Assessment and Management of
Patients With Diabetes Mellitus
Prepared by Dr. ImanAbdullah
Out Line
 Definition of diabetes mellitus
 Risk factors for diabetes mellitus
 Diabetes and its classification
 Overview in type I and 2 diabetes
 Pathophysiology of diabetes
 Clinical manifestations of diabetes
 Diagnostic findings of diabetes
 Management of diabetes
 Monitoring glucose levels and ketones
 Pharmacologic therapy
 Insulin therapy
Out Line
 Complications of insulin
 Oral antidiabetic agents
 Nursing management
 Patient education
 Acute complications of diabetes
 Nursing process for patient newly diagnosed with
diabetes mellitus
 Patient education (foot care)
 Long-term complications of diabetes
 Special issues in diabetes care
 Nursing process for patient with diabetes as a secondary
diagnosis
Learning Objectives
On completion of this lecture, the student will be able to:
 Differentiate between type I and type 2.
 Describe etiologic factors associated with diabetes.
 Relate the clinical manifestations of diabetes to the
associated pathophysiologic alterations.
 Explain the dietary modifications used for management
of people with diabetes.
 Describe the relationships among diet, exercise, and
medication.
 Differentiate between hyperglycemia with DKA and
HHNS
Cont.
 Describe management strategies for a person with
diabetes to use during “sick days”.
 Describe the major macrovascular, microvascular, and
neuropathic complications of diabetes.
 Use the nursing process as a framework for care of
patients with diabetes.
Diabetes Mellitus
Definition:
 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.
Risk Factors for Diabetes Mellitus
Diabetes and its Classification
Type I diabetes: Insulin-dependant diabetes (IDDM).
Type II diabetes: non Insulin-dependant diabetes
(NIDDM).
Gestational diabetes mellitus.
Diabetes mellitus associated with other conditions or
syndrome.
Overview
In type I diabetes
 In type 2 diabetes
Pathophysiology of Diabetes
 Type I diabetes
 Type 2 diabetes
Gestational Diabetes
Clinical Manifestations
Clinical manifestations of all types of include:
“Three Ps”: polyuria, polydipsia, and polyphagia
Fatigue and weakness
Sudden vision changes
Tingling or numbness in hands or feet
Dry skin
Skin lesions or wounds that are slow to heal
Recurrent infections
Diagnostic Findings
Criteria for the diagnosis of diabetes mellitus:
 Symptoms of diabetes plus casual plasma glucose
concentration equal to or greater than 200mg/dl.
 Fasting plasma glucose greater than or equal to 126mg/dl
(7.0mmol/L).
 Two-hour postload glucose equal to or greater than
200mg/dl during an oral glucose tolerance test.
 If fasting glucose level are normal, the diagnosis must be
based on a Glucose Tolerance test.
Management
Nutritional
therapy
Education
Pharmacologic
therapy
Exercise
Monitoring
Monitoring Glucose levels and Ketones
 Self-Monitoring Blood Glucose (SMBG)
 Continuous Glucose Monitoring System
(CGMS)
 Glycated Hemoglobin
 Urine Glucose Testing
 Testing for Ketones
Pharmacologic Therapy
 Insulin Therapy and
Insulin Preparations
 Insulin preparations
vary according to three
main characteristics:
 Time course of action
 Species ( source)
 Manufacturer
Insulin Regimens
 There are two general approaches to insulin therapy:
 Conventional
 And intensive
Complications of Insulin
Local Allergic Reactions
Systemic Allergic Reactions
Insulin Lipodystrophy
Resistance to Injected Insulin
Morning Hyperglycemia
Alternative methods of Insulin Delivery
Insulin Pens
Jet injectors
Cont.
 Insulin Pumps
 Implantable and inhalant
insulin delivery
 Transplantation of pancreatic
cells
 Implantable and inhalant
insulin delivery
 Transplantation of pancreatic
cells
Oral Antidiabetic Agents
 Sulfonylureas
 Biguanides
Nursing Management
Patient Education
Acute Complications of Diabetes
There are three major acute complications of diabetes
related to short-term imbalances in blood glucose levels:
Hypoglycemia
Diabetic ketoacidosis (DKA)
Hyperglycemic hyperosmolar nonketotic
syndrome (HHNS)
Gerontologic Considerations
 In elderly patients with diabetes, hypoglycemia is a
particular concern for many reasons:
 Elderly people frequently live alone and may not
recognize the symptoms of hypoglycemia.
 With decreasing renal function, it takes longer for oral
hypoglycemic agents to be excreted by the kidneys.
 Skipping meals may occur because of decreased appetite
or financial limitations.
 Decreased visual acuity may lead to errors in insulin
administration.
Nursing Process
The patient newly diagnosed with diabetes mellitus:
Assessment
 Nursing Diagnosis.
Potential Complications
Planning and Goals
Nursing Intervention
Evaluation
Patient education (foot care)
 Take care of your diabetes
Cont.
 Inspect your feet every day
 Wash your feet every day
Cont.
 Keep the skin soft & smooth
Cont.
 Smooth corns and
calluses gently
 Trim your toenails each
week or when needed
Cont.
 Wear shoes and socks at
all times
 Protect your feet from
hot and cool
 Keep the blood flowing
to your feet
 Check with your health
care provider.
Long-Term Complications of Diabetes
The general categories of longterm diabetic complications are:
Macro vascular
Micro vascular
Neuropathy
Foot and Leg Problem
Three diabetic complications contribute to the increased
risk of foot problems and infections include:
 Neuropathy
 Peripheral vascular disease
 Immunocompromise
 Management (teaching proper foot care )
Special Issues in Diabetes Care
 Patient with diabetes who are undergoing surgery
 Management of Hospitalized Patients With Diabetes
 Hyperglycemia During Hospitalization
 Hypoglycemia During Hospitalization
 Common Alteration in Diet
 Hygiene
 Stress
Nursing Process
The Patient With Diabetes as a Secondary Diagnosis
Assessment
Nursing Diagnosis
Potential Complications
Planning and Goals
Nursing Intervention
Evaluation
Reference
Brunner, L. and Suddarath, D. (2010). Text Book of
Medical Surgical Nursing. 12th Edition. J.B. Lippincott
Williams & Wilikins, Library of Congress Catalging-inPublication Data.]
Thank You