Medical-Surgical: Diabetes Mellitus

Diabetes Mellitus (DM), otherwise known as diabetes, is a “group of diseases characterized by high blood glucose levels that result from defects in the body’s ability to produce and/or use insulin” (American Diabetes Association [ADA], 2012).

Types of Diabetes

  • Type I – autoimmune destruction of insulin-producing beta cells; present at birth; may also be referred to as insulin-dependent DM
  • Type II – characterized as insulin resistance or decreased ability of pancreas to produce insulin; occurs later in life; may also be referred to as non-insulin-dependent DM
  • Gestational – present during pregnancy

How is DM diagnosed?

  • less than 100 mg/dL = normal
  • 100 to 126 mg/dL impaired fasting glucose (IFG) = prediabetes
  • greater than 126 mg/dL = diabetes
  • two hour oral glucose test > 200 with glucose load of 75g
  • diagnosis of DM must be confirmed on a subsequent day with FBS, TFG or 2 hour glucose tolerance test

Glycosylated hemoglobin, also known as A1C, measures glucose control over the past 3 months.

How do we manage DM?

  • Nutrition:
    – For Type I DM, insulin doses are balanced with usual food intake and exercise. Patient must be consistent with the timing of insulin administration and amount of food consumed (especially carbohydrates [CHO]).
    – For Type 2 DM, initial dietary management aimed at decreasing calories, fats and simple sugars. Weight loss may help improve glycemic control (recommended weight loss of 5-7%).
  • Exercise may help decrease insulin resistance, lower blood glucose levels directly, improve circulation and muscle tone
    a caution about exercise and DM: AVOID exercise if hyperglycemia is present WITH ketosis
    – exercise lowers blood glucose levels for about 48 hours after activity
    – patients should exercise for 1 hour after a meal or have a 10-15g CHO snack
    – patients must check their blood glucose before, during and after exercise
    *do NOT exercise if blood glucose is less than 100
  • Drug therapy:
    – insulin: given subcutaneously or IV (only Regular can be given IV); different types of insulin with different onsets and peaks**; abdomen is highest rate of absorption followed by the arm, thigh then buttocks
    – oral agents: sulfonylureas, meglinitides, metformin

**Insulin types, peaks, onsets and durations

Complications of DM

  • Hypoglycemia
    – caused by too much insulin or by too much exercise compared to the amount of food eaten
    – BG < 70 mg/dL
    – symptoms: “wet and shaky” – cold sweats, weakness, irritability, pallor, increased HR, confusion, fatigue
    – treatment: give a fast acting CHO; when symptoms improve, give a long lasting CHO; Glucagon injection also given
  • Diabetic Ketoacidosis
     defined as a profound deficiency in insulin leading to an extremely elevated BG level 
    most likely occurs in type I DM, but can occur in type II DM during stress or illness
    – symptoms: polyuria, dry mouth, thirst, restlessness, sunken eyeballs, Kussmaul respirations, CNS changes, fruity breath, ketonuria
    – treatment: 1.) low dose regular insulin (0.1 units) in normal saline (NS) IV; 2.) when BG reaches 250, glucose is added to the IV to prevent hypoglycemia; 3.) replace electrolytes; 4.) prevent cerebral edema and monitor VS, I&O and cardiac status
  • Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
    – 
    a life-threatening syndrome that occurs mainly in type II DM and leads to an extremely elevated BG level
    – symptoms: polyuria, dehydration; but NO ketones
    – treatment: 1.) rapid replacement of fluid via IV NS or 1/2NS; 2.) administer regular insulin via IV; 3.) when BG reaches 250, glucose is added to the IV to prevent hypoglycemia; 4.) replace electrolytes and monitor VS, I&O and cardiac status

Complications associated with insulin therapy

  • Allergy – now rare due to use of human insulin
  • Lipodystrophy – occurs if the same injections sites are used subsequently; hypertrophy may also occur is a site is not used for 6 months; this is also rare with human insulin
  • Somogyi effect – body abnormally overreacts to hypoglycemia occurring at night or during sleep by increasing BG levels; elevated BG noted on morning BG checks and is associated with undetected hypoglycemia during sleep; treatment with less insulin
  • Dawn phenomenon – hyperglycemia is present in the morning due to counter-regulatory hormones released in the predawn hours; treatment by adjusting timing of insulin or increasing insulin
Content Sources:
American Diabetes Association.
Medical-Surgical Nursing: Assessment and Management of Clinical Problems.
Diabetes Self-management.
Image source.
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One thought on “Medical-Surgical: Diabetes Mellitus

  1. Barry Achter says:

    Pre-diabetes mellitus is actually a condition in which your blood glucose levels are elevated, but not high enough to be considered diabetes. It’s a condition that comes before type 2 diabetes and is sometimes called impaired fasting glucose or impaired glucose tolerance.Pre-diabetes mellitus has become more prevalent within the U.S. affecting as many as 55 million Americans and millions more worldwide. It has already been diagnosed in millions of people, and yet millions of others still have no idea of their condition. The treatment costs of diabetes averages about $174 billion each year.-

    Find out more about our webpage as well
    <http://www.healthmedicinelab.com/pinched-nerve-in-back/

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