Diabetes mellitus is a systemic metabolic disorder that involves improper metabolism of cabs, fats, and protein.

Type 1 insulin dependent because the pancreas cannot secrete insulin due to the absence of beta cells. They can also exersice and check blood sugar before, during and after. Type 2 not insulin dependent , however it is managed by administering oral anti diabetic agents which increase insulin production, improve cell receptor binding, regulate hepatic glucose production and delay carbohydrate absorption from the small intestine. They can also excersice b/c it is important Mixed insulin is a mixture of slow acting and long lasting insulin. Lantus is the only insulin that cannot be mixed. DM ACUTE COMPLICATION coma may be due to : diabetic ketoacidosis , hyperglycemic hyperosmolar non ketotic, hypoglycemic reaction, and infection. DM LONG TERM COMPLICATION Diabetic retinopathy, cardiovascular problems, renal failure, peripheral neuropathy. Decreased peripheral pulses, dependent rubor Polyneuropathy: peripheral, symmetrixal decreased sensation to touch, temperature, in feet and legs. Autonomic neuropathy: Decreased stomach emptying Cellulitis of the feet Treated with moist packs, using aseptic technique to prevent infections Prevent injury and infection to feet by using shoes with soles at all times Inspect feet and legs daily Kidney failure Monitor labs Blood creatinine urine microalbumin hypertension is a major cause or coronary artery disease coronary artery disease causes half the deaths in DM normalize blood pressure to decrease hypertension and prevent diabetic renal disease

NURSING DIAGNOSIS risk for infection, sexual dysfunction, innefective coping, imbalance nutrition, disturbed body image, activity intolerance. Hypoglycemic: avoid dieting, alcohol ingestion, strenuous activity, unless approved by a medical doctor. Oral hypoglycemic medication may cause hypoglycemia in the patient especially in elders Main side effect causes may be from increased exercise, decreased nutrition intake ,illness, or incorrect dosage of these drugs, Symptoms are sweating, trembling Exercise: decreases insulin requirements Before giving an oral fluid or substance to correct the hypoglycemia it is necessary to confirm the patients ability to swallow and their gag reflex is present

Glucagon : may be used to treat hypoglycemic reaction , hormones secreted by the alpha cells of the pancreas, stimulate the liver to change stored glycogen into glucose to be released into the blood stream, may be administered subcutaneously, intramacularly, o intravenously.

HYPERGLYCEMIA Ketoacidosis Ketones are from the breakdown of fats and are acidic, resulting in ketoacidosis Cause by acute insulin deficiency ,decreased peripheral glucose utilization, and increased fat mobilization and ketogenesis When the body runs out of carbs and protein to burn, it starts burning fat. Kussmall respiration, sweet breath. Early s/s may include thirstiness, drowsiness and may proceed to a diabetic come Diabetic ketoacidosis causes the breath to smell like acetone and the pt breath noisily.

Self monitorin of blood glucose should be done before meals and at bed time. It also helps to adjust medication and or food intake for better bs control. Glucose level of 200 or more need to be reported to the physician DM Teach Good skin care Report any skin abnormalities to physician Foot care do not trim toenails- go to rediatrist No hot water bottles or heating pads Assess for symptoms of hypoglycemia HGB A 1 C normal levels are approximately 4% to 6% Oral hypoglycemic should be given with breakfast or before the first meal of the day.