Nursing Care of
Clients with
Diabetes Mellitus
Nursing Care for DM
• Clients face lifelong changes in lifestyle and
health status
• Major role of the nurse is that of educator in
both hospital and community settings
• Plan of care and content differ according to
the type of diabetes
• Nursing care focuses on teaching to manage
the illness
Type 1 and
Type 2 Diabetes
• Type 1
– Occurs in childhood/ adolescence
– Genetic predisposition
– Hyperglycemia
– Polyuria, polyphagia, glucosuria, polydipsia
Type 1 and
Type 2 Diabetes
Type 1 and
Type 2 Diabetes
Type 1 and
Type 2 Diabetes
Type 1 and
Type 2 Diabetes
Type 1 and
Type 2 Diabetes
Type 1 and
Type 2 Diabetes
Type 1 and
Type 2 Diabetes
Type 1 and
Type 2 Diabetes
• Type 2
– Occurs at any age
– Heredity plays a role
– Slow onset
– Symptoms not as severe as type 1
Complications
• Manifestations of Diabetic Ketoacidosis
– Dehydration (from hyperglycemia)
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Thirst
Weakness
Warm, dry skin with poor turgor
Malaise
Soft eyeballs
Rapid, weak pulse
Dry mucous membranes
Hypotension
Complications
– Metabolic acidosis (from ketosis)
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Nausea and vomiting
Lethargy
Ketone (fruity, alcohol-like) breath odor
Coma
– Other manifestations
• Abdominal pain (cause unknown)
• Kussmaul’s respirations (increased rate and depth of
respirations, with a longer expiration; a compensatory
response to prevent a further decrease in pH)
Complications
– Manifestations of hyperosmolar hyperglycemic
state (HHS)
• Occurs in clients who have type 2 diabetes and is
characterized by a plasma osmolarity of 340 mOsm/L or
greater, and blood glucose levels of over 600 mg/dl,
which causes altered levels of consciousness
Complications
– Manifestations of hypoglycemia caused by
responses of the autonomic nervous system
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Hunger
Shakiness
Nausea
Irritability
Anxiety
Rapid pulse
Pale, cool skin
Hypotension
Sweating
Complications
– Manifestations caused by impaired cerebral function
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Strange or unusual feelings
Slurred speech
Blurred vision
Headache
Decreasing levels of consciousness
Difficulty in thinking
Inability to concentrate
Seizures
Change in emotional behavior
Coma
Complications
– Interdisciplinary Care
• Maintaining blood glucose
• Definitions of normal blood glucose levels vary in
clinical practice, depending on the laboratory that
performs the assay
• Pharmacologic treatment for diabetes mellitus depends
on the type of diabetes
• Dietary management for adults with diabetes, based on
guidelines established by the ADA.
• The ability to maintain an exercise program is affected
by many different factors
DKA, HHS, and
Hypoglycemia Compared
DKA, HHS, and
Hypoglycemia Compared
DKA, HHS, and
Hypoglycemia Compared
DM Screening and
Monitoring Tests
• DM Screening Tests
– Casual plasma glucose (PG): (>200 mg/dL) any
time of day without regard to time since the last
meal
– Fasting plasma glucose (FPG): (> 126 mg/dL) no
caloric intake in 8 hours
– Two-hour PG: (>200mg/dL) during an oral glucose
tolerance test
DM Screening and
Monitoring Tests
• Management of Diabetes
– Fasting blood glucose (FBG): normal range 70-110
mg/dL
– Glycosylated hemoglobin: used to determine the
average glucose level over 2–3 months, values
above 7%–9% considered elevated
– Urine glucose and ketone levels: not as accurate
as monitoring changes in blood glucose levels
DM Screening and
Monitoring Tests
– Urine test: indicates presence of protein as
albumin
– Serum cholesterol and triglyceride levels:
indicators of arthrosclerosis and increased
cardiovascular impairment
– Serum electrolytes: measure in clients who have
DKA or HHS to determine imbalances
Insulin and Oral
Hypoglycemic Agents
• Insulin
– Monitor storage and expiration of insulin
– Monitor and maintain a record of blood glucose readings
as prescribed
– Monitor food intake
• Oral Hypoglycemics
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Administer with food
Assess diet and exercise
Monitor for hypoglycemia and hyperglycemia
Assess for side effects
Self-Management of DM
• Maintain prescribed diet and exercise
• Insulin needs are increased if you have surgery,
trauma, fever, or infection
• Monitor blood glucose
• Report any illness or side effects to healthcare
provider
• Undergo periodic lab evaluations
• Avoid alcohol intake
• Take medications as prescribed
• Some medications (oral) may interfere with oral
contraceptives
Nursing Process
Framework
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Health promotion
Assessment
Risk for impaired skin integrity
Risk for infection
Risk for injury
Sexual dysfunction
Ineffective coping