This presentation is used during my 1st year 2nd sem in my Master's in FEU.

1. By: STEPHANIE KAYE GABIT
GARY RUZ

2. Case Presentation
Name: Mr. Mel Dy
Age: 65 years old
Gender: Male
He was diagnosed of having Type II Diabetes Mellitus a year ago.
The client was admitted in the hospital and he verbalized that he
experienced loss of appetite, frequent urination, tiredness, weight
loss, body weakness. His wife noticed that he is always thirsty.
The client don’t have regular medications for Diabetes Mellitus but
the client and his family are conscious about the food that they eat.
The client admitted that before he is diagnosed with Diabetes
Mellitus he is more prone of having sickness.

3. Diabetes Mellitus

4. Global Statistics

5. Local Statistics

6. Anatomy and Physiology

7. Anatomy and Physiology

11. CLASSIFICATION
• In 1979 the National Diabetes Data Group (NDDG)
developed criteria for the classification and diagnosis of
diabetes mellitus.
• By 1997, and again in 2003, the Expert Committee on the
Diagnosis and Classification of Diabetes Mellitus
proposed changes to the original NDDG classification.
• Changes were supported by the American Diabetes
Association (ADA) and the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK) .
The four classifications of Diabetes Mellitus :
• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes mellitus
• Other specific types of diabetes

12. Type 1 Diabetes

13. Type 2 Diabetes

14. Gestational Diabetes Mellitus

15. Other specific types of diabetes

16. Distinguish Features of DM type 1 and type 2
Feature Type 1 Type 2
Insulin-dependent diabetes Non-insulin-dependent diabetes
Synonyms mellitus, juvenile diabetes, mellitus, adult or maturity-onset
labile or brittle diabetes diabetes, mild diabetes
Usually occurs before age 30, Usually occurs after age 30, but
Age at onset
but may occur at any age can occur in children
Incidence ~10% ~90%
Insidious, may be asymptomatic
Usually abrupt, with rapid onset or mildly asymptomatic; body
Type of onset
of hyperglycemia adapts to slow onset of
hyperglycemia
Endogenous insulin Below normal, normal, or above
Little or none
production normal
85% of clients are obese, may be
Body weight at onset Ideal body weight or thin
of ideal body weight
Prone to ketosis, usually present
Resistant to ketosis, can occur
ketosis at onset, often present during
with infections or stress
poor control
Polyuria, polydipsia, polyphagia, Often none, may be mild
manifestations
fatigue manifestation of hyperglycemia
Etiology Genetic factors, auto immune Genetic factors, Obesity,

18. Disease Process
Absolute Insulin Deficiency

19. Insulin Resistance

22. Clinical Manifestation

23. The following are the distinguish features of diabetes mellitus:
The following are the distinguish features of diabetes mellitus:
Clinical
Type 1 Pathophysiologic Basis Type 2
Manifestation
Water not reabsorbed from renal tubules
Polyuria
secondary to osmotic activity of glucose;
(frequent ++ +
leads to loss of water, glucose, and
urination)
electrolytes
Polydipsia Dehydration secondary to polyuria causes
++ +
(excessive thirst) thirst
Polyphagia
Starvation secondary to tissue breakdown
(excessive ++ +
( catabolism) causes hunger
hunger)
Initial loss secondary to depletion of water,
glycogen, and triglyceride stores; chronic
Weight loss ++ loss secondary to decreased mnuscle mass -
as amino acides are diverted to form
glucose and ketone bodies.
Recurrent blurred Secondary to chronic exposure of ocular
+ ++
vision lens and retina to hyperosmolar fluids
Black, J. (2008). Medical-Surgical Nursing 8th Edition. Singapore: Elsevier Pte. Ltd

24. Clinical
Type 1 Pathophysiologic Basis Type 2
Manifestation
Pruritus, skin
Bacterial and fungal infections of skin seem
infections, + ++
to be more common; research conflicting
vaginitis
When glucose cannot be used for energy in
insulin-dependent cells, fatty acids are used
for energy; fatty acids are broken down into
ketones in blood and excreted by kidneys; in
Ketonuria ++ -
type 2 diabetes mellitus, sufficient insulin is
present to depress excessive use of fatty
acids but not enough to permit use of
glucose
Weakness and Decreased plasma volume leads to postural
fatigue, ++ hypotension; potassium loss and protein +
dizziness catabolism contribute to weakness
Body can “adapt” to a slow rise in blood
Often
- glucose level to a greater extent than it can ++
asymptomatic
to a rapid rise
Black, J. (2008). Medical-Surgical Nursing 8th Edition. Singapore: Elsevier Pte. Ltd

