Nursing Process
The Patient Newly Diagnosed With Diabetes Mellitus
Assessment
The history and physical assessment focus on the signs and symptoms of prolonged
hyperglycemia and on physical, social, and emotional factors that may affect the patient's
ability to learn and perform diabetes self-care activities. The patient is asked to describe
symptoms that preceded the diagnosis of diabetes, such as polyuria, polydipsia,
polyphagia, skin dryness, blurred vision, weight loss, vaginal itching, and nonhealing
ulcers. Blood glucose levels are measured in patients with either type 1 or type 2
diabetes. In addition, urine ketone levels are measured, because the patient with type 1
diabetes may have ketones in the urine.
Patients diagnosed with type 1 diabetes are assessed for signs of DKA, including
ketonuria, Kussmaul respirations, orthostatic hypotension, and lethargy. The patient is
asked about symptoms of DKA, such as nausea, vomiting, and abdominal pain.
Laboratory values are monitored for metabolic acidosis (ie, decreased pH and decreased
bicarbonate level) and for electrolyte imbalance. Patients diagnosed with type 2 diabetes
are assessed for signs of HHNS, including hypotension, altered sensorium, seizures, and
decreased skin turgor. Laboratory values are monitored for hyperosmolality and
electrolyte imbalance.
If the patient exhibits signs and symptoms of DKA or HHNS, nursing care first focuses
on treatment of these acute complications, as outlined earlier. Once these complications
are resolving, nursing care then focuses on long-term management of diabetes, as
discussed in this section.
Then the patient is assessed for physical factors that may impair his or her ability to learn
or perform self-care skills, such as
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Visual deficits (the patient is asked to read numbers or words on the insulin
syringe, menu, newspaper, or written teaching materials)
Deficits in motor coordination (the patient is observed eating or performing other
tasks or handling a syringe or finger-lancing device)
Neurologic deficits caused by stroke, other neurologic disorders, or other
disabling conditions, from the history in the chart (the patient is assessed for
aphasia or decreased ability to follow simple commands)
The nurse evaluates the patient's social situation for factors that may influence the
diabetes treatment and education plan, such as
Low literacy level (may be evaluated while assessing for visual deficits by having
the patient read from teaching materials)
Limited financial resources or lack of health insurance
Presence or absence of family support
Typical daily schedule (the patient is asked about timing and number of usual
daily meals, work and exercise schedule, plans for travel)
The patient's emotional status is assessed by observing his or her general demeanor (eg,
withdrawn, anxious) and body language (eg, avoids eye contact). The patient is asked
about major concerns and fears about diabetes; this allows the nurse to assess for any
misconceptions or misinformation regarding diabetes. Coping skills are assessed by
asking how the patient has dealt with difficult situations in the past.
Diagnosis
Nursing Diagnoses
Based on the assessment data, major nursing diagnoses may include the following:
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Risk for fluid volume deficit related to polyuria and dehydration
Imbalanced nutrition related to imbalance of insulin, food, and physical activity
Deficient knowledge about diabetes self-care skills/information
Potential self-care deficit related to physical impairments or social factors
Anxiety related to loss of control, fear of inability to manage diabetes,
misinformation related to diabetes, fear of diabetes complications
Collaborative Problems/Potential Complications
Based on assessment data, potential complications may include the following:
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Fluid overload, pulmonary edema, and heart failure
Hypokalemia
Hyperglycemia and ketoacidosis
Hypoglycemia
Cerebral edema
Planning and Goals
The major goals for the patient may include maintenance of fluid and electrolyte balance,
optimal control of blood glucose levels, reversal of weight loss, ability to perform
diabetes survival skills and self-care activities, decreased anxiety, and absence of
complications.
Nursing Interventions
Maintaining Fluid and Electrolyte Balance
Intake and output are measured. IV fluids and electrolytes are administered as prescribed,
and oral fluid intake is encouraged when it is permitted. Laboratory values of serum
electrolytes (especially sodium and potassium) are monitored. Vital signs are monitored
hourly for signs of dehydration (tachycardia, orthostatic hypotension) along with
assessment of breath sounds, level of consciousness, presence of edema, and cardiac
status (ECG rhythm strips).
Improving Nutritional Intake
Meal planning is implemented, with the control of glucose as the primary goal. Planning
must take into consideration the patient's lifestyle, cultural background, activity level, and
food preferences. An appropriate caloric intake allows the patient to achieve and maintain
the desired body weight. The patient is encouraged to eat full meals and snacks as
prescribed in the diet prescription. Arrangements may be made with the dietitian for extra
snacks before increased physical activity. It is important for the nurse to ensure that
insulin orders are altered as needed to correspond to delays in eating caused by diagnostic
and other procedures that affect timing of meals.
