Diabetes

mellitus 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 (American Diabetes Association [ADA], 2009a).

Type 1 diabetes (T1D):

TYPES

The body stops producing insulin or produces too little insulin to regulate blood glucose level.

Type 2 diabetes (T2D):

Although the pancreas still secretes insulin, the body of someone with type 2 diabetes is partially or completely unable to use this insulin. The pancreas tries to overcome this resistance by secreting more and more insulin.

CAUSES

TYPE 1

believed to be an autoimmune disease---body's immune system specifically attacks the cells in the pancreas that produce insulin genetic causes (a positive family history)

Environmental factors

TYPE 2

unknown
Genetic factor

 Fatigue,

SYMPTOMS

constantly tired weight loss

Unexplained

Excessive
Excessive Excessive Poor Infections Altered Blurry

thirst (polydipsia)
urination (polyuria)

eating (polyphagia)

wound healing mental status

vision

CONSIDERATIONS FOR OLDER ADULTS:

The

older client with diabetic retinopathy also has visual changes from aging
adults are at risk for malnutrition, hypoglycemia, and especially dehydration cognition and depression may disrupt self-care.

Older

Impaired

 Older

client may have a marginal food supply because of inadequate income

may
may

have poor understanding of meal planning goals

live alone and have reduced incentive to prepare or eat proper meals.

the

ability of the heart to and lungs to deliver oxygen to tissues and organs declines

CULTURAL CONSIDERATIONS
Diabetes

is a significant health problem for African Americans, Native Americans/American Indians, and Mexican Americans. The increase in obesity Philippines are still and sedentary lifestyles in the U.S population is the low on this score probable cause of this compared with growing problem other countries

GENETIC CONSIDERATIONS

Diabetes

is determined by inheritance of the HLA-DR3 and HLA-DR4 genes.

DIABETES DIAGNOSIS
Finger

stick blood glucose

The test involves sticking the patient's finger for a blood sample, which is then placed on a strip. The strip goes into a machine that reads the blood sugar level. These machines are only accurate to within about 10% to 20% of true laboratory values.

 Fasting

plasma glucose The patient will be asked to eat or drink nothing for 8 hours before having blood drawn (usually first thing in the morning). If the blood glucose level is greater than or equal to 126 mg/dL (without eating anything), they probably have diabetes.
If

abnormal, the test may be repeated on a different day to confirm the result, may undergo an oral glucose tolerance test or a glycosylated hemoglobin test (often called "hemoglobin A1c") as a confirmatory test.

Oral

glucose tolerance test

This test involves drawing blood for a fasting plasma glucose test, then drawing blood for a second test at two hours after drinking a very sweet drink containing up to 75 grams of sugar.
greater

than or equal to 200 mg/dL, the patient has diabetes.

Glycosylated

A1c

hemoglobin or hemoglobin

This test is a measurement of how high the blood sugar levels have been over approximately the last 120 days (the average life-span of the red blood cells on which the test is based). A1c result of 7% or less indicates good glucose control. A result of 8% or greater indicates that blood sugar levels are too high, too much of the time.

DIABETES MEDICATIONS Sulfonylurea stimulate the pancreas to make more insulin

Biguanides decrease the amount of glucose produced by the liver slows absorption of the starches a person eats. This slows down glucose production. increase sensitivity to insulin

Alphaglucosidase inhibitors
Thiazolidine diones

Meglitinides Dphenylalanin e derivatives Sodiumglucose cotransporter 1 (SGLT2) inhibitors

stimulate the pancreas to make more insulin stimulate the produce more quickly. pancreas to insulin more

blocks reabsorption of glucose by the kidney, leading to increased glucosse excretion and reduction of blood sugar levels

Amylin synthetic derivatives

Incretin mimetics

administered as a subcutaneous injection along with insulin and helps achieve lower blood sugar levels after meals promote insulin secretion by the pancreas and mimics other blood sugar level lowering actions that naturally occur in the body Insulin must be given as an injection just under the skin. If taken by mouth, insulin would be destroyed in the stomach before it could get into the blood where it is needed

Insulin

NURSING INTERVENTIONS
1. Administer insulin (IV, IM, SC, or ORAL
hypoglycemics)

2. Monitor fingerstick blood glucose levels according

to unit protocol, typically every 6 hours or before meals and at bedtime.

3. Always check the blood glucose level before

giving hypoglycemic medications

4.

Follow established protocol for withholding the dose based on normal values.

5.

Be aware of differences in peak action and duration to action for various hypoglycemic medications

6. Establish and maintain an I.V fluid infusion (usually

NSS), as ordered

7. Monitor for dry mucous membranes, poor skin turgor,

cracked lips, abdominal pain, elevated urine specific gravity, elevated hematocrit, and other signs or symptoms of dehydration

8. Keep an accurate intake and output record.

9. Observe for s/s of medication in induced
hypoglycemia: pallor, confusion, diaphoresis, headache, weakness, shallow respirations, irritability, and restlessness

10.Make sure the patient is served the prescribed

therapeutic diet at consistent times

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