Diabetes Mellitus

"Trouble moving glucose"

Osmosis

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Pathophysiology

Type 1: the immune system attacks and destroys the insulin-producing beta cells of the pancreas. Beta-cell deficiency leads to complete insulin deficiency. Thus, it terms it as an autoimmune disease where there are anti-insulin or anti-islet cell antibodies present in the blood. This causes destruction of the islet of the pancreas, and while destruction takes time, the onset is rapid and may happen over a few days or weeks.

Type 2: This type is caused by a deficiency of insulin that is not absolute. The body is able to produce insulin, just not enough to meet the needs of the body.

 

Etiology

Causes of Diabetes Mellitus include:

  • Type 1:

    • Autoimmune disorder

    • Genetic association

    • Ketosis

    • no presence of insulin

  • Type 2:

    • Insulin resistance

    • Obesity

    • Family history

    • insulin is present in the body

 

Lab & Diagnostics

Labs and diagnostics for Diabetes Mellitus  include:

  • Blood Glucose to test for abnormally high blood sugar.

  • FPG or Fasting plasma glucose – in a lab after fasting for 8 or more hours.

  • 2-hour, post-load test – tested 2 hours after the pt. receives glucose

  • HgbA1c (A1C) Test Test for microalbuminuria

  • Serum creatinine level

  • Urinalysis

  • Electrocardiogram

 

Signs & Symptoms

S/S of Diabetes Mellitus include:

  • 3 P's

    • Polyuria (increased urination)

    • Polydipsia (increased thirst)

    • Polyphagia (increased appetite)

  • Fatigue

  • weakness

  • sudden vision changes

  • tingling or numbness in hands or feet

  • dry skin

  • slow-healing wounds

  • recurrent infection

 

Type 1: sudden weight loss or nausea, vomiting, or abdominal pains, if DKA (Diabetic Keto Acidosis) has developed.

 

Risk Factors

Risk factors for Diabetes Mellitus include:

  • Being of the minority population

  • Family history

  • Obesity

  • Age equal to or greater than 45

  • Hx of gestational diabetes or delivery of a baby over 9 lb

 

Treatment

The main goal of treatment is to normalize insulin activity and blood glucose to reduce the development of complications.

 

Medical: Insulin Injections, Insulin Pump, frequent glucose monitoring. SMBG Therapy (Self-monitoring of blood glucose)

5 components of management:

  • Nutrition (can reverse type 2)

  • exercise

  • monitoring

  • pharmacologic

  • education

 

Pharmacologic:

  • Type 1: Insulin for life

  • Type 2: can be controlled by meal planning, but may require long-term insulin for those that cannot meal plan or oral agents are ineffective.

 

Nursing

Interventions

Manage the patient glucose level while hospitalized.

Patient Teaching:

  • Develop an education plan,

  • educate about basic skills in administering insulin.

  • Access the patient's knowledge level, and willingness to learn.

  • Teach pt. how to self administer insulin.

 

Injections: The nurse needs to know all info regarding insulin (types, needles, etc.)