Diabetes

1. Insulin- dependent diabetes mellitus
2. Juvenile- onset diabetes

Characteristics of Type I Diabetes

• Hypoinsulinemia
• 10% of diabetes case
• Patient require insulin
• Age onset is childhood
• Ketoacidosis

Etiology of Type I Diabetes

• Autoimmune disease
• Selective destruction of beta cells by T cells
• Several circulating antibodies against beta cells
• Cause of autoimmune attack
• Both genetic and environmental factor are important

II. Type 2 Diabetes

• Non- insulin- dependent diabetes mellitus
  Adult- onset diabetes

Characteristics of Type 2 Diabetes

• Impaired insulin action
• Insulin secretion is normal or increased
• 90% 0f diabetes cases
• Age of onset is adulthood
• Associated with obesity
• Ketoacidosis but rare
• Most cases don’t require insulin

Etiology of Type 2 Diabetes

• Response to insulin is decreased
• The mechanism of insulin resistance is unclear
• Both genetic and environmental factor are responsible
• Post insulin receptor defect

Mechanism of hyperglycemia in diabetes

1. Increase in hepatic glucose output

• Decrease insulin secretion in Liver
• Decrease homeostatic effect on glucagon secretion resulting in increased glucagon
• Gluconeogenesis and glycogenolysis occurs in Liver
• Results in increased plasma glucose

2. Decrease in uptake of glucose in Muscles

• Decrease in insulin in muscles
• Decreased uptake of glucose and amino-acids in muscles
• Increased breakdown of proteins
• Results in increased plasma glucose and plasma amino acids

3. Decrease in uptake of glucose in adipose tissue

• Decrease in insulin
• Increased lipolysis and decreased lipogenesis
• Results in increased plasma fatty acids

Sign and symptoms of Diabetes

• thirst and frequent drinking
• most frequent urination particularly at night
• unexplained weight loss
• fatigue
• blurred vision
• frequent infection of skin, genital

Diagnostic evaluation of Diabetes

• history taking
• physical examination
• symptoms + random plasma glucose > 11.1 Mm (200mg/ dl )
• fasting plasma glucose >7Mm (126mg/dl)
• oral glucose tolerance test (OGTT) 2 hour plasma glucose >11.1Mm (200mg/dl)

1. Medical management of Diabetes

Type 1 Diabets

• insulin injection should be given as per needed by analyzing blood sugar level
• frequent blood sugar check
• carbohydrate counting should be done

Type 2 Diabetes

• 7,5 % monotherapy ( metformin unless contraindicated)
• 5 – 9,0% dual therapy ( metformin + other medication)
• If the patient have diabetic complication then we must go for insulin therapy
• As Metformin is contraindicated in-case of renal failure, liver, or lung disease

2. Surgical management of Diabetes

• Gastric bypass and biliopancreatic diversion
• Pancreatic transplantation
• Islet cell transplantation

3. Nursing management of Diabetes

1. Nursing assessment of Diabetes A

• History taking, history of family and past medical history
• Past surgical history and other treatment
• Information about medication and insulin therapy
• Assessment of nutritional status
• Assess the blood sugar level
• Assess for sign and symptoms

2. Nursing diagnosis of Diabetes

• Imbalanced nutrition less than body requirement related to reduction of carbohydrate metabolism due to insulin deficiency
• Fluid volume deficit related to polyuria, decreased fluid intake
• Impaired skin integrity related to decreased sensory sensation, impaired circulation
• Risk for infection related to high glucose level reduction in leukocyte function
• Deficit knowledge about the disease the process related to lack of information

3. Nursing intervention of Diabetes

• Monitor vitals sign of the patient
• Provide medication as per cardex , administer insulin or an oral anti diabetic drug
• Analysis blood glucose level
• Maintain fluid and electrolyte balance
• Increase knowledge about diabetes management
• Monitoring and managing potential cmplications
• Provide skin care especially to the feet and legs
• Assist the client for coping mechanism
• Teach patient self- care and about disease condition

Complications of Diabetes mellitus

1. Acute complications of Diabetes

• Glucosuria ( glucose appear in urine)
• Polyuria( frequent urination)
• Polydipsia( excessive thirst)
• Polyphagia(excessive food intake)
• Ketoacidosis

2. Chronic complications of Diabetes

• Neuropathy ( loss of sensation due to damage of nerve fibres )
• Retinopathy ( damage of retina)
• Cataract ( damage of lens)
• In cardiovascular there may be atherosclerosis, hypertension, myocardial infraction
• In nephropathy there may be severe kidney failure and follow- up proteinuria