Reducing Anxiety
The nurse provides emotional support and sets aside time to talk with the patient who
wishes to express feelings, cry, or ask questions about the new diagnosis. Any
misconceptions the patient or family may have regarding diabetes are dispelled (see
Table 41-7). The patient and family are assisted to focus on learning self-care behaviors.
The patient is encouraged to perform the skills that he or she fears most and must be
reassured that once a skill such as self-injection or lancing a finger for glucose
monitoring is performed for the first time, anxiety will decrease. Positive reinforcement is
given for the self-care behaviors attempted, even if the technique is not yet completely
mastered.
Improving Self-Care
As previously discussed, patient teaching is the major strategy used to prepare patients
for self-care. Special equipment may be needed for instruction on diabetes survival skills,
such as a magnifying glass for insulin preparation or an injection-aid device for insulin
injection. Low-literacy information and literature in other languages can be obtained from
the ADA. Families are also taught so that they can assist in diabetes management; for
example, they can prefill syringes or monitor the patient's blood glucose level. The
diabetes educator is consulted regarding various blood glucose monitors and other
equipment for use by patients with physical impairments. The patient is assisted in
identifying community resources for education and supplies as needed. Other members of
the health care team are informed about variations in the timing of meals and the work
schedule (eg, if the patient works at night or in the evenings and sleeps during the day) so
that the diabetes treatment regimen can be adjusted accordingly.
Monitoring and Managing Potential Complications
Fluid Overload
Fluid overload can occur because of the administration of a large volume of fluid at a
rapid rate, which is often required to treat patients with DKA or HHNS. This risk is
increased in elderly patients and in those with preexisting cardiac or renal disease. To
avoid fluid overload and resulting heart failure and pulmonary edema, the nurse monitors
the patient closely during treatment by measuring vital signs and intake and output at
frequent intervals. Central venous pressure monitoring and hemodynamic monitoring
may be initiated to provide additional measures of fluid status. Physical examination
focuses on assessment of cardiac rate and rhythm, breath sounds, venous distention, skin
turgor, and urine output. The nurse monitors fluid intake and keeps careful records of IV
and other fluid intake, along with urine output measurements.
Hypokalemia
As previously described, hypokalemia is a potential complication during the treatment of
DKA as potassium is lost from body stores. Low serum potassium levels may result from
rehydration, increased urinary excretion of potassium, and movement of potassium from
the extracellular fluid into the cells with insulin administration. Prevention of
hypokalemia includes cautious replacement of potassium; however, before its
administration, it is important to ensure that a patient's kidneys are functioning. Because
of the adverse effects of hypokalemia on cardiac function, monitoring of the cardiac rate,
cardiac rhythm, ECG, and serum potassium levels is essential.
Hyperglycemia and Ketoacidosis
Although the hyperglycemia and ketoacidosis that may have led to the new diagnosis of
diabetes may be resolved, patients are at risk for their subsequent recurrence. Therefore,
blood glucose levels and urine ketones are monitored, and medications (insulin, oral
antidiabetic agents) are administered as prescribed. The nurse monitors the
concentrations of blood glucose and urine ketones and reports any value out of the target
range. IV insulin and IV fluids may need to be administered again.
Hypoglycemia
Hypoglycemia may occur if the patient skips or delays meals, does not follow the
prescribed meal plan, or greatly increases the amount of exercise without modifying food
intake and insulin. In addition, hospitalized patients or outpatients who fast in preparation
for diagnostic testing are at risk for hypoglycemia. Juice, milk, or glucose tablets are used
for treatment of hypoglycemia. The patient is encouraged to eat full meals and snacks as
prescribed in the meal plan. If hypoglycemia is a recurring problem, the total therapeutic
regimen should be reevaluated.
Because of the risk of hypoglycemia, especially with intensive insulin regimens, it is
important for the nurse to review with the patient the signs and symptoms, possible
causes, and measures for prevention and treatment of hypoglycemia. The nurse should
stress to the patient and family the importance of having information on diabetes at home
for reference.
