Copyright © 2007 Lippincott Williams & Wilkins. Diabetes in my family Slide 1 My grandmother was a Type 2 Diabetic. My husband’s cousin is a Type 1 Diabetic.

Copyright © 2007 Lippincott Williams & Wilkins.

Diabetes in my family

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My grandmother was a Type 2 Diabetic.

My husband’s cousin is a Type 1 Diabetic


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Timby/Smith: Introductory Medical-Surgical Nursing, 9/e

Chapter 57: Caring for Clients With Diabetes Mellitus


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Diabetes Mellitus

Prediabetes MellitusCan lead to

Type 2 diabetesHeart diseaseStroke

Impaired fasting glucose (IFG)

100 to 125 mg/dL Impaired glucose tolerance (IGT)

140 to 199 mg/dL


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Diabetes Mellitus

Hyperglycemia Associated: Other disorders; their managementPancreatitis; adrenocortical hormones

Pathophysiology and Etiology Type 1 diabetes mellitus (IDDM)

Juvenile diabetes; no insulin producedLipolysis; ketones; ketoacidosisAutoimmune disorder

Type 2 diabetes mellitus (NIDDM)Insulin resistant; insufficient insulin; inherited


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Diabetes Mellitus

Pathophysiology and EtiologyType 2 diabetes mellitus (NIDDM) (cont’d)

Obesity—trigger; glycosuria; impaired renal threshold; ketonemia; Kussmaul respirations

Assessment Findings Signs and symptoms

Polyuria; polydipsia; polyphagia; weight loss; dehydration; blurred vision; thirst; infections: Skin, urinary tract, vaginal

Diagnostic findingsUrinary tests; blood tests; glucometer; hemoglobin A1c test


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Diabetes Mellitus

Medical Management Depends on type of diabetesDiet and weight loss: Major component of treatmentExercise

Reduces need for insulin Improves blood circulation

InsulinTypes of insulin

Human; beef and porkAlternatives to injection


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Diabetes Mellitus

Medical Management Insulin (cont’d)

Administration of insulin

Dosage: u-100; typeIV; subcutaneous; lipoatrophy; lipohypertrophyInsulin pen Jet injector Insulin pump

Figure 57-8 Absorption of

Insulin through

(A) A needle (B) Jet Injector


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Diabetes Mellitus

Medical Management Oral antidiabetic agents-type 2

1.Sulfonylureas and meglitinidesSAM- insulin releaser 2.Biguanides and thiazolidinediones BAT- insulin sensitizer (GI complications)3.Alpha-glucosidase inhibitors (balancer)-glucose formation is slowed, 15 mintues AC *interferes with conversion of Carbs, can not give juice must give glucose tablets or injection


Pancreas transplantation- Life long Immunosuppressant drugs

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Islet Cell Transplantation2 pancreas, pigs, used in 12hours, no steroids with immunosuppressant drugsVery little Insulin/can eat whatever!

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Diabetes Mellitus

Nursing Management History: medical; drug; allergy; familyWeight; head-to-toe physical examination; vital signsObserve for physical changes; edema; visual changesClient and family education

DietTreatment: Insulin administration; blood glucose monitoring; urine testing; rotation of injection sites


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Diabetes Mellitus

Nursing Management Client and family education (cont’d)

Exercise; weight reduction Drinking adequate water; skin care; foot care Signs and symptoms of hyperglycemia and hypoglycemiaIntegration of dietary exchange list


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Acute Complications of Diabetes Mellitus: Diabetic Ketoacidosis (DKA) Pathophysiology and Etiology

Brittle diabetes; noncompliance with treatment; infection Acidotic state; coma

Assessment FindingsWeakness; thirst; anorexia; vomiting; drowsiness; abdominal pain; Kussmaul respirations; low BPBlood glucose; urine test; laboratory tests; blood pH


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Acute Complications of Diabetes Mellitus: Diabetic Ketoacidosis

