3. What is diabetes Mellitus?
The term diabetes mellitus describes a metabolic disorder of multiple
aetiology characterized by chronic hyperglycaemia with disturbances
of carbohydrate, fat and protein metabolism resulting from defects in
insulin secretion, insulin action, or both.
Middle-aged and elderly age groups are most commonly affected by
diabetes. Diabetes is one of the four major types of non-communicable
diseases (cardiovascular disease, diabetes, cancer and chronic
respiratory diseases).
4.
5.
6.
7.
8. Definition
Diabetes mellitus (DM) is a group of diseases characterized by high
levels of blood glucose resulting from defects in insulin
production, insulin action, or both.
Or
A disease in which the body’s ability to produce or respond to the
hormone insulin is impaired, resulting in abnormal metabolism of
carbohydrates and elevated levels of glucose in the blood.
15. Classification / Etiology of diabetes mellitus
1. Type 1 diabetes
2. Type 2 diabetes
3. Secondary diabetes
4. Gestational diabetes
16. Type 1 diabetes
• Occur at any age, but usually <30 years
• Usually thin at diagnosis
• Can be due to genetic, immunologic or
environmental factors
• Can have islet cell antibodies
• No endogenous insulin , so require
exogenous insulin
• Diabetic ketoacidosis prone
17. Type 2 Diabetes
• Onset at age , usually >30 years
• Usually obese at diagnosis
• Can be due to hereditary or
environmental factors
• No islet cell antibodies
• Decreased insulin production or
decreased sensitivity to insulin
• Oral anti-diabetic agents may
improve blood glucose levels
• Diabetic keto-acidosis is rare
18.
19. Gestational Diabetes
• Onset usually in 2nd or 3rd trimester
•Placental hormones reduces action of
insulin
• Treated with diet or insulin
44. Management of DM
The major components of the treatment of diabetes are:
• Diet and ExerciseA
• Oral hypoglycaemic
therapy
B
• Insulin TherapyC
45. Dietary Considerations
• BMI
• Activity level
• Age / Sex
• Present food habits
• Economic status
• Complications in Diabetes
• Treatment of Diabetes
46. A. Diet
Diet is a basic part of management in every case.
Dietary treatment should aim at:
◦ Ensuring weight control
◦ Providing nutritional requirements
◦ Allowing good glycaemia control with blood glucose levels as
close to normal as possible
47.
48. A. Diet (cont.)
The following principles are recommended as dietary guidelines for
people with diabetes:
Dietary fat should provide 25-35% of total intake of calories but saturated
fat intake should not exceed 10% of total energy.
Cholesterol consumption should be restricted and limited to 300 mg or less
daily.
Protein intake can range between 10-15% total energy (0.8-1 g/kg of
desirable body weight).
Excessive salt intake is to be avoided. It should be particularly restricted in
people with hypertension and those with nephropathy.
51. Considerations during exercise
• Use proper footwear during
exercise
• Avoid exercise in extremes of
temperature
• Inspect feet daily
• Avoid exercise in periods of
poor metabolic control
• Do not exercise empty or full
stomach
52. Monitoring
A – A1C Levels {estimated average
BS level}
B – Blood pressure
C – Cholesterol
D – Diabetic education
E – Eye Examination
F – Foot Examination
G – Blood Glucose Examination
H – Health
I – Indications & Referral
54. B. Oral Anti-Diabetic Agents
There are currently four classes of oral anti-diabetic agents:
i. Biguanides
ii. Sulphonylureas
iii. Non-sulphonylureas
iv. α-glucosidase inhibitors
v. Thiazolidinediones (TZDs)
65. Nursing Diagnosis
1) Imbalanced Nutrition Less Than Body Requirements R/T reduction of carbohydrate
metabolism due to insulin deficiency, inadequate intake due to nausea and vomiting.
2) Fluid Volume Deficit related to osmotic diuresis from hyperglycemia, polyuria, decreased
fluid intake.
3) Impaired Skin Integrity related to decreased sensory sensation, impaired circulation,
decreased activity / mobilization, lack of knowledge of skin care.
4) Activity Intolerance related to weakness due to decreased energy production.
5) High risk of injury associated with decreased sensation sensory (visual), weakness, and
hypoglycemia.
6) Anxiety related to a lack of knowledge (diabetes management), the ability to remember the
less, diagnosis or treatment of a new way, cognitive limitations.
7) Risk for ineffective management of therapeutic rules at home due to a lack of knowledge
about the condition of the therapeutic management, inadequate support systems.
66. Nursing diagnosis ……(Contd.)
Altered nutrition : less than
body requirements
•Abnormal glucose
metabolism
•Depletion of fat stores,
cellular proteins
•Decreased oral intake –
dislike of prescribed diet,
anorexia gastric fullness
70. Self-Care
Patients should be educated to practice self-care. This allows the patient to assume
responsibility and control of his / her own diabetes management. Self-care should include:
◦ Blood glucose monitoring
◦ Body weight monitoring
◦ Foot-care
◦ Personal hygiene
◦ Healthy lifestyle/diet or physical activity
◦ Identify targets for control
◦ Stopping smoking