Cerebral Edema
Although the cause of cerebral edema is unknown, rapid correction of hyperglycemia,
resulting in fluid shifts, is thought to be the cause. Cerebral edema, which occurs more
often in children than in adults, can be prevented by gradual reduction in the blood
glucose level (ADA, 2004h). An hourly flow sheet is used to enable close monitoring of
the blood glucose level, serum electrolyte levels, urine output, mental status, and
neurologic signs. Precautions are taken to minimize activities that could increase
intracranial pressure.
Promoting Home and Community-Based Care
Teaching Patients Self-Care
The patient is taught survival skills, including treatment modalities (diet, insulin
administration, monitoring of blood glucose, and, for type 1 diabetes, monitoring of urine
ketones); recognition, treatment, and prevention of acute complications (hypoglycemia
and hyperglycemia); practical information (where to obtain supplies, when to call the
physician); and simple pathophysiology that the patient will understand. If the patient has
signs of long-term diabetes complications at the time of diagnosis of diabetes, teaching
about relevant preventive behaviors (eg, foot care, eye care) is appropriate at this time
(Chart 41-10).
Continuing Care
Follow-up education is arranged with a home care nurse and dietitian or an outpatient
diabetes education center. This is particularly important for patients who have had
difficulty coping with the diagnosis, patients who have limitations that may affect their
ability to learn or to carry out the management plan, and patients who are without any
family or social supports. Referral to social services and community resources (eg,
centers for the visually impaired) may be needed, depending on the patient's financial
circumstances and physical limitations. The importance of self-monitoring and of
monitoring and follow-up by primary health care providers is reinforced, and the patient
is reminded about the importance of keeping follow-up appointments. Patients who are
newly diagnosed with diabetes are also reminded about the importance of participating in
other health promotion activities and health screening. Chart 41-11 is a checklist of selfcare skills.
Evaluation
Expected Patient Outcomes
Expected patient outcomes may include the following:
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Achieves fluid and electrolyte balance
o Demonstrates intake and output balance
o Exhibits electrolyte values within normal limits
o Exhibits vital signs that remain stable, with resolution of orthostatic
hypotension and tachycardia
Achieves metabolic balance
o Avoids extremes of glucose levels (hypoglycemia or hyperglycemia)
o Exhibits glucose levels within target range with minimal episodes of
hypoglycemia
o Recognizes and treats hypoglycemia appropriately
o Demonstrates rapid resolution of hypoglycemic episodes
o Avoids further weight loss (if applicable) and begins to approach desired
weight
Demonstrates/verbalizes diabetes survival skills.
o Defines diabetes as a condition in which high blood glucose levels are
present
o States normal and target blood glucose ranges
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Identifies factors that cause the blood glucose level to fall (insulin,
exercise, some oral antidiabetic medications)
Identifies factors that cause the blood glucose level to rise (food, illness,
stress, and infections)
Describes the major treatment modalities: nutrition therapy, exercise,
monitoring, medication, education
Demonstrates proper technique for drawing up and injecting insulin
(including mixing two types of insulin, if necessary)
States dose and timing of injections, peak action, duration, and adverse
effects of insulin
States dose, timing, peak action, and duration of prescribed oral
antidiabetic agents
Verbalizes plan for rotating insulin injection sites
Verbalizes understanding of food group classifications (depending on
system used)
Verbalizes appropriate schedule for eating snacks and meals; orders
appropriate foods on menus; identifies foods that may be substituted for
one another on the meal plan
Demonstrates proper technique for monitoring blood glucose, including
using finger-lancing device; obtaining a drop of blood; applying blood
properly to strip; obtaining value of blood glucose; and recording blood
glucose value. Also, is able to calibrate and clean meter, change batteries,
identify alarms and warnings on meter, and use control solutions to
validate strips.
