Diabetes mellitus complete Disorder Exclusively for Nursing Students

BY :- Mr. Baljinder Singh

Assistant Professor

PIMS, Panipat

An endocrine disorder in which there is

insufficient amount or lack of insulin

secretion to metabolize carbohydrates.

It is characterized by hyperglycemia,

glycosuria and ketonuria.

Diabetes mellitus is a group of

metabolic diseases characterized by

elevated levels of glucose in the blood

(hyperglycemia) resulting from defects in

insulin secretion, insulin action, or both

Insulin, a hormone produced by thepancreas, controls the level of glucose inthe blood by regulating the production andstorage of glucose. In the diabetic state, thecells may stop responding to insulin or thepancreas may stop producing insulin entirely.This leads to hyperglycemia, which mayresult in acute metabolic complications suchas diabetic ketoacidosis (DKA) andhyperglycemic hyperosmolar nonketoticsyndrome (HHNS).

THEINSULIN

WHEN

SOMEONE

SUFFER

HAPPEN

WITH

Risk of diabetes typically increase when you are: Older age (45 years or older) Less active (sedentary life) Overweight or obeseFamily history of diabetesPre-diabetesHigh blood pressureHigh lipids (triglycerides and low

HDL)Diabetes during pregnancy or baby

>9 lbs.

Type 1 - IDDM

• little to no insulin

produced

• 20-30% hereditary

• Ketoacidosis

Gestational

• overweight; risk for

Type 2

Type 2 - NIDDM

• some insulin produced

• 90% hereditary

Other types include Secondary

Diabetes :

• Genetic defect beta cell or insulin

• Disease of exocrine pancreas

• Drug or chemical induced

• Infections-pancreatitits

• Others-steroids,

Type 1 diabetes is a chronic (lifelong)

disease that occurs when the pancreas

produces too little or no insulin to regulate

blood sugar levels appropriately.

Causes :-

Viral infection

Genetics

Not caused by life style.

Type 2 diabetes also called NIDDM is

a chronic, life-long disease that

results when the body's insulin does

not work effectively.

Causes and risk factors

Genetics

low activity level

poor diet

excess body weight (especially around the

waist)

Race/ethnicity;

PATHOPHYSIOLOGY

History

Blood tests

• Fasting blood glucose test: two tests > 126 mg/dL

• Oral glucose tolerance test: blood glucose > 200

mg/dL at 120 minutes

• Glycosylated hemoglobin (Glycohemoglobin test)

assays

• Glucosylated serum proteins and albumin

FSBS – (finger stick) monitoring blood sugar

Urine testing for ketones

Urine testing for renal function

Urine testing for glucose

ORAL ANTI-DIABETIC DRUGS:-

Oral sulfonylureas (like glimepiride,

glyburide, and tolazamide) trigger the

pancreas to make more insulin.

Biguanides (Metformin) tell the liver to

decrease its production of glucose, which

increases glucose levels in the blood

stream.

Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract, thereby lowering the after-meal glucose levels.

Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell site. In essence, they increase the cell's sensitivity (responsiveness) to insulin.

Oral Antidiabetic Agents

Insulin lowers blood sugar by allowing it to leave the blood stream and enter cells. Patients with Type 1 diabetes mellitus depend on external insulin (most commonly injected subcutaneously)

The commonly used types of insulin are:

Rapid-acting insulin These begin to work within 5 to 15 minutes and are active for 3 to 4 hours.

Short-acting, such as regular insulin – starts working within 30 minutes and is active about 5 to 8 hours.

Intermediate-acting,– starts working in 1 to

3 hours and is active 16 to 24 hours.

Long-acting, insulin – starts working in 4 to

6 hours, and is active well beyond 32

hours.

Diabetes Diet: A healthy diet is

key to controlling blood sugar

levels and preventing diabetes

complications.

Eat a consistent, well-balanced

diet that is high in fiber, low in

saturated fat, and low in

concentrated sweets.

Purpose - controls

blood glucose and

lowers blood glucose

Purpose - reduce the

amount of insulin

needed

Urine - Ketones

FBS

Wear ID Bracelet

Diabetic ketoacidosis

Hyperglycemic-hyperosmolar-

nonketotic syndrome

Hypoglycemia from too much insulin or

too little glucose

Physical General signs

Ill appearance

Dry skin

Dry mucous membranes

Decreased skin turgor

Vital signs

Tachycardia

Hypotension

Tachypnea

Hypothermia

Fever, if infection

Specific signs

Ketotic breath (fruity, with acetone smell)

Confusion

Coma

Abdominal tenderness

1. Fluids

- If in shock, initial resuscitation with normal saline. Dehydration

should then be corrected gradually over 48 to 72 hour

using 0.45% Saline

- Monitor :

- Fluid input and output

- Electrolytes, creatinine and acid-base status regularly

- Neurological states

2. Insulin- insulin infusion is started, titrating the dose according to the

blood glucose. Monitor blood glucose regularly.

- aim for gradual reduction of blood glucose .

Cardiovascular disease

Cerebrovascular disease

Retinopathy (vision) problems

Diabetic neuropathy

Diabetic nephropathy

Male erectile dysfunction

Uncontrolled diabetes

can lead to…

Kidney failure

Amputations

Loss of Sensations

Heart disease

and strokes

Blindness

Death

By :- Baljinder Singh , Assistant Professor PIMS, Panipat08053142473