Diabetes Mellitus I

Answers : Diabetes Mellitus - 1

Pathophysiology

Lack of insulin → glucose storage in the form of glycogen in the liver is affected and glucose remains in the blood → increased levels of blood glucose

→ gluconeogenesis from glycogen and from proteins and fat (gluconeogenesis from non-carbohydrate substrates) is uninhibited → increases blood levels of glucose

→ glucose utilization by the muscle as fuel is decreased leading to increased blood levels of glucose

→ transport of glucose into fat and muslces is decreased → blood glucose levels increase

→ protein synthesis becomes poor and other metabolic derangements such as acidosis occur

Persistently high blood glucose → higher renal threshold of reabsorption → increased level in urine → osmotic diuresis (polyuria) → dehydration → polydipsia

Complications of Diabetes Mellitus

Diabetic Retinopathy

Diabetic Nephropathy

Diabetic Neuropathy

Diabetic Microangiopathy, peripheral vascular disease, → skin ulcers → diabetic foot

Diabetic foot - diabetic gangrene - most common cause of non-traumatic adult amputation, usually of toes and or feet

Diabetic Ketoacidosis

Hyperglycemia hyperosmolar stateulcers

Hypoglycemia

Diabetic Coma

Respiratory infections

Periodontal disease

Diabetic Cardiomyopathy

Diabetic Encephalopathy

Coronary Artery Disease

Diabetic myonecrosis

Female infertility - delayed puberty and menarche, oligomenorrhoea, polycystic ovarian syndrome, earlier menopause

Nursing Care

A. Nursing Diagnosis : Fluid Volume Deficit related to osmotic diuresis.

Goal:

Adequate hydration evidenced by stable vital signs, palpable peripheral pulse, skin turgor and capillary refill well

apppriate urinary output

Normal Electrolyte levels.

Nursing Intervention:

1.) Monitor vital signs.

Hypovolemia can be manifested by hypotension and tachycardia.

2.) Assess peripheral pulses, capillary refill, skin turgor, and mucous membranes.

This is an indicator of the level of dehydration, or an adequate circulating volume.

3.) Monitor input and output, record the specific gravity of urine.

To provide estimates of fluid replacement, renal function, and effectiveness of the therapy given.

4.) Measure weight every day.

To provide the best assessment of fluid status.

5.) Provide fluid therapy as indicated.

B. Nursing Diagnosis : Imbalanced Nutrition.

Goal:

Digest the amount of calories / nutrients right

Improve the energy level.

Achieve Stable or increasing weight.

Nursing Intervention:

1.) Determine the patient's diet and eating patterns.

Rationale: Identify deficiencies and deviations from the therapeutic needs.

2.) Weigh the patient daily

To ensure adequate food intake (including absorption and utilization).

3.) Identification of preferred food

If the patient's food preferences can be included in meal planning, cooperation will be better

4.) Involve patients in planning the family meal.

It increases the sense of involvement in the patient and the family.

5.) Give regular insulin treatment.

Regular insulin has a rapid onset and quickly moves glucose into cells.

C. Nursing Diagnosis : Risk for Infection related to hyperglicemia.

Goal:

Identify interventions to prevent / reduce the risk of infection.

Demonstrate techniques, lifestyle changes to prevent infection.

Nursing Intervention:

1). Observe signs of infection and inflammation.

Patients may have an infection that usually induces a state of ketoacidosis or may have nosocomial infections.

2). Prevent nosocomial infection by good hand washing for all people including the patients themselves.

It Prevents cross infection.

3). Maintain aseptic technique in invasive procedures.

High glucose levels in blood would be the best medium for the growth of germs.

4). Care for the patient's skin regularly

The peripheral circulation may be disturbed that puts patients at increased risk of damage to the skin / skin irritation and infection.

5). Ensure effective coughing and encourage deep breathing by appropriate positioning of the patient.

It Assists mobilization pulmonary secretions.

???????????????????????????????????????????????????????????????

ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä ä

???????????????????????????????????????????????????????????????

Mrs.S admitted with DM with a glucose level of 295 mg %

(a) Discuss the pathophysiology of diabetes Mellitus. (3).

(b) List down the complications of Diabetes Mellitus. (2)

Mr.Raju , 50 years old man is admitted in I.C.U. with diabetes mellitus. He is a known case of diabetes on irregular treatment. On admission his blood sugar level is 300 mg %.

(a) Discuss the pathophysiology of DM (5)

(b) List down the complications of DM. (10)