Demonstrates proper technique for disposal of lancets and needles used for
blood glucose monitoring and insulin injections (ie, discarding them into
sharps container)
Demonstrates proper technique for urine ketone testing (for patients with
type 1 diabetes) and verbalizes appropriate times to assess for ketones
(when ill or when blood glucose test results are repeatedly and
inexplicably greater than 250 to 300 mg/dL [13.8 to 16.6 mmol/L])
Identifies community, outpatient resources for obtaining further diabetes
education
Identifies acute complications (hypoglycemia and hyperglycemia)
Verbalizes symptoms of hypoglycemia (shakiness, sweating, headache,
hunger, numbness or tingling of lips or fingers, weakness, fatigue,
difficulty concentrating, change of mood) and dangers of untreated
hypoglycemia (seizures and coma)
Identifies appropriate treatment of hypoglycemia, including 15 g simple
carbohydrate (eg, two to four glucose tablets, 4 to 6 oz juice or soda, 2 to 3
teaspoons sugar, 6 to 10 hard candies) followed by a snack of protein and
carbohydrate (eg, cheese and crackers or milk) or by a regularly scheduled
meal
States potential causes of hypoglycemia (too much insulin, delayed or
decreased food intake, increased physical activity) and verbalizes
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preventive behaviors, such as frequent monitoring of blood glucose when
daily schedule is changed and eating a snack before exercise
o Verbalizes importance of wearing or carrying medical identification and
carrying a source of simple carbohydrate at all times
o Verbalizes symptoms of prolonged hyperglycemia (increased thirst and
urination)
o Verbalizes rules for sick day management
o Describes where to purchase and store insulin, syringes, and glucose
monitoring supplies
o Identifies appropriate circumstances for calling the physician (when ill,
when glucose levels repeatedly exceed a certain level [per physician
guidelines], or when skin wounds fail to heal) and also identifies name of
physician (or other health care team member) and 24-hour phone number
Absence of complications
o Exhibits normal cardiac rate and rhythm and normal breath sounds
o Exhibits no jugular venous distention
o Exhibits blood glucose and urine ketone levels within target range
o Exhibits no manifestations of hypoglycemia or hyperglycemia
o Shows improved mental status without signs of cerebral edema
Chart 41-10: Patient Education
Foot Care Tips
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Take care of your diabetes.
o Work with your health care team to keep your blood glucose level within a
normal range.
Inspect your feet every day.
o Look at your bare feet every day for cuts, blisters, red spots, and swelling.
o Use a mirror to check the bottoms of your feet or ask a family member for
help if you have trouble seeing.
o Check for changes in temperature.
Wash your feet every day.
o Wash your feet in warm, not hot, water.
o Dry your feet well. Be sure to dry between the toes.
o Do not soak your feet.
o Do not check water temperature with your feet; use a thermometer or
elbow.
Keep the skin soft and smooth.
o Rub a thin coat of skin lotion over the tops and bottoms of your feet, but
not between your toes.
Smooth corns and calluses gently.
o Use a pumice stone to smooth corns and calluses.
Trim your toenails each week or when needed.
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Trim your toenails straight across and file the edges with an emery board
or nail file.
Wear shoes and socks at all times.
o Never walk barefoot.
o Wear comfortable shoes that fit well and protect your feet.
o Feel inside your shoes before putting them on each time to make sure the
lining is smooth and there are no objects inside.
Protect your feet from hot and cold.
o Wear shoes at the beach or on hot pavement.
o Wear socks at night if your feet get cold.
Keep the blood flowing to your feet.
o Put your feet up when sitting.
o Wiggle your toes and move your ankles up and down for 5 minutes, 2 or 3
times a day.
o Do not cross your legs for long periods of time.
o Do not smoke.
Check with your health care provider.
o Have your health care provider check your bare feet and find out whether
you are likely to have serious foot problems. Remember that you may not
feel the pain of an injury.
o Call your health care provider right away if a cut, sore, blister, or bruise on
your foot does not begin to heal after one day.
o Follow your health care provider's advice about foot care.
o Do not self-medicate or use home remedies or over-the-counter agents to
treat foot problems.
Nursing Process
The Patient With Diabetes as a Secondary Diagnosis
Patients with diabetes frequently seek medical attention for problems not directly related
to blood glucose control. However, during the course of treatment for the primary
medical diagnosis, blood glucose control may worsen. In addition, the only opportunity
for some patients with diabetes to update their knowledge about diabetes self-care and
prevention of complications may be during hospitalization. Therefore, it is important for
nurses caring for patients with diabetes to focus attention on the diabetes as well as the
primary health issue. Furthermore, control of blood glucose levels is important, because
hyperglycemia impairs resistance to certain infections and impedes wound healing.
Assessment
Assessment of patients with diabetes who have a primary problem such as cardiac
disease, renal disease, cerebrovascular disease, peripheral vascular disease, surgery, or
any other type of illness is the same as that for all patients and is described in other
chapters. In addition to nursing assessment for the primary problem, assessment of the
patient with diabetes must also focus on hypoglycemia and hyperglycemia, skin
breakdown, and diabetes self-care skills, including survival skills and measures for
prevention of long-term complications. In addition, the patient is asked about use of
alternative and complementary therapies; studies have demonstrated that patients with
diabetes are twice as likely as other patients to use these therapies, some of which may be
harmful (Egede, Ye & Zheng, 2002).
