Diabetes Mellitus Type 2

Uncontrolled
Modifiable Factors
Non-modifiable factors
 Diet (High in fats and sweets,  Age (59 y.o)
drinks soda and coffee everyday  Gender (Male)
 Hypertensive  Race (Asian)
 Occasional Alcoholic drinker  Family history (Paternal and Maternal)

Dysfunction of the
beta cells in the Decreased sensitivity of
pancreas the cells to insulin

Glucose is unable to
Production of impaired enter the cells
insulin

Glucose remains in the

Desensitization of the blood stream
liver and extremities to
the levels of blood
glucose

Continued release of
glucose by the liver
Legend:
 Manifestation
 Nursing diagnosis
Hyperglycaemia
 Medications

 Diagnostic test
 Nursing managament:
Increased Osmolarity o HGT: 250(70-110mg/dL)  Surgical management
due to glucose o FBS:8.81 (3.3-5mmol/L
o Glycosylated hemoglobin: 7
(<7%)
 Chronic elevation of
Serum Glucose

Incresased Incresed
Increased glucose glucose intake
glucose concentration
concentration of the cells Impaired immune
Accelerated
function
Small vessel atherosclerosis
disease Diabetic
Decreased osmotic nephropathy
Decreased production
Increased glucose in pressure in the
of ATP
urine/ blood
Hypertension
Symmetrical loss of Edema on
Decreased glucose sensation
Decreased energy for left foot
reabsorption in the renal
tubules H2O move from normal cellular
the cells towards functions Creatinine: 126.51(71- ECG: NSTE-ACS
the blood Numbness and 115umol/L
Decreased osmotic paresthesia Albumin: 21.1(35-
pressure
Dehydration 54g/L Troponin: 47.7
Polyphagia
Decreased H2O Occlusion of Calcium: 1.00(2.2-
reabsorption Wasting of intrinsic neurial 2.7mmol/L)
Stimulation of Ineffective tissue
muscles capillaries
osmoreceptors perfusion
Risk for decreased
Furosemide 40 mg cardiac output
Increased Urine Increased 1 trab
output Thirst foot pressure NERVE HYPOXIA
Calcium carbonate
1 tab BID Clopidogrel 75mg 1 tab
Human albumin Simvastatin 40 mg 1 tab Delayed wound
Polyuria Polydipsia Callus Autonomic neuropathy 20% 50 ml IV OD pc supper healing
formation drops for 2 hours Coralan 5 mg BID

Ulceration Avoid straining

Sweet foul smelling urine Wt.Loss Restrict fluid intake
Weakness
Infection
 Right foot pus filled- purulent-swelling

Imbalanced
Deficient fluid volume Fatigue nutrition INFECTION

Omeprazole4 mg 1 Mosegor vita 1 CBC:

cap OD tab OD WBC: 25.16(5-10 x10 9/L
Mertronidazole Insulin glargine Aminobrain 1 RBC:2.56 (4-6 x 12/L)
500mg IVTTq8h 10units sc pc tab OD Hematocrit: 0.20(0.40-0.54)
lunch
Hemoglobin::67(130-160 g/L
Insulin glulisine 4
Urinalysis Segmenters: 0.87(0.50-0.65
units Lymphocytes: 0.11(0.25-0.35
+ 3 Bacteria
+3 sugar DM Diet Platelet ccount: 690 (140-450 x 10
+ Protein 0/L)
+Acetone

Ceftriaxone 1 gm IVTT q8hr

PNSS 1 L Co-amoxiclav 625 mg TID
20gtts/min

Closely monitoring of v/s Below Knee Amputation

Monitor I and O

Blood transfusion: 4 PRBC

400cc

Phantom pain

Enoxaparin 40 mg SQ q 24hr
Pregabalin 50mg 1 cap BID
Dolcet 1 tab BID
Tramadol 500 Q 6h