OBJECTIVES OF THE CASE

PRESENTATION
General Objective:
At the end of the presentation, it is critically important that the
students are expected to gain the necessary information
regarding Diabetes Mellitus for them to determine the appropriate
nursing care management they should provide to those patients
having this kind of illness. In addition, students will help the patient to
work toward adapting to life with a chronic condition

SPECIFIC OBJECTIVES:
The students will be able to:
Understand the nature of DIABETES MELLITUS.
Differentiate between type 1 and type 2 diabetes.
Distinguishes its clinical manifestations and predisposing factors.
Outline the Anatomy and Physiology, as well as its Pathophysiology
of the disease or
condition
Determine the health status of the patient through:
Knowing the past history and present illnesses of the patient of the
patient as well
as their family health history.
Conducting physical examinations.
Analyzing the laboratory examination done and correlate it to the
present condition of the patient
Determine the appropriate nursing care that should be provided to
the client.
Understand the different drugs that the client is taking and
determine how it will benefit the client as well as the possible adverse
effect it may give.
Create a good and a therapeutic nurse-patient interaction.
Teach the client’s relatives on how to minimize the risk developing
DIABETES
MELLITUS
OVERVIEW:
DIABETES MILLETUS is a group of metabolic diseases
characterized by elevated levels of glucose in the blood
(hyperglycemia) resulting from abnormal endocrine secretion by the
pancreas (either an absolute or relative insulin sufficiency), an
insufficient number of insulin receptor sites on cell, a post receptor
defects, or a combination of abnormalities, alters the metabolism of
food. Eventually, structural abnormalities develop in a number of different
body tissues. The four general components of diabetes are
hyperglycemia, large blood vessel (macrovascular) dse., small blood
vessel (microvascular) dse., and neuropathy. A useful definition of
diabetes is symptomatic (polyuria, polydipsia, and polyphagia) or
asymptomatic state of altered CHON, CHO, and fat metabolism

Normally a certain amount of glucose circulates in blood. The major sources of glucose
are absorption of ingested food in the gastrointestinal (GI) tract and formation of glucose
by liver from substances and stored as glycogen.

The blood glucose level is consistently monitored by cells of the

islet of the langerhans of the pancreas. If the concentration of glucose in the bloodstream
begins to increase, more insulin is secreted by the beta cells of the islet of the langerhans
and blood glucose level decrease as the excess glucose is converted to glycogen.
Conversely, if glucose level decrease, the alpha cells in the islet secrets glucagon, which
increase the blood glucose level by stimulating the liver by releasing the glycogen. The
release of glycogen is converted to glucose to maintain blood glucose levels within the
normal range.

Insulin a hormone produced by the pancreas, controls the level of glucose in the blood by
regulating the production and storage of glucose. In the diabetic state, the cell may stop
responding to insulin or the pancreas may stop producing insulin entirely.

SIGNS AND SYMPTOMS

 lethargy
 polyuria, polydipsia and polyphagia
 sudden weight loss
 slow wound healing
 urinary tract infections
 gum disease
 blurred vision
 Irreducible mental fatigue
 Numbness of the hand and feet
  Feeling of tiredness much of the times

CLASSIFICATIONS:

☺ Type 1 Diabetes (insulin dependent diabetes mellitus)

☺ Type 2 Diabetes (non insulin dependent diabetes mellitus)

☺ Gestational diabetes mellitus

☺ Diabetes mellitus associated with other conditions or syndrome.

INDIVIDUALS WHO ARE AT HIGH RISK OF DEVELOPING TYPE II DIABETES
MELLITUS INCLUDE PEOPLE WHO:

 obesity
 have a relative with diabetes mellitus
 belong to a high-risk ethnic
 Pregnancy
 have been diagnosed with gestational diabetes or have delivered a baby weighing
more than 9 lbs (4 kg)
 have high blood
 have a high density lipoprotein cholesterol level and/or triglyceride
 have had impaired glucose tolerance or impaired fasting glucose on previous
testing
 Physiologic or emotional stress
 Some medication

DIAGNOSTIC TESTS

♠ Random blood glucose test — for a random blood glucose test, blood can be
drawn at any time throughout the day, regardless of when the person last ate. A
random blood glucose level of 200 mg/dL (11.1 mmol/L) or higher in persons
who have symptoms of high blood glucose suggests a diagnosis of diabetes.