Assessment for hypoglycemia and hyperglycemia involves frequent blood glucose
monitoring (usually prescribed before meals and at bedtime) and monitoring for signs and
symptoms of hypoglycemia or prolonged hyperglycemia (including DKA or HHNS), as
described previously.
Careful assessment of the skin, especially at pressure points and on the lower extremities,
is important. The skin is assessed for dryness, cracks, skin breakdown, and redness. The
patient is asked about symptoms of neuropathy, such as tingling and pain or numbness of
the feet. Deep tendon reflexes are assessed.
The nurse should assess the patient's diabetes self-care skills as soon as possible to
determine whether further diabetes teaching is required. The nurse observes the patient
preparing and injecting the insulin, monitoring blood glucose, and performing foot care.
(Simply questioning the patient about these skills without actually observing performance
of the skills is not sufficient.) The patient's knowledge about diet can be assessed with the
help of a dietitian through direct questioning and review of the patient's menu choices.
The patient is asked about signs and symptoms, treatment, and prevention of
hypoglycemia and hyperglycemia. The patient's knowledge of risk factors for
macrovascular disease, including hypertension, increased lipids, and smoking, is
assessed. In addition, the patient is asked the date of his or her last eye examination
(including dilation of the pupils). It is also important to assess the patient's use of
preventive health measures, including annual influenza vaccination (flu shot), date of the
most recent pneumonia vaccination (ADA, 2004k), and daily dose of aspirin (unless
contraindicated) (ADA, 2004a).
Nursing Diagnoses
Based on the assessment data, major nursing diagnoses may include the following:
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Imbalanced nutrition related to increase in stress hormones (caused by primary
medical problem) and imbalances in insulin, food, and physical activity
Risk for impaired skin integrity related to immobility and lack of sensation
(caused by neuropathy)
Deficient knowledge about diabetes self-care skills (caused by lack of basic
diabetes education or lack of continuing in-depth diabetes education)
Collaborative Problems/Potential Complications
Based on the assessment data, potential complications may include the following:
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Inadequate control of blood glucose levels (hyperglycemia, hypoglycemia)
DKA and HHNS
Planning and Goals
The major goals for the patient may include improved nutritional status, maintenance of
skin integrity (foot care), ability to perform basic diabetes self-care skills as well as
preventive care for the avoidance of chronic diabetes complications, and absence of
complications.
Nursing Interventions
Improving Nutritional Status
The patient's food intake is planned with the primary goal of glucose control; however,
the dietary prescription must also consider the primary health problem in addition to
lifestyle, cultural background, activity level, and food preferences. If alterations are
needed in the patient's diet because of the primary health problem (eg, gastrointestinal
problems), alternative strategies to ensure adequate nutritional intake must be
implemented. The patient's nutritional intake is monitored carefully along with blood
glucose, urine ketones, and daily weight.
Maintaining Skin Care
The skin is assessed daily for dryness or breaks. The feet are cleaned with warm water
and soap. Excessive soaking of the feet (eg, to the point of wrinkling the skin) is avoided.
The feet are dried thoroughly, especially between the toes, and lotion is applied to the
entire foot except between the toes. For patients who are confined to bed (especially
those with a history of neuropathy), the heels are elevated off the bed with a pillow
placed under the lower legs and the heels resting over the edge of the pillow. A bed
cradle may be used to keep the bed covers off the feet of the patient with diabetic
neuropathy. Dermal ulcers are treated as indicated and prescribed. The nurse promotes
optimal blood glucose control in the patient with skin breakdown.
Addressing Knowledge Deficits
Hospital admission of the patient with diabetes provides an ideal opportunity for the
nurse to assess the patient's level of knowledge about diabetes and its management. The
nurse uses this opportunity to assess the patient's understanding of diabetes management,
including blood glucose monitoring, administration of medications (ie, insulin, oral
agents), meal planning, exercise, and strategies to prevent long- and short-term
complications of diabetes. The nurse also assesses the adjustment of the patient and
family to diabetes and its management and identifies any misconceptions they have.
Monitoring and Managing Potential Complications
Inadequate control of blood glucose levels may hinder recovery from the primary health
problem. Blood glucose levels are monitored, and insulin is administered as prescribed. It
is important for the nurse to ensure that prescribed insulin dosage is modified as needed
to compensate for changes in the patient's schedule or eating pattern. Treatment is given
for hypoglycemia (with oral glucose) or hyperglycemia (with supplemental regular
insulin no more often than every 3 to 4 hours). Blood glucose records are assessed for
patterns of hypoglycemia and hyperglycemia at the same time of day, and findings are
reported to the physician for modification in insulin orders. In the patient with prolonged
elevations in blood glucose, laboratory values and the patient's physical condition are
monitored for signs and symptoms of DKA or HHNS.
