1. Assessment and Management of Patients With Diabetes Mellitus Prepared by Dr. ImanAbdullah

2. Out Line  Definition of diabetes mellitus  Risk factors for diabetes mellitus  Diabetes and its classification  Overview in type I and 2 diabetes  Pathophysiology of diabetes  Clinical manifestations of diabetes  Diagnostic findings of diabetes  Management of diabetes  Monitoring glucose levels and ketones  Pharmacologic therapy  Insulin therapy

3. Out Line  Complications of insulin  Oral antidiabetic agents  Nursing management  Patient education  Acute complications of diabetes  Nursing process for patient newly diagnosed with diabetes mellitus  Patient education (foot care)  Long-term complications of diabetes  Special issues in diabetes care  Nursing process for patient with diabetes as a secondary diagnosis

4. Learning Objectives On completion of this lecture, the student will be able to:  Differentiate between type I and type 2.  Describe etiologic factors associated with diabetes.  Relate the clinical manifestations of diabetes to the associated pathophysiologic alterations.  Explain the dietary modifications used for management of people with diabetes.  Describe the relationships among diet, exercise, and medication.  Differentiate between hyperglycemia with DKA and HHNS

5. Cont.  Describe management strategies for a person with diabetes to use during “sick days”.  Describe the major macrovascular, microvascular, and neuropathic complications of diabetes.  Use the nursing process as a framework for care of patients with diabetes.

6. Diabetes Mellitus Definition:  Is a group of metabolic diseases characterized by increased levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. Risk Factors for Diabetes Mellitus

7. Diabetes and its Classification Type I diabetes: Insulin-dependant diabetes (IDDM). Type II diabetes: non Insulin-dependant diabetes (NIDDM). Gestational diabetes mellitus. Diabetes mellitus associated with other conditions or syndrome.

8. Overview  In type I diabetes  In type 2 diabetes

9. Pathophysiology of Diabetes  Type I diabetes  Type 2 diabetes  Gestational Diabetes

10. Clinical Manifestations Clinical manifestations of all types of include:  “Three Ps”: polyuria, polydipsia, and polyphagia  Fatigue and weakness  Sudden vision changes  Tingling or numbness in hands or feet  Dry skin  Skin lesions or wounds that are slow to heal  Recurrent infections

11. Diagnostic Findings Criteria for the diagnosis of diabetes mellitus:  Symptoms of diabetes plus casual plasma glucose concentration equal to or greater than 200mg/dl.  Fasting plasma glucose greater than or equal to 126mg/dl (7.0mmol/L).  Two-hour postload glucose equal to or greater than 200mg/dl during an oral glucose tolerance test.  If fasting glucose level are normal, the diagnosis must be based on a Glucose Tolerance test.

12. Management Nutritional therapy Exercise Monitoring Pharmacologic therapy Education

13. Monitoring Glucose levels and Ketones  Self-Monitoring Blood Glucose (SMBG)  Continuous Glucose Monitoring System (CGMS)  Glycated Hemoglobin  Urine Glucose Testing  Testing for Ketones

14. Pharmacologic Therapy  Insulin Therapy and Insulin Preparations  Insulin preparations vary according to three main characteristics:  Time course of action  Species ( source)  Manufacturer

15. Insulin Regimens  There are two general approaches to insulin therapy:  Conventional  And intensive

16. Complications of Insulin  Local Allergic Reactions  Systemic Allergic Reactions  Insulin Lipodystrophy  Resistance to Injected Insulin  Morning Hyperglycemia

17. Alternative methods of Insulin Delivery II nsulin Pens JJ et injectors

18. Cont. II nsulin Pumps II mplantable and inhalant insulin delivery TT ransplantation of pancreatic cells II mplantable and inhalant insulin delivery TT ransplantation of pancreatic cells

19. Oral Antidiabetic Agents  Sulfonylureas  Biguanides Nursing Management Patient Education

20. Acute Complications of Diabetes There are three major acute complications of diabetes related to short-term imbalances in blood glucose levels: Hypoglycemia Diabetic ketoacidosis (DKA) Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

21. Gerontologic Considerations  In elderly patients with diabetes, hypoglycemia is a particular concern for many reasons:  Elderly people frequently live alone and may not recognize the symptoms of hypoglycemia.  With decreasing renal function, it takes longer for oral hypoglycemic agents to be excreted by the kidneys.  Skipping meals may occur because of decreased appetite or financial limitations.  Decreased visual acuity may lead to errors in insulin administration.

23. Nursing Process The patient newly diagnosed with diabetes mellitus:  Assessment  Nursing Diagnosis.  Potential Complications  Planning and Goals  Nursing Intervention  Evaluation

24. Patient education (foot care)  Take care of your diabetes

25. Cont. II nspect your feet every day WW ash your feet every day

26. KK eep the skin soft & smooth

27. SS mooth corns and calluses gently TT rim your toenails each week or when needed

28. WW ear shoes and socks at all times PP rotect your feet from hot and cool KK eep the blood flowing to your feet CC heck with your health care provider.

29. Long-Term Complications of Diabetes  The general categories of long- term diabetic complications are:  Macro vascular  Micro vascular  Neuropathy

30. Foot and Leg Problem Three diabetic complications contribute to the increased risk of foot problems and infections include:  Neuropathy  Peripheral vascular disease  Immunocompromise  Management (teaching proper foot care )

31. Special Issues in Diabetes Care  Patient with diabetes who are undergoing surgery  Management of Hospitalized Patients With Diabetes  Hyperglycemia During Hospitalization  Hypoglycemia During Hospitalization  Common Alteration in Diet  Hygiene  Stress

32. Nursing Process The Patient With Diabetes as a Secondary Diagnosis  Assessment  Nursing Diagnosis  Potential Complications  Planning and Goals  Nursing Intervention  Evaluation

33. Reference Brunner, L. and Suddarath, D. (2010). Text Book of Medical Surgical Nursing. 12 th Edition. J.B. Lippincott Williams & Wilikins, Library of Congress Catalging-in- Publication Data.]

34. Thank You