DIABETES MELLITUS I & II
V. THOMAS, DNP, RN, CMSRN
DIABETES MELLITUS
• DIABETES MELLITUS (DM) ACTUALLY IS NOT A SINGLE DISEASE
BUT A GROUP OF PROGRESSIVE DISEASES. IT IS OFTEN
REGARDED AS A SYNDROME RATHER THAN A DISEASE.
• TWO TYPES
• TYPE 1
• TYPE 2
TYPE 1 DIABETES MELLITUS
• LACK OF INSULIN PRODUCTION OR PRODUCTION OF
DEFECTIVE INSULIN
• AFFECTED PATIENTS NEED EXOGENOUS INSULIN
• FEWER THAN 10% OF ALL DM CASES ARE TYPE 1
TYPE 2 DIABETES MELLITUS
• MOST COMMON TYPE: 90% OF ALL CASES
• CAUSED BY INSULIN DEFICIENCY AND INSULIN RESISTANCE
• MANY TISSUES ARE RESISTANT TO INSULIN:
• REDUCED NUMBER OF INSULIN RECEPTORS
• INSULIN RECEPTORS LESS RESPONSIVE
GESTATIONAL DIABETES
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HYPERGLYCEMIA THAT DEVELOPS DURING PREGNANCY
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INSULIN MUST BE GIVEN TO PREVENT BIRTH DEFECTS
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USUALLY SUBSIDES AFTER DELIVERY
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30% OF PATIENTS MAY DEVELOP TYPE 2 DM WITHIN 10
TO 15 YEARS
CHRONIC COMPLICATIONS OF DIABETES
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RETINOPATHY
NEPHROPATHY
NEUROPATHY
CARDIOVASCULAR DISEASE
CEREBROVASCULAR DISEASE
GLYCEMIC GOAL OF TREATMENT
• HBA1C OF LESS THAN 7%
• FASTING BLOOD GLUCOSE GOAL FOR DIABETIC PATIENTS
OF 70 TO 130 MG/DL
• ESTIMATED AVERAGE GLUCOSE
TYPES OF ANTIDIABETIC DRUGS
• INSULINS
• ORAL HYPOGLYCEMIC DRUGS
• BOTH AIM TO PRODUCE NORMAL BLOOD GLUCOSE STATES
• SOME NEW INJECTABLE HYPOGLYCEMIC DRUGS MAY BE USED
IN ADDITION TO INSULIN OR ANTIDIABETIC DRUGS
INSULINS
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RAPID-ACTING TREATMENT FOR TYPES 1 AND 2 DM
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MOST RAPID ONSET OF ACTION (5 TO 15 MINUTES)
PEAK: 1 TO 2 HOURS
DURATION: 3 TO 5 HOURS
PATIENT MUST EAT A MEAL AFTER INJECTION
INSULIN LISPRO (HUMALOG)
• SIMILAR ACTION TO ENDOGENOUS INSULIN
INSULIN ASPART (NOVOLOG)
INSULIN GLULISINE (APIDRA)
MAY BE GIVEN SUBCUTANEOUSLY (SQ) OR VIA CONTINUOUS SQ INFUSION
PUMP (BUT NOT INTRAVENOUSLY [IV])
SHORT-ACTING INSULINS
• SHORT ACTING
• REGULAR INSULIN (HUMULIN R)
• ROUTES OF ADMINISTRATION: IV BOLUS, IV INFUSION,
INTRAMUSCULAR (IM), SQ
• ONSET (SQ ROUTE): 30 TO 60 MINUTES
• PEAK (SQ ROUTE): 2.5 HOURS
• DURATION (SQ ROUTE): 6 TO 10 HOURS
INTERMEDIATE-ACTING INSULINS
• INTERMEDIATE ACTING
