Diabetes Mellitus: Types, Risks, and Causes

• Diabetes Mellitus refers to a group of metabolic diseases
• It is characterized by elevated blood glucose levels (hyperglycemia)
• This results from defects in insulin secretion, insulin action, or both

Classification of Diabetes Mellitus

• Type I Diabetes
• Type II Diabetes
• Gestational diabetes occurs when a pregnant woman without prior diabetes develops high blood sugar levels due to the pregnancy
• Latent autoimmune diabetes of adults (LADA)
• Diabetes associated with other conditions
• Prediabetes is classified as impaired glucose tolerance or impaired fasting glucose

Risk Factors of Diabetes

• Age > 30 years for Type 2 Diabetes, and < 30 years for Type 1 Diabetes
• Hypertension
• Family history of diabetes
• Obesity
• High-density lipoprotein (HDL) < 35 mg/dL and triglycerides > 250 mg/dL

Causes

• The cause of diabetes mellitus can be unknown

Predisposing Factors

• Stress
• Heredity
• Obesity
• Viral infection
• Autoimmune disorder

Clinical Manifestations

• Clinical manifestations depend on the patient's level of hyperglycemia
• Polyuria: Increased urine output
• Polyphagia: Excessive hunger
• Polydipsia: Excessive thirst, due to excess fluid loss from osmotic diuresis
• Fatigue and weakness
• Sudden vision changes
• Tingling and numbness of feet or hands
• Skin lesions or wounds that are slow to heal
• Recurrent infection
• Sudden weight loss

Diagnostic Findings

• Normal blood sugar level: 80-120 mg/dL
• Fasting blood sugar (FBS) ≥ 126 mg/dL
• Postprandial blood sugar (PPBS) > 200 mg/dL
• Hemoglobin A1C > 6.5%

Diagnostic Assessments

• Fasting Blood Sugar (FBS) requires no caloric intake for at least 8 hours
• Post Prandial Blood Sugar (PPBS) involves taking a sample on an empty stomach, administering a meal, and measuring blood sugar after 2 hours
• OGTT/GTT (Oral Glucose Tolerance Test) is used to detect gestational diabetes and Type II diabetes mellitus

OGTT/GTT Preparation

• Maintain a normal diet in the days leading up to the test
• Consult with a doctor about current medications, especially corticosteroids, beta-blockers, or diuretics
• Abstain from food for at least 8 hours before the test
• Avoid using the bathroom just before the procedure, as a urine sample may be needed

OGTT/GTT Procedure

• A blood sample will be collected upon arrival to check the fasting blood glucose value
• Drink a sweet liquid containing a measured amount of glucose (75-100 grams for standard GTT)
• Blood samples collected at timed intervals of 1, 2, and sometimes 3 hours after glucose is consumed

Glycosylated Hemoglobin

• This test is the most accurate
• It reflects serum glucose levels for the past 3-4 months
• Excess glucose in the blood attaches to hemoglobin

Nutritional Management

• Goals of nutritional management include providing essential food constituents (vitamins, minerals)
• Meeting energy needs
• Achieving and maintaining a reasonable weight
• Decreasing serum lipid levels

Diet Advice

• Calorie distribution should be: 50-60% carbohydrates, 20-30% fat, and 10-20% protein
• Increasing fiber intake may improve blood glucose levels and decrease the need for exogenous insulin

Exercise

• Brisk walking is the best exercise as it increases carbohydrate uptake by cells and decreases insulin requirements

General Precautions for Exercise

• Wear proper footwear
• Avoid exercise in extreme heat or cold
• Inspect feet daily after exercise
• Exercise at the same time and in the same amount each day
• Avoiding trauma to the lower extremities

Medications

• Oral Hypoglycemic Agents (OHA) stimulate the pancreas to secrete insulin and are indicated only in Type II DM
• Examples include Diabenese, Orinase, Micronase, Dionil, Glucotrol (sulfonylureas), and Glucophage (Metformin) - Biguanide group
• Observe for signs and symptoms of GI upset and hypoglycemia

Insulin Administration

• Inject insulin subcutaneously at a 90-degree angle

Nursing Responsibilities

• Administer insulin at room temperature, as cold insulin may cause lipodystrophy
• Rotate the site of injection to prevent lipodystrophy
• Store the vial of insulin in current use at room temperature
• Other vials should be refrigerated
• Gently roll the vial between the palms to redistribute insulin particles, do not shake
• Observe for side effects like redness, swelling, lipodystrophy (localized)
• Observe for edema and hypoglycemia (generalized)

Complications

• Hypoglycemia
• Hyperglycemia
• Diabetic Foot

Hypoglycemia

• Hypoglycemia is low blood sugar
• Causes include taking too much insulin, not eating enough carbohydrates, mis-timed insulin dosage, physical activity, drinking alcohol, meal composition (fat, protein, fiber), weather, and schedule changes

Clinical Manifestations of Hypoglycemia

• Looking pale
• Shakiness
• Sweating
• Headache
• Hunger or nausea
• Irregular or fast heartbeat
• Fatigue
• Irritability or anxiety
• Difficulty concentrating
• Dizziness or lightheadedness
• Tingling or numbness of the lips, tongue, or cheek

Management of Hypoglycemia

• Administer simple sugar orally such as 3-4 oz. regular soft drinks, 8 oz. fruit juice, 5-7 pieces of candies, 1 tbsp sugar, 5 ml pure honey, or 10-15 grams of carbohydrate
• If the patient is unconscious, administer Dextrose 50% (20-50 ml) intravenously
• Monitor blood sugar levels
• Teach the patient to keep a diabetic card or identification band when going out

Hyperglycemia

• Hyperglycemia is when the level of glucose in the blood is higher than normal

Hyperglycemia Symptoms

• Urinating large amounts
• Excessive thirst
• Feeling tired
• Frequent hunger
• Dry mouth
• Weight loss
• Blurred vision
• Recurrent infections

Later Signs of Hyperglycemia

• Fruity-smelling breath
• Dry mouth
• Abdominal pain
• Nausea and vomiting
• Shortness of breath
• Confusion
• Loss of consciousness

Management of Hyperglycemia

• Maintain patient airway
• Oxygen therapy
• Administer Normal Saline + Regular Insulin intravenously
• Once sugar level reaches 250 mg/dL, administer Dextrose 10% with a balanced dose of insulin
• Monitor blood sugar
• Teach patient causes, prevention, and management

Diabetic Foot

• Diabetic foot is a condition where the foot develops a wound that cannot heal for a long period, sometimes requiring amputation

Foot Care

• Inspect the feet daily, preferably in a mirror
• Wash feet with warm water and mild soap
• Pat the feet dry with soft towel, don't rub
• Wear comfortable, properly fitted shoes that are not too tight
• Do not go barefoot
• Trim the toe nails straight across
• Apply lotion to the feet
• Exercise/Massage the feet daily