Lauren & Drew

Chronic multisystem disease affecting 20% of

U.S. population

6th leading cause of death in the U.S.

Results from dysfunctional glucose transport in

body

The increase of glucose in your blood

stimulates beta cells in the pancreas to

secrete “insulin”

Insulin facilitates glucose transport into cells for

oxidation & energy production

Insulin transports glucose from bloodstream

into cells

There is an impaired glucose transport

because of decreased or absent insulin

secretion and/or ineffective insulin action

Patient can not store glucose in their liver

and muscle as glycogen

Type 1: absolute deficiency of insulin due to

destruction of pancreatic beta cells

If insulin is not given, fats are metabolized,

which can result in Metabolic Acidosis (Diabetic

Ketoacidosis)

Type 2: lack of insulin or resistance to the

action of insulin

Gestational DM

Detected during 24-28 weeks gestation

Neonate: macrosomia, hypoglycemia, hypocalcemia,

and hyperbilirubinemia

Normal glucose 6 weeks postpartum

Secondary DM

Associated with other conditions and syndromes

Cushing’s syndrome and pancreatic disease

Once underlying condition treated, secondary DM

is resolved

Hyperglycemia

Polyuria

Polydipsia

Unintentional weight loss

Polyphagia

Recurrent blurred vision

Weakness/fatigue

Dizziness

Pruritus, skin infections, vaginitis,

Ketonuria

Macro:

Coronary artery disease

Hypertension

Cardiomyopathy

Infection

Micro:

Nephropathy (kidney)

Neuropathy (nerve)

60% of DM pt’s have neuropathy

Retinopathy (eyes)

‘pathy’ – damage or distress to that area

Fasting glucose level of 126mg/dl –OR-

Classic symptoms of DM with casual glucose

reading at 200mg/dl or above –OR-

2-hour postload glucose reading at 200mg/dl

or above during an oral glucose tolerance

test.

Affects 10% of pts with DM

Usually diagnosed before age 30

Inherited as a heterogeneous multigenic trait

Environmental triggers (viruses) trigger an

autoimmune response that destroys the beta

cells

Gradual, subtle, more slowly developing disease

Affects 90% of all people with diabetes mellitus

Usually diagnosed after the age of 40

More than 85% of people with type 2 diabetes are

obese

Native Americans, African Americans, and Hispanic

Americans are at an increased risk

ASSESSMENT

Assess for signs and symptoms of hyperglycemia

Polyuria, polydipsia, polyphagia, weight loss, fatigue,

blurred vision, flushed dry skin, fruity breath odor,

rapid deep breathing

Assess for signs and symptoms of hypoglycemia

Anxiety, restlessness, tingling (in hands, feet, lips, or

tongue, chills, cold sweats, confusion, cool pale skin,

drowsiness, excessive hunger, headache, irritability,

nausea, tachycardia, tremor, weakness

Assess for signs of altered tissue response

Decrease wound healing, recurrent infection,

especially on the skin

Serum glucose levels Fasting blood glucose ≥ 126 mg/dl on two

occasions

Random blood glucose ≥ 200 mg/dl with DM signs

Glucose tolerance test Fasting blood sugar is obtained before ingestion

of glucose load, blood samples drawn 30min, 1, 2, 3, 4, and sometimes 5 hours after

Diagnostic for DM if 2 hour result is 200 mg/dl or greater

Glycosylated hemoglobin (A1c) Measures glycemic control over 60-120 day

period

Analysis

Activity intolerance related to fatigue

Anxiety related to potential complications

Deficient knowledge related to diabetes self-

management

Imbalanced nutrition: more than body

requirements related to increased caloric

consumption

Risk for impaired skin integrity related to

compromised circulation

Risk for injury related to blurred vision, fatigue

Planning

Maintain optimal body weight

Remain free from infection

Avoid complications

Increase understanding of disorder and

treatment

Promote adaptive coping behaviors

Implementation

Basic care and comfort measures

Evaluation

Client maintain optimal body weight

Client has no signs and symptoms of infection

Client is free from evidence of complications

Client verbalizes knowledge of DM and its

treatment

Client demonstrates adaptive coping behaviors

Physiological: Aim towards target glucose, glycosylated hemoglobin,

lipid and BP levels according to American Diabetes

Association

Modest calorie restriction for weight loss (type 2)