• INSULIN ISOPHANE SUSPENSION (ALSO CALLED NPH)
• CLOUDY APPEARANCE
• OFTEN COMBINED WITH REGULAR INSULIN
• ONSET-1-2 HOURS
• PEAK- 4-8 HOURS
• DURATION- 10-18 HOURS
LONG-ACTING INSULINS
• LONG ACTING
• INSULIN GLARGINE (LANTUS)
• CLEAR, COLORLESS SOLUTION
• CONSTANT LEVEL OF INSULIN IN THE BODY
• USUALLY DOSED ONCE DAILY
• CAN BE DOSED EVERY 12 HOURS
• REFERRED TO AS BASAL INSULIN
• ONSET: 1 TO 2 HOURS
• PEAK: NONE
• DURATION: 24 HOURS
ORAL ANTIDIABETIC DRUGS
• USED FOR TYPE 2 DM
• EFFECTIVE TREATMENT INVOLVES SEVERAL ELEMENTS
• CAREFUL MONITORING OF BLOOD GLUCOSE LEVELS
• THERAPY WITH ONE OR MORE DRUGS
• TREATMENT OF ASSOCIATED COMORBID CONDITIONS
SUCH AS HIGH CHOLESTEROL AND HIGH BLOOD PRESSURE
HYPOGLYCEMIA
• ABNORMALLY LOW BLOOD GLUCOSE LEVEL (BELOW
50 MG/DL)
• MILD CASES CAN BE TREATED WITH DIET—HIGHER INTAKE
OF PROTEIN AND LOWER INTAKE OF CARBOHYDRATES—
TO PREVENT REBOUND POSTPRANDIAL HYPOGLYCEMIA
GLUCOSE-ELEVATING DRUGS
• ORAL FORMS OF CONCENTRATED GLUCOSE
• BUCCAL TABLETS, SEMISOLID GEL
• 50% DEXTROSE IN WATER (D50W)
• GLUCAGON
NURSING IMPLICATIONS
• BEFORE GIVING DRUGS THAT ALTER GLUCOSE LEVELS
• ASSESS THE PATIENT’S ABILITY TO CONSUME FOOD
• ASSESS FOR NAUSEA OR VOMITING
• HYPOGLYCEMIA MAY BE A PROBLEM IF ANTIDIABETIC DRUGS ARE GIVEN
AND THE PATIENT DOES NOT EAT
• IF A PATIENT IS NPO FOR A TEST OR PROCEDURE, CONSULT THE
PRIMARY CARE PROVIDER TO CLARIFY ORDERS FOR ANTIDIABETIC DRUG
THERAPY
NURSING IMPLICATIONS
• THOROUGH PATIENT EDUCATION IS ESSENTIAL REGARDING:
• DISEASE PROCESS
• DIET AND EXERCISE RECOMMENDATIONS
• SELF-ADMINISTRATION OF INSULIN OR ORAL DRUGS
• POTENTIAL COMPLICATIONS
NURSING IMPLICATIONS
• INSULIN
• CHECK BLOOD GLUCOSE LEVEL BEFORE GIVING INSULIN.
• ROLL VIALS BETWEEN HANDS INSTEAD OF SHAKING THEM TO
MIX SUSPENSIONS
• ONLY USE INSULIN SYRINGES, CALIBRATED IN UNITS, TO
MEASURE AND GIVE INSULIN
• ENSURE CORRECT TIMING OF INSULIN DOSE WITH MEALS
NURSING IMPLICATIONS
• ORAL ANTIDIABETIC DRUGS
• ALWAYS CHECK BLOOD GLUCOSE LEVELS BEFORE GIVING
• USUALLY GIVEN 30 MINUTES BEFORE MEALS
• METFORMIN WILL NEED TO BE DISCONTINUED IF THE PATIENT IS TO
UNDERGO STUDIES WITH CONTRAST DYE BECAUSE OF POSSIBLE
RENAL EFFECTS; CHECK WITH THE PRESCRIBER
NURSING IMPLICATIONS
• MONITOR FOR THERAPEUTIC RESPONSE:
• DECREASE IN BLOOD GLUCOSE LEVELS TO THE LEVEL
PRESCRIBED BY PHYSICIAN
• MEASURE HBA1C TO MONITOR LONG-TERM
COMPLIANCE WITH DIET AND DRUG THERAPY