Medical ManagementMain goals

Reduce the elevated blood glucoseCorrect fluid and electrolyte imbalancesClear the urine and blood of ketones

IV Insulin; glucoseIsotonic fluidPotassium replacements


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Acute Complications of Diabetes Mellitus: Diabetic Ketoacidosis

Nursing ManagementMonitor

IV infusions; vital signs; urinary output

CheckSerum electrolyte findings; blood glucose level

Check forKetones; hyperkalemia


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Acute Complications of Diabetes Mellitus: Hyperosmolar Hyperglycemic Nonketotic Syndrome Pathophysiology and Etiology

Results from serious illness; diuresis; blood glucose >500; pH normal range

Assessment Findings Hypotension; mental changesExtreme thirst; dehydration; tachycardiaFever; neurologic signsPhysical examination; blood glucoseSerum potassium; sodiumSerum osmolarity


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Acute Complications of Diabetes Mellitus: Hyperosmolar Hyperglycemic Nonketotic Syndrome Medical Management

Insulin administration; correction of fluid and electrolyte imbalances; CVP

Nursing Management Assess for electrolyte imbalancesBlood glucose levels Implement medical orders for insulin Evaluate hydration status; skin turgor; vital signs; electrolyte studies Observe neurologic, cognitive symptoms


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Long-Term Complications of Diabetes

Tissue or Organ Affected

What Happens Complications

Blood vessels Fatty material (atherosclerotic plaque) builds up and blocks large or medium-sized arteries in the heart, brain, legs, and penis.The walls of small blood vessels are damaged so that the vessels do not transfer oxygen to tissues normally, and the vessels may leak.

Poor circulation causes wounds to heal poorly and can lead to heart disorders, strokes, gangrene of the feet and hands, erectile dysfunction (impotence), and infections.

Eyes The small blood vessels of the retina are damaged.

Decreased vision and, ultimately, blindness occur.


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Kidney Blood vessels in the kidney thicken.Protein leaks into urine.Blood is not filtered normally.

The kidneys malfunction, and ultimately, kidney failure occurs.

Nerves Nerves are damaged because glucose is not metabolized normally and because the blood supply is inadequate.

Legs suddenly or gradually weaken.People have reduced sensation, tingling, and pain in their hands and feet.

Autonomic nervous system

The nerves that control blood pressure and digestive processes are damaged.

Swings in blood pressure occur.Swallowing becomes difficult.Digestive function is altered, and sometimes bouts of diarrhea occur.Erectile dysfunction develops.

Skin Blood flow to the skin is reduced, and sensation is decreased, resulting in repeated injury.

Sores and deep infections (diabetic ulcers) develop.Healing is poor.

Blood White blood cell function is impaired.

People become more susceptible to infections, especially of the urinary tract and skin.

Connective tissue

Glucose is not metabolized normally, causing tissues to thicken or contract

Carpal tunnel syndrome and Dupuytren's contracture develop


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Acute Complications of Diabetes Mellitus: Hypoglycemia

Pathophysiology and Etiology Hyperinsulinism—blood glucose <60 mg/dLContributing factors: Diet; exercise; alcohol

Assessment Findings Signs and symptoms: Nausea; drowsiness; hunger; malaise; excessive perspiration; confusion; coordination difficulty; personality or behavior changesDiagnostic findings: Symptoms; history; blood glucose levels; glucometer test


http://www.youtube.com/watch?v=zLrsCnBvQFo

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Acute Complications of Diabetes Mellitus: Hypoglycemia

Medical Management Administration of 15 to 20 g of simple carbohydrate as soon as possibleGlucagon; IV administration of 50% glucoseComplex carbohydrates

Nursing Management Oral source glucose-conscious clientImplements medical orders for parenteral medicationsMonitor blood glucose levelMeasures to prevent hypoglycemia


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Chronic Complications of Diabetes Mellitus: Peripheral Neuropathy Pathophysiology and