Regular aerobic exercise

Daily foot care

Prevention of complications by removing coexisting

risk factors (smoking, htn, hyperlipidemia, nephrotoxic

drug use)

Safety, Infection control, reduction of risk potential

For hyperglycemic crisis, administer IV fluids with insulin drip and insulin replacement

Patient should inject insulin into abdominal site on days when arms and legs are exercised

Treat all injuries, cuts, and blisters promptly

Assessment of feet

Skin temperature

Sensation

Soft tissue injuries

Corns, calluses, dryness

Pulses and deep tendon reflexes

Hair distribution

Oral Antidiabetic agents

Insulins

Rapid-acting

Humalog, NovoLog, Apidra

Short-acting

Regular R, Exubera (inhaled)

Intermediate-acting

Lente, NPH

Long-acting

U, Lantus, Levemir

Combination insulin

70/30; 50,50; and 75/25 Humalog mix

Action Appearance Onset Peak Duration

Rapid Clear 5-10 min 1 hr 2-4 hrs

Short Clear 30-60 min 2-4 hrs 4-6 hrs

Intermediate Cloudy 2-4 hrs 4-10 hrs 10-16 hrs

Long Clear 1 hr None 24 hrs

Self-Monitoring of Blood Glucose Recommended for all DM patients, regardless of

type

Pt’s with type 1 should test 3+ times daily (before each meal, before bed, and possibly in the middle of the night)

Pt’s with type 2 don’t have to monitor as often

All pts should monitor more when: Starting a new med or insulin or dosage changes

Sick or under stress

Weight changes

You think your glucose level is too high or low

Your eating or exercise habits change

Insulin self-administration

Video

http://www.youtube.com/watch?v=KP6Zm9vl3F

M&feature=related

Diet

Limitation of alcohol due to its hypoglycemic

effects and judgment impairment

Use of artificial sweeteners to maintain blood

glucose levels

Nutritive sweeteners contain calories but do not cause

significant rise in blood glucose (xylitol, fructose,

sorbitol)

Non-nutritive sweeteners contain little to no calories

and cause no rise in blood glucose levels (saccharine,

aspartame, sucralose)

Encourage pt to eat a well-balanced, nutritious

diet

Encourage regular

physical activity to

increase carb

metabolism,

lose/maintain

weight, increase

insulin sensitivity,

increase HDL levels,

lower triglyceride

levels, lower BP,

and reduce stress

1. An adult client with type 1 diabetes is

scheduled for cataract surgery in the

Same-Day Surgery Department. On

arrival, the client’s fingerstick blood

glucose is 210 mg/dl. The nurse should

a. Add an insulin drip to the IV therapy

b. Reschedule the surgery for another date

c. Instruct the client to ambulate

d. Contact the client’s HCP

D. Contact the client’s HCP

Blood glucose over 180 mg/dl is considered to be

hyperglycemia

Both emotional and physical stress can elevate.

The nurse does not initiate and insulin drip without

orders from a physician.

Clients who use insulin are at increased risk for

hypoglycemia when there is an increase in physical

activity.

1. An adult client who has type 2 diabetes

and requires insulin tells the nurse about

feeling trembly, weak, and anxious

before supper. The nurse should:

a. Tell the client to lie down for 30 minutes.

b. Have the client drink a glass of milk or orange

juice

c. Contact the client’s physician to decrease the

insulin dose

d. Administer the next dose of insulin

B. Have the client drink a glass of milk or orange juice

Hypoglycemia is a blood glucose level below 70 mg/dl. The signs and symptoms include: confusion, irritability, diaphoresis, tremors, hunger, weakness, and visual disturbances

Contacting the physician and having them lay down would delay treating the possible hypoglycemia

Administering insulin would cause the blood sugar to go even lower