26. Complications of Diabetes Mellitus
DKA ( Diabetic Ketoacidosis )
– Dehydration
– Fruity odor of ketones on
breath
– Hyperpnea or
kussmauul’s respirations
– Impaired level of
consciousness or coma
– Tachycardia
– Weakness

27. • Hypoglycemia
– Shakiness
– Irritability
– Nervousness
– Tachycardia
– Tremor, pallor
– Hunger
– Headache
– Mental illness
– Slurred
speech
– Confusion;
Lethargy
– Seizure

28. Macrovascular
– Coronary artery
disease
– Cerebrovascular
disease
– Hypertension
– Peripheral vascular
disease
– Infection
Microvascular
– Retinopathy
– Nephropathy
– Leg and foot ulcer
– Sensorimotor
neuropathy
– Autonomic
neuropathy

29. Diagnostics

31. Oral Glucose Tolerance Test

32. Values Interpretation
Oral Glucose < 140 mg/dl Normal fasting glucose
Tolerance 140-199 mg/dl Impaired fasting glucose
test, 2 hours Diagnosis of diabetes
after eating >200 mg/dl
mellitus

33. Laboratory Tests Related to DM ( ketones )

34. Laboratory Tests Related to DM (ketones)
• Urine levels of ketones can be tested by clients
use of dip strips or tablets.
• The presence of ketones in the urine (a condition
called ketonuria) indicates that the body is using
fat as a major source of energy ,which may result
in ketoacidosis.
• Test results are indicated by the presence of
color changes, indicating the presence of ketone.
• All clients with diabetes mellitus should test their
urine for ketones during acute illness or stress

35. Laboratory Tests Related to DM ( Protein )
•• Micro albuminuria
Micro albuminuria
measures microscopic
measures microscopic
amounts of protein in the
amounts of protein in the
urine (proteinuria).
urine (proteinuria).
•• Presence of protein (micro
Presence of protein (micro
albuminuria) in urine is an
albuminuria) in urine is an
EARLY sign of kidney
EARLY sign of kidney
disease.
disease.
•• Testing the urine for micro
Testing the urine for micro
albuminuria shows early
albuminuria shows early
nephropathy, long before it
nephropathy, long before it
would be evident on
would be evident on
routine urinalysis.
routine urinalysis.

36. Medical Management
Restoring and maintaining blood glucose levels
to as near normal as possible by:
 Balanced diet
Exercise
Use of oral hypoglycemic agents or insulin.
Initial as well as ongoing client education is vital
in helping the client manage this chronic
condition

37. Promote Proper Nutrition
It can help clients improve metabolic control by
making changes in nutrition habits. The specific
goals include:
Improving blood glucose and lipid levels,
Providing consistency in day-to-day food intake ( in
type 1 diabetes mellitus),
Facilitating weight management ( in type 2 diabetes
mellitus ), and
Providing adequate nutrition for all stages of life.

38. Dietary management is an essential component of
diabetic care and management

39. Promote Regular Physical Activity
Physical activity:
Physical activity:
Lowers blood glucose
Lowers blood glucose
level by increasing
level by increasing
carbohydrate metabolism,
carbohydrate metabolism,
fosters weight reduction
fosters weight reduction
and maintenance.
and maintenance.
Increase insulin
Increase insulin
sensitivity,
sensitivity,
increased high-density
increased high-density
lipoprotein levels,
lipoprotein levels,
Decreases triglyceride
Decreases triglyceride
levels, lowers blood
levels, lowers blood
pressure, and reduces stress
pressure, and reduces stress
and tension.
and tension.

40. Administer Oral Medications
A. Sulfonylureas
 Stimulate beta cells of the pancreas
to secrete insulin
 Second generation also increase
tissue response to insulin and
decrease glucose production by the
liver.
1) Chlorpropamide (diabinese )
 It works by stimulating the release of
your body's natural insulin, thereby
lowering your blood sugar.
 Take this medication by mouth usually
once daily with breakfast.

41. Glipizide
 It works by stimulating
the release of your body's
natural insulin.
Take this medication by
mouth 30 minutes before
a meal, usually once daily
before breakfast.

42. B. Biguanides
Increase tissue response to insulin
Decrease hepatic production of glucose
Decrease absorption of glucose from the small intestine
Decrease triglyceride and low-density lipoprotein level.
1) Metformin
Works by helping to restore your body's proper response
to the insulin you naturally produce.
Decreases the amount of sugar that your liver makes and
that your stomach/intestines absorb.
Take metformin with a meal.

43. C. Thiazolidinediones
Increase insulin action at receptors and post receptors
in hepatic and peripheral tissue to decrease insulin
resistance
Often decrease triglyceride level.
1) Rosiglitazone
Take this medication by mouth, with or without food,
usually once or twice daily.
It may take up to 2 to 3 months before the full benefit of
this drug takes effect.

