Diabetes Mellitus Nursing Management hard

Study Notes

Diabetes Mellitus: Nursing Management

Diabetes mellitus (DM) is a group of metabolic disorders characterized by high blood sugar (hyperglycemia). This arises from issues with insulin production, function, or both.
Types of diabetes include Type 1 (insulin-dependent), Type 2 (non-insulin-dependent), gestational diabetes, and prediabetes. Type 1 results from an autoimmune attack damaging insulin-producing cells, while Type 2 involves insulin resistance and impaired production. Gestational diabetes develops during pregnancy due to placental hormones. Prediabetes involves elevated blood sugar but not yet diagnostic diabetes.

Pathophysiology

Normal insulin actions include increasing glucose uptake, promoting glycogen storage, decreasing glucose production by the liver, and aiding fat and protein storage.
Type 1 DM is marked by a lack of insulin, leading to consistently high blood sugar levels (both fasting and after eating), frequent urination (osmotic diuresis) due to excess sugar in the urine, and potential ketone production from fat breakdown leading to diabetic ketoacidosis (DKA).
In Type 2 DM, body tissues are resistant to insulin and, with progression, insulin production may also decrease, resulting in high blood sugar; advanced cases can lead to hyperglycemic hyperosmolar syndrome (HHS).

Risk Factors

Risk factors for diabetes include family history, obesity, age over 45, high blood pressure, abnormal cholesterol levels, and previous gestational diabetes, as well as certain racial/ethnic backgrounds.

Clinical Manifestations

General symptoms include fatigue, weakness, frequent infections, and slow-healing sores.
Specific symptoms of Type 1 DM include unexpected weight loss, nausea, vomiting, and abdominal pain (especially with DKA).
The "three Ps" (polyuria, polydipsia, and polyphagia) – increased urination, extreme thirst, and increased hunger – are also common symptoms.

Diagnostic Criteria

Diagnostic criteria involve a random blood sugar reading greater than 200 mg/dL with symptoms, fasting blood sugar ≥126 mg/dL (after 8 hours without food), a 2-hour post-meal blood sugar ≥200 mg/dL during a glucose tolerance test (OGTT), and an HbA1c ≥6.5% (measuring average blood sugar over time).

Management of Diabetes

Management goals focus on maintaining healthy blood sugar levels, preventing long-term complications, and improving overall quality of life. Intensive therapy might involve multiple daily insulin injections or an insulin pump, with frequent glucose monitoring.
Nutritional therapy recommends a balanced diet consisting of 50-60% carbohydrates, 20-30% fats, and 10-20% protein, emphasizing fiber and portion control.
Exercise improves blood sugar control and insulin sensitivity, but should be avoided if blood sugar is >250 mg/dL with ketones present. Consider snacks to adjust appropriate glucose levels.
Pharmacologic therapy includes insulin of various regimens (eg., conventional vs. intensive) and oral antidiabetics, supplementing diet and exercise in cases where diet/exercise alone aren't sufficient.

Complications of Diabetes (Acute)

Hypoglycemia, characterized by low blood sugar.

Description

This quiz covers the nursing management of diabetes mellitus, exploring its types, pathophysiology, and the roles of insulin in glucose metabolism. Test your knowledge on the characteristics and implications of Type 1 and Type 2 diabetes, gestational diabetes, and prediabetes.