Development of acute complications of diabetes secondary to inadequate control of blood
glucose levels may be associated with other health care problems because of changes in
activity level and diet and physiologic alterations related to the primary health problem
itself. Therefore, the patient must be monitored for acute complications (hyperglycemia,
hypoglycemia), and measures must be implemented for their prevention and early
treatment.
Promoting Home and Community-Based Care
Teaching Patients Self-Care
Even if the patient has had diabetes for many years, it is important to assess his or her
knowledge and adherence to the plan of care. It may be necessary to plan and implement
a teaching plan that includes basic information about diabetes, its cause and symptoms,
and acute and chronic complications and their treatment. The nurse asks the patient to
give repeated return demonstrations of skills that were not performed correctly during the
initial assessment. The patient is taught self-care activities for the prevention of long-term
complications, including foot care, eye care, and risk factor management. The nurse also
reminds the patient and family about the importance of health promotion activities and
recommended health screening.
Continuing Care
A patient who is hospitalized for another health problem may require referral for home
care for that problem or if gaps in knowledge about self-care are uncovered. In either
case, the home care nurse can use this opportunity to assess the patient's knowledge about
diabetes management and the patient's and family's ability to carry out that management.
The nurse reinforces the teaching provided in the hospital, clinic, office, or diabetes
education center and assesses the home care environment to determine its adequacy for
self-care and safety.
During home care visits, the nurse assesses the patient for signs and symptoms of longterm complications and assesses the patient's and family's techniques in blood glucose
monitoring, insulin administration, and food selection. In addition, the patient and family
are reminded of the importance of keeping appointments with health care providers and
participating in health promotion activities as well as recommended health screening.
Evaluation
Expected Patient Outcomes
Expected patient outcomes may include the following:
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Achieves optimal control of blood glucose
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Avoids extremes of hypoglycemia and hyperglycemia
Takes steps to resolve rapidly any hypoglycemic episodes
Maintains skin integrity
o Demonstrates intact skin without dryness and cracking
o Avoids ulcers caused by pressure and neuropathy
Demonstrates/verbalizes diabetes survival skills and preventive care
Understands treatment modalities
o Demonstrates correct technique for administering insulin or oral
antidiabetic medications and assessing blood glucose
o Demonstrates appropriate knowledge of diet through proper menu
selections and identification of pattern used for selecting foods at home
o Verbalizes signs, appropriate treatment, and prevention of hypoglycemia
and hyperglycemia
Demonstrates proper foot care
o Inspects feet (using mirror if necessary to see the bottoms of both feet),
including inspection for cracks or fungal infections between toes
o Washes feet with warm water and soap; dries feet thoroughly
o Applies lotion to entire foot except between toes
o Identifies strategies that decrease the risk of foot ulcers, including wearing
shoes at all times; using hand or elbow, not foot, to test temperature of
bath water; avoiding use of heating pad on feet; avoiding constrictive
shoes; wearing new shoes for brief periods only; avoiding home remedies
for treatment of corns and calluses; having feet examined at every
appointment with the physician or nurse practitioner; and consulting a
podiatrist for regular nail care if necessary
Takes steps to prevent eye disease
o Verbalizes need for yearly or more frequent thorough dilated eye
examinations by an ophthalmologist (starting at 5 years after diagnosis for
type 1 diabetes or the year of diagnosis for type 2 diabetes)
o Verbalizes that retinopathy usually does not cause change in vision until
serious damage to the retina has occurred
o States that early laser treatment along with good control of blood glucose
and blood pressure may prevent visual loss from retinopathy
o Identifies hypoglycemia and hyperglycemia as two causes of temporary
blurred vision
States measures to control macrovascular risk factors
o Smoking cessation
o Limitation of fats and cholesterol
o Control of hypertension
o Exercise
o Regular monitoring of renal function
Reports absence of acute complications
o Maintains blood glucose and urine ketones within normal limits
o Experiences no signs or symptoms of hypoglycemia or hyperglycemia
o Identifies signs and symptoms of hypoglycemia or hyperglycemia
o Reports appearance of symptoms so that treatment can be initiated