Assessment and Management of Patients With Diabetes Mellitus

1. Assessment and Management of Patients With Diabetes Mellitus Prepared by Dr. ImanAbdullah

2. Out Line • Definition of diabetes mellitus • Risk factors for diabetes mellitus • Diabetes and its classification • Overview in type I and 2 diabetes • Pathophysiology of diabetes • Clinical manifestations of diabetes • Diagnostic findings of diabetes • Management of diabetes • Monitoring glucose levels and ketones • Pharmacologic therapy • Insulin therapy

3. Out Line • Complications of insulin • Oral antidiabetic agents • Nursing management • Patient education • Acute complications of diabetes • Nursing process for patient newly diagnosed with diabetes mellitus • Patient education (foot care) • Long-term complications of diabetes • Special issues in diabetes care

4. Learning Objectives On completion of this lecture, the student will be able to: • Differentiate between type I and type 2. • Describe etiologic factors associated with diabetes. • Relate the clinical manifestations of diabetes to the associated pathophysiologic alterations. • Explain the dietary modifications used for management of people with diabetes. • Describe the relationships among diet, exercise, and medication. • Differentiate between hyperglycemia with DKA and HHNS

5. Cont. • Describe management strategies for a person with diabetes to use during “sick days”. • Describe the major macrovascular, microvascular, and neuropathic complications of diabetes. • Use the nursing process as a framework for care of patients with diabetes.

6. Diabetes Mellitus • Definition: • Is a group of metabolic diseases characterized by increased levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. • Risk Factors for Diabetes Mellitus

7. Diabetes and its Classification • Type I diabetes: Insulin-dependant diabetes (IDDM). • Type II diabetes: non Insulin-dependant diabetes (NIDDM). • Gestational diabetes mellitus. • Diabetes mellitus associated with other conditions or syndrome.

8. Overview • In type I diabetes • In type 2 diabetes

9. Pathophysiology of Diabetes • Type I diabetes • Type 2 diabetes • Gestational Diabetes

10. Clinical Manifestations Clinical manifestations of all types of include: • “Three Ps”: polyuria, polydipsia, and polyphagia • Fatigue and weakness • Sudden vision changes • Tingling or numbness in hands or feet • Dry skin • Skin lesions or wounds that are slow to heal • Recurrent infections

11. Diagnostic Findings Criteria for the diagnosis of diabetes mellitus: • Symptoms of diabetes plus casual plasma glucose concentration equal to or greater than 200mg/dl. • Fasting plasma glucose greater than or equal to 126mg/dl (7.0mmol/L). • Two-hour postload glucose equal to or greater than 200mg/dl during an oral glucose tolerance test. • If fasting glucose level are normal, the diagnosis must be based on a Glucose Tolerance test.

12. Management

13. Monitoring Glucose levels and Ketones • Self-Monitoring Blood Glucose (SMBG) • Continuous Glucose Monitoring System (CGMS) • Glycated Hemoglobin • Urine Glucose Testing • Testing for Ketones

14. Pharmacologic Therapy • Insulin Therapy and Insulin Preparations • Insulin preparations vary according to three main characteristics: • Time course of action • Species ( source) • Manufacturer

15. Insulin Regimens • There are two general approaches to insulin therapy: • Conventional • And intensive

16. Complications of Insulin • Local Allergic Reactions • Systemic Allergic Reactions • Insulin Lipodystrophy • Resistance to Injected Insulin • Morning Hyperglycemia

17. Alternative methods ofInsulin Delivery • Insulin Pens • Jet injectors

18. Cont. • Insulin Pumps • Implantable and inhalant insulin delivery • Transplantation of pancreatic cells • Implantable and inhalant insulin delivery • Transplantation of pancreatic cells

19. Oral Antidiabetic Agents • Sulfonylureas • Biguanides Nursing Management Patient Education

20. Acute Complications ofDiabetes There are three major acute complications of diabetes related to short-term imbalances in blood glucose levels: • Hypoglycemia • Diabetic ketoacidosis (DKA) • Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

21. Gerontologic Considerations • In elderly patients with diabetes, hypoglycemia is a particular concern for many reasons: • Elderly people frequently live alone and may not recognize the symptoms of hypoglycemia. • With decreasing renal function, it takes longer for oral hypoglycemic agents to be excreted by the kidneys. • Skipping meals may occur because of decreased appetite or financial limitations. • Decreased visual acuity may lead to errors in insulin administration.

23. Nursing Process The patient newly diagnosed with diabetes mellitus: • Assessment • Nursing Diagnosis. • Potential Complications • Planning and Goals • Nursing Intervention • Evaluation

24. Patient education (foot care) • Take care of your diabetes

25. Cont. • Inspect your feet every day • Wash your feet every day

26. Cont. • Keep the skin soft & smooth

27. Cont. • Smooth corns and calluses gently • Trim your toenails each week or when needed

28. Cont. • Wear shoes and socks at all times • Protect your feet from hot and cool • Keep the blood flowing to your feet • Check with your health care provider.

29. Long-Term Complications of Diabetes The general categories of long-term diabetic complications are: Macro vascular Micro vascular Neuropathy

30. Foot and Leg Problem Three diabetic complications contribute to the increased risk of foot problems and infections include: • Neuropathy • Peripheral vascular disease • Immunocompromise • Management (teaching proper foot care )

31. Special Issues in Diabetes Care • Patient with diabetes who are undergoing surgery • Management of Hospitalized Patients With Diabetes • Hyperglycemia During Hospitalization • Hypoglycemia During Hospitalization • Common Alteration in Diet • Hygiene • Stress

32. Nursing Process The Patient With Diabetes as a Secondary Diagnosis • Assessment • Nursing Diagnosis • Potential Complications • Planning and Goals • Nursing Intervention • Evaluation

33. Reference Brunner, L. and Suddarath, D. (2014). Text Book of Medical Surgical Nursing. 13th Edition. J.B. Lippincott Williams & Wilikins, Library of Congress Catalging-in- Publication Date: 2013 ISBN/ISSN: 9781451130607

34. Thank You