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S
MELLITU
S
PREPARED BY:
RESURRECCION, CARLS BURG
A.
SAMSON, AIZA
SANTOS, MARK FRANCIS
TALAUE, TYRONE JIG
TANSECO, MA. SHIELA
TOLENTINO, RYAN JOE
PREPARED TO:
MR. JEFF SAPLALA, R.N
OVERVIEW
Diabetes mellitus is a group of metabolic diseases characterized by
increased levels of glucose in the blood (hyperglycemia) resulting
fromdefects in insulin secretion, insulin action, or both. Normally,a certain
amount of glucose circulates in the blood. The major sources of this glucose
are Absorption of ingested food in the gastrointestinal tract and Formation of
glucose by the liver from food substances.
Insulin, a hormone produced by the pancreas, controls the level of
glucose in the blood by regulating the production and storage of glucose. In
diabetes,the cells may stop respnding to insulin or the pancreas may stop
producing insulin entirely. This leads to hyperglycemia,which may results in
acute metabolic complications such as diabetes ketoacidosis (DKA) and
hyperglycemic hyperosmolar non-ketotic syndrome (HHNS).
1. GESTATIONAL DIABETES
• Gestational diabetes is characterized by any degree of glucose
intolerance with onset during pregnancy (second or third
trimester).
• Hyperglycemia develops during pregnancy because of the
secretions of the placental hormones, which causes insulin
resistance
• It occurs in women 25 years of age or older, women younger than
25 years of age who are obese , women with a family history of
diabetes in first degree relatives , or members of certain ethnic
racial groups.
“3 Ps”
>Polyuria( increase urination)
>Polydipsia(increase thirst)
>Polyphagia(increase appetite)
Fatique
Weakness
Sudden vision changes
Tingling or numbness in hands or feet
Dry skin
Skin lesions or wounds that are slow to heal
Recurrent infection
Onset of type 1 diabetes may be associated with nausea, vomiting, or
stomach pains.
Type 2 diabetes results from a slow(over years), progressive glucose
intolerance and result in long term complications if diabetes goes
undetected for many years (eye disease, peripheral neuropathy,
peripheral vascular disease). Complication may have developed the
actual diagnosis is made.
Sign and symptoms of DKA include abdominal pain, nausea ,vomiting,
hyperventilation and fruity breath odor. Untreated DKA may result in
altered level of consciousness, coma and death.
PATHOPHYSIOLOGY
Insulin is secreted by beta cells, which are one of four types of cells
in the islets of Langerhans in the pancreas. Insulin is an anabolic, or storage,
hormone. When a person eats a meal, insulin secretion increases and moves
glucose from the blood into the muscle, liver, and fat cells. In those cells,
insulin;
• Transport and metabolizes glucose for energy
• Stimulates storage of glucose in the liver and muscle (in the form of
glycogen)
• Signals the liver to stop the release of glucose
• Enhances the storage of dietary fat in adipose tissue
• Accelerates transport of amino acids (derived from dietary protein)
into cells
Insulin also inhibits the breakdown of stored glucose, protein, and fat.
During fasting periods (between meals and overnight), the pancreas
continuously releases a small amount of insulin (basal insulin); another
pancreatic hormone called glucagon (secreted by th alpha cells of the islets
of Langerhans) is released when blood glucose levels decrease and
stimulates the liver to release storage glucose. The insulin and glucagon
together maintain a constant level of glucose in the blood by stimulating the
release of glucose from the liver.
Initially, the liver produces glucose through the breakdown of
glycogen (glycogenolysis). After 8 to 12 hours without food, the liver forms
glucose from the breakdown of noncarbohydrate substances, including
amino acids (gluconeogenesis).
DIAGNOSTIC TESTS
The list of diagnostic tests mentioned in various sources as used in
the diagnosis of Diabetes includes:
• Physical Examination
• Urine sugar test
• Urine ketones test
• Oral Glucose Tolerance Test (OGTT) - also called "glucose challenge"
test.
• Blood glucose tests
○ Fasting plasma glucose (FPG)
○ Random plasma glucose
• C-peptide blood test
• Insulin level blood test
• Self-managed blood glucose testing
○ Finger prick blood drop blood glucose tests
○ Urine glucose home testing
○ Urine ketone home testing
• Type 1 diabetes antibody tests
○ Glutamic Acid Decarboxylase (GAD) antibody tests
○ Islet cell antibody (ICA) tests
○ Insulin antibody tests
• Tests for conditions related to Type 1 diabetes
○ TSH blood test - tests thyroid function
○ Vitamin B12 blood test - test for pernicious anemia and other
digestive problems
• Tests for ongoing monitoring of diabetes control:
○ HbA1c blood test - an average blood sugar measure over about 3
months.
○ Fructosamine blood test - an average blood sugar measure over
about 2 weeks
• Tests to detect initially and then regularly screen for diabetes
complications:
○ Lipids and cholesterol - used to test risks of heart disease from
diabetes.
○ Blood pressure tests
○ Eye tests
○ Foot tests
○ Urine protein test - tests for kidney problems.
○ Microalbumin urine test - also called "microalbuminurea" test;
detects early kidney problems.
MEDICAL MANAGEMENT
The main goal of treatment is to normalize insulin activity and blood
glucose levels to reduce the development of vascular and neuropathic
complications.
The therapeutic goal within each type of diabetes is to achieve normal
blood glucose levels (euglycemia) without hypoglycemia and without
seriously disrupting the usual activities.
There are five components of management for diabetes: nutrition,
exercise, monitoring, pharmacologic therapy, and education.
Primary treatment of type 1 diabetes is insulin
Primary treatment of type 2 diabetes is weight loss.
Exercise is important in enhancing the effectiveness of insulin.
Use oral hypoglycemic agents if diet and exercise are not successful in
controlling blood glucose levels. Insulin injections may be used in
acute situations.
NURSING MANAGEMENT
Maintaining Fluid and Electrolyte Balance
Measure intake and output
Administer intravenous fluids and electrolytes as ordered
Encourage fluid intake
Measure serum electrolytes ( sodium, potassium) and monitor closely
Monitor vital signs to detect hydration: tachycardia
Improving Nutritional intake
Plan the diet with glucose control as the primary goal
Take into consideration patient’s lifestyle, cultural background, activity
level and food preferences
Encourage patient to eat full meals and snacks as per diabetic diet
Make arrangement for extra snacks before increased physical activity
Ensure that insulin orders are altered as needed for delays in eating
Reducing anxiety
Provide emotional support
Clear up misconception with patients
Assist patient and family to focus on learning self care behaviors
Positive reinforcement
Monitoring and managing potential complication
Teaching patient about self care
Teach preventive behaviors for long term complication and patient
survival skill
Provide special equipment for instruction on diabetic survival skills
Tailor information
Instruct family
Recommends follow up education; physical impairments
Nutrition
Eating habits, relationship of food and insulin meal plan
Follow up education; management skills
Exercise
Exercise is extremely important because of its effects on lowering of
blood glucose levels
Exercise is useful in losing weight and maintaining a feeling of well
being
Exercise alters blood lipids, increasing levels of high density
lipoproteins and decreasing total cholesterol and triglyceride level
Pharmacologic therapy
IDDM
• Insulin replacement therapy (a must)
• Insulin + Oral hypoglycemic agents (sometimes)
NIDDM
• Oral hypoglycemic agents