Etiology Poor glucose control; decreased blood circulation to nerve tissue Motor neuropathy; sensory neuropathy; autonomic neuropathy

Assessment Findings Signs and symptoms: Pain; swollen feet

Figure 57-8 Neuropathic ulcers occur on pressure

points


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Chronic Complications of Diabetes Mellitus: Peripheral Neuropathy Assessment Findings

Signs and symptoms: Disturbing sensations; digestive, urinary, and sexual dysfunction; dizziness; smaller skeletal musclesDiagnostic findings: Neurologic examination; screening test; electromyography

Medical Management Diet; exercise; pain relief measuresDrug therapy; antibiotic therapyDrugs to reverse diabetic neuropathies


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Chronic Complications of Diabetes Mellitus: Peripheral Neuropathy Nursing Management

Teaching plan: Management; potential complicationsFoot carePrecautions for autonomic neuropathy, digestive problems Compliance with prescribed medications and dosageReferral to urologist


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Chronic Complications of Diabetes Mellitus: Diabetic Nephropathy Pathophysiology and Etiology

Glomerular deterioration; five stages Assessment Findings

Swollen feet and handsGradually increasing BPTirednessWeaknessUrinalysisSerum creatinine testRenal creatinine clearance test


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Chronic Complications of Diabetes Mellitus: Diabetic Nephropathy Medical Management

Control blood glucose levels, hypertension Drug therapy; Dietary protein reduction; smoking cessation

Nursing ManagementMonitor blood glucose and hemoglobin A1c resultsCheck for albuminuria Smoking cessation measuresExplain the therapeutic regimen


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Chronic Complications of Diabetes Mellitus: Diabetic Retinopathy Pathophysiology and Etiology

Vascular changes in retina Types

NonproliferativeProliferative—blindness

Assessment Findings Diminished visual acuityOpthalmic examination; fluorescein angiography

Figure 57-11 Top: In the normal eye Bottom: In diabetic retinopathy


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Chronic Complications of Diabetes Mellitus: Diabetic Retinopathy Medical Management

Laser photocoagulation; vitrectomy; ACE inhibitor

Nursing ManagementEncourage therapeutic regimen for tight glucose controlClient education

Complications of diabetes Regular ophthalmic examinationsMedication


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Chronic Complications of Diabetes Mellitus: Vascular Disturbances Pathophysiology and Etiology

Thickening of arterial walls; coronary artery disease Insensitivity to leptin; hyperlipidemia

Assessment Findings Cool extremities; leg crampsGangrene; skin ulcers; myocardial infarctions Laboratory tests; angiographyDoppler ultrasonic flow studies


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Chronic Complications of Diabetes Mellitus: Vascular DisturbancesMedical and Surgical Management

Lipid-lowering measures; vasodilatorsPlatelet aggregation reduction drugsAmputationInsulin; antidiabetic drugs

Nursing ManagementRelated to

Type of vascular disturbance Client’s signs and symptoms


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General Considerations

Nutritional ConsiderationsNutrition therapy: Cornerstone of treatment Diet depends on the type of diabetesIndividualized meal plansExchange lists to simplify meal planningConsistency in the total amount of carbohydrate consumed influences blood glucose level


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Pharmacologic ConsiderationsProperties of insulin: Onset; peak; duration Clients may be sensitive to minute insulin dose changesInsulin; oral antidiabetic drugs: Control hyperglycemia, but do not cure diabetesOral antidiabetic drugs along with insulin therapy decreases the incidence of hypoglycemia (with IDDM)


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Gerontologic ConsiderationsProvide sufficient time, instruction, and assistance to learn self-careActive involvement of client and familyPlan meals and treatment based on eating and sleeping habits of older adults Emphasize foot care Review all drugs for any that may interact with oral antidiabetic drugs


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End of Presentation

Copyright © 2007 Lippincott Williams & Wilkins. Diabetes in my family Slide 1 My grandmother was a Type 2 Diabetic. My husband’s cousin is a Type 1 Diabetic.

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