♠ Fasting blood glucose test — fasting blood glucose testing involves measuring
blood glucose after not eating or drinking for 8 to 12 hours (usually overnight). A
normal fasting blood glucose level is less than 100 mg/dL. A fasting blood
glucose of 126 mg/dL (7.0 mmol/L) or higher indicates diabetes. The test is done
by taking a small sample of blood from a vein or fingertip. It must be repeated on
another day to confirm that it remains abnormally high.

♠ Hemoglobin A1C test (A1C) — The A1C blood test measures the average blood
glucose level during the past two to three months. It is used to monitor blood
glucose control in people with known diabetes, but is not normally used to
 diagnose diabetes. Normal values for A1C are 4 to 6 percent. The test is done by
taking a small sample of blood from a vein or fingertip.

♠ Oral glucose tolerance test — Oral glucose tolerance testing (OGTT) is the most
sensitive test for diagnosing diabetes and pre-diabetes. However, the OGTT is not
routinely recommended because it is inconvenient compared to a fasting blood
glucose test.

PREVENTION:

 Restrict eating sweet foods

 Limit CHO intake
 Eat a nutritious balanced diet
 Have a good healthy lifestyle
 Exercise daily
 Avoid drinking and smoking
 Have a regular blood glucose monitoring

ANATOMY AND PHYSIOLOGY

Pancreas
The pancreas is a gland organ in the digestive and endocrine system of
vertebrates. It is both an endocrine gland producing several important hormones,
including insulin, glucagon, and somatostatin, as well as an exocrine gland, secreting
pancreatic juice containing digestive enzymes that pass to the small intestine. These
enzymes help in the further breakdown of the carbohydrates, protein, and fat in the
chyme.

Under a microscope, stained sections of the pancreas reveal two

different types of parenchymal tissue. Lightly staining clusters of cells are called islets of
Langerhans, which produce hormones that underlie the endocrine functions of the
pancreas. Darker staining cells form acini connected to ducts. Acinar cells belong to the
exocrine pancreas and secrete digestive enzymes into the gut via a system of ducts.

Structure Appearance Function

Lightly staining, large,
Islets of Langerhans
spherical clusters
Darker staining, small,
Pancreatic acini
berry-like clusters
Hormone production and
secretion (endocrine
pancreas)
Digestive enzyme
production and secretion
(exocrine pancreas)

Functions

The pancreas is a dual-function gland, having features of both

endocrine and exocrine glands.

Endocrine

The part of the pancreas with endocrine function is made

up of approximately a million cell clusters called islets of Langerhans. There are four
main cell types in the islets. They are relatively difficult to distinguish using standard
staining techniques, but they can be classified by their secretion: glucagon, insulin,
somatostatin, and PP cells secrete pancreatic polypeptide.

The islets are a compact collection of endocrine cells

arranged in clusters and cords and are crisscrossed by a dense network of capillaries. The
capillaries of the islets are lined by layers of endocrine cells in direct contact with vessels,
and most endocrine cells are in direct contact with blood vessels, by either cytoplasmic
processes or by direct apposition. The islets are busily manufacturing their hormone and
generally disregarding the pancreatic cells all around them, as though they were located
in some completely different part of the body.

Exocrine
 In contrast to the endocrine pancreas, which secretes hormones into the blood, the
exocrine pancreas produces digestive enzymes and an alkaline fluid, and secretes
them into the small intestine through a system of exocrine ducts in response to the
small intestine hormones secretin and cholecystokinin. Digestive enzymes include
trypsin, chymotrypsin, pancreatic lipase, and pancreatic amylase, and are
produced and secreted by acinar cells of the exocrine pancreas. Specific cells that
line the pancreatic ducts, called centroacinar cells, secrete a bicarbonate- and salt-
rich solution into the small intestine]
Regulation
  The pancreas receives regulatory innervation via hormones in the blood and
through the autonomic nervous system. These two inputs regulate the secretory
activity of the pancreas.

Sympathetic (adrenergic) Parasympathetic (muscarinic)

increases stimulation from alpha cells and

decreases secretion from beta cells, increases
beta cell
secretion from alpha cells