44. D. Alpha-glucosidase inhibitiors
Delay the digestion of complex carbohydrates
and certain sugars to blunt the peak of blood
glucose and insulin levels after meals.
1) Acarbose
Can be use with other medications (e.g., insulin,
metformin, sulfonylureas such as glipizide) to control
diabetes because they work in different ways.
Take this medication by mouth, usually 3 times a day
at the start (with the first bite) of each main meal.

45. E. Insulin
Drug of choice for patients who have type 1 DM.
Patients with DM 2 may take this to have adequate
insulin control during times of illness and stress.
Two thirds of the dose is commonly given in the morning,
and one third is given in the evening.
Insulin is made chemically by recombinant DNA
technology (human insulin) with different durations of
action, there are four types:
– Rapid acting
– Short acting
– Intermediate acting
– Long acting

46. Site of Injection

48. Foot Care

49. Latest Modalities
MiniMed insulin pump
Continuous subcutaneous insulin infusing involves
the use of small, externally worn devices that closely
mimic the functioning of the normal pancreas. Insulin
pumps contain a 3-mL syringe attached to a long (24-
42in), thin, narrow-lumen tube with a needle or Teflon
catheter attached to the end.

50. Advantages: Disadvantages:
Increased flexibility in Unexpected
lifestyle (in terms of disruptions in the
timing and amount of flow of insulin from
meals, exercise and the pump
travel). Infection
Improved blood glucose
control

51. Alternative Treatment
Bitter melon
natural remedy for type 2
diabetes among
traditional medicine
practitioners.
Green tea
Green tea
can improve glucose tolerance,
can improve glucose tolerance,
and upping the sensitivity to
and upping the sensitivity to
insulin.
insulin.

52. Chinese Wolfberries
Chinese Wolfberries
way to help lessen vision
way to help lessen vision
problems associated
problems associated
with type-2 diabetes.
with type-2 diabetes.
Root of the Zingiber
a medicinal plant in Asian, Indian,
and Arabic herbal traditions since
ancient times as a digestive aid
and an anti-inflammatory helping
to treat arthritis and the common
cold. Researchers from the
University of Sydney have also
found that extracts may help
improve long-term diabetic blood
sugar control

53. RESEARCH FOCUS
Sugar-Sweetened Beverages Increase Risk of
Type 2 Diabetes and Metabolic Syndrome
An analysis conducted by an American Diabetes
Association-funded researcher,
Frank Hu, MD, PhD, MPH., shows that regular
consumption of sugar-sweetened beverages is strongly
associated with developing type 2 diabetes and
metabolic syndrome. Providing the first quantitative
confirmation of this link, Dr. Hu and fellow researchers
at the Harvard School of Public Health analyzed data
from eleven different studies with 310,819 individuals
evaluated for diabetes and 19,431 for metabolic
syndrome. Results showed that participants who drank
one to two 12 ounce servings per day increased their
risk of developing type 2 diabetes by 26% and of
developing metabolic syndrome increased by 20%,
compared to those who drank less than one serving per
month.

54. "The association that we observed between soda
consumption and risk of diabetes is likely a cause-and-effect
relationship because other studies have documented that
sugary beverages cause weight gain, and weight gain is
closely linked to the development of type 2 diabetes," said Dr.
Hu, senior author of the study published in the
November 2010 edition of Diabetes Care.
Apart from overall weight gain, the authors also
consider that since these liquid carbohydrates are usually
consumed in fairly high quantities and can quickly raise
blood-sugar levels, the drinks may lead to insulin resistance
and glucose intolerance—both of which are linked to type 2
diabetes. The researchers recommend that consumers "limit
consumption of these beverages in place of healthy
alternatives such as water to reduce obesity-related chronic
disease risk."
(Malik VS, Popkin BM, Bray GA, Despres JP, Willet WC, Hu, FB. Sugar-sweetened
beverages and risk of metabolic syndrome and type 2 diabetes: a meta-
analysis. Diabetes Care. 2010 Nov; 33(11): 2477-2483.)

55. REFERENCES
• http://www.diabetes.org.uk
• Black, J. (2008). Medical-Surgical Nursing 8th Edition.
Singapore: Elsevier Pte. Ltd
• Morrison A., Lykestos C. (2005). The Pathophysiology of
Alzheimer’s Disease and Directions in Treatment. Galen
Publishing LLC.
• http://care.diabetesjournals.org/content/33/11/2477.full
• Patrick M., Woods S., Craven R., Rokosky J., Medical-
Surgical Nursing Pathophysiological Concenpts, 2nd
edition. Lippincott
• Corwin E. Handbook of Pathophysiology. 3rd edition,
Lippincott. 2008