Diabetes Mellitus Overview

Types of Diabetes Mellitus (DM)

• Four types of DM exist: Type 1 (Insulin-Dependent), Type 2 (Non-Insulin-Dependent), Gestational, and Borderline Diabetes.

Non-Modifiable Risk Factors for Type 1 DM

• Genetic susceptibility
• Autoimmune factors
• Family history of Type 1 DM
• Age (often develops in childhood or adolescence)

Modifiable Risk Factors for Type 2 DM

• Lack of physical activity
• Poor diet
• Excessive weight
• Sedentary lifestyle

Clinical Manifestations of DM

• Polyuria (excessive urination)
• Polydipsia (excessive thirst)
• Polyphagia (excessive hunger)
• Weight loss
• Extreme fatigue
• Blurred vision
• Poor wound healing
• Recurrent infections

Insulin Onset of Action

• NPH insulin: 1 to 2 hours
• Humulin R insulin: 30 minutes

Insulin Injection Sites

• Abdomen
• Thigh
• Upper arm
• Buttocks

Insulin Therapy Complications

• Local or systemic allergic reactions
• Insulin lipodystrophy (lipoatrophy or lipohypertrophy)
• Insulin resistance
• Morning hyperglycemia (e.g., dawn phenomenon, Somogyi effect)

Nursing Interventions for Insulin Therapy

• Rotate injection sites to prevent lipodystrophy.
• Monitor blood glucose levels regularly.
• Educate the patient about recognizing signs of hypoglycemia.
• Ensure the patient understands the correct administration technique.

Deep, Rapid Breathing

• Kussmaul respiration

Causes of Hypoglycemia

• Too much insulin or oral agents
• Too little food
• Excessive physical activity

Diabetic Ketoacidosis (DKA) Clinical Manifestations

• Hyperglycemia
• Dehydration
• Acidosis
• Kussmaul respirations (deep, rapid breathing)

Nursing Interventions for DKA

• Monitor fluid and electrolyte status.
• Administer intravenous fluids and insulin as per protocol.
• Monitor vital signs and blood glucose levels frequently.
• Assess urine output to ensure adequate renal function.

Macrovascular Complications of DM

• Coronary artery disease
• Cerebrovascular disease
• Peripheral arterial disease

Preventive Measures for Macrovascular Diseases

• Control of blood glucose levels
• Diet and exercise to manage obesity and hypertension
• Use of medications to manage hypertension and hyperlipidemia
• Smoking cessation

Microvascular Complications of DM

• Diabetic retinopathy
• Diabetic nephropathy
• Diabetic neuropathy

Hypoglycemia vs. DKA vs. HHNS Comparison

• Onset, heart rate, blood pressure, respiration, breath odor, mental status, insulin level, and blood glucose level during these different conditions are detailed.

Discharge Plan for DM Patient

• Diet
• Exercise
• Monitoring blood glucose levels
• Education
• Follow-Up appointments
• Medications

Nursing Care Plan for DM Patient

• Risk for fluid volume deficit related to polyuria and dehydration.
• Imbalanced nutrition related to imbalance of insulin, food, and physical activity.
• Potential for self-care deficit related to physical impairments or social factors.

Interventions for Nursing Diagnoses

• Interventions (specific actions for each nursing diagnosis listed.) are provided in the text.