Diabetes Mellitus (DM)

Diabetes mellitus (DM) is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin, an anabolic hormone.

Normal glucose metabolism
: Blood glucose regulated by insulin andglucagon. Insulin and glucagons are hormones. Glucose is stored as glycogen in liver and muscles or as fat in adipose tissue.
Insulin: Secreted by beta cells in Islets of Langerhans in pancreas. Insulin
decreases blood glucose by promoting its entry into cells.
Glucagon: Secreted by alpha cells in pancreas as blood glucose falls. Promotes release of glycogen from liver.

Etiology and Pathophysiology

■ Decreased amount of insulin or ↓response to insulin leads to ↑blood
glucose (hyperglycemia)

Type 1
■ 10% of DM; beta cell destruction → little or no insulin for cellular
metabolism of glucose; requires exogenous insulin; Type 1 DM is
associated with specific human leukocyte antigens (HLA), autoantibodies,
viruses. Presents at >30yr old

Type 2
■ 90% of DM; ↓sensitivity to insulin (insulin resistance) and ↓secretion of
insulin; may be controlled by diet, exercise, and hypoglycemics; may need
insulin when stressed; Type 2 DM is associated with obesity, genetics,
inactivity, gestational diabetes. Usually presents at >45yr old

Signs and Symptoms

■ The 3 Ps: Polyuria, Polydipsia, Polyphagia (excessive urination, thirst, hunger)
■ Fasting blood glucose >126mg/dL, random blood glucose >200mg/dL
■ ↑Glycosylated hemoglobin (HbA1C) level indicates lack of glucose control
over prior 3mo; glycosuria
■ ↓Healing
■ Type 1: ↓weight; Type 2: ↑weight

Treatment

■ Regular exercise to control weight and ↓insulin resistance
■ ↓Calorie diet (50-60% carbohydrates, 20% protein, 20-30% fat) based on
glycemic food index; ↑soluble fiber → slow glucose absorption
■ Insulin and/or oral hypoglycemics
■ Pancreatic or Islets of Langerhans transplants
■ Treatment of DKA and HHNS: IVF, rapid acting insulin, eventual Na and K†
replacement
■ Treatment of hypoglycemia: 10-15g of simple sugar followed by complex
carbohydrate and protein if conscious; glucagon injection or 50% dextrose
IV if unconscious

Nursing Management

■ Monitor S&S
■ Provide foot care:
■ Inspect daily for lesions
■ Wash/dry between toes daily, wear socks and well-fitting shoes, avoid
heat/cold
■ Encourage weight control efforts and need for continued medical
supervision (certified diabetic educator, dietician, podiatrist,
ophthalmologist)
■ Provide emotional support
■ Teach self-monitoring of blood glucose (SMBG) and urine testing for
ketones if hyperglycemic
■ Teach S&S and management of hyperglycemia, hypoglycemia, and med
administration
■ Explain need for medical alert ID
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