Glucose Regulation and Diabetes Mellitus in Nursing

Glucose regulation is the priority concept in this chapter, interrelated with nutrition, tissue integrity, sensory perception, perfusion, immunity, fluid and electrolyte balance, and acid-base balance.
Diabetes mellitus (DM) is a common chronic health problem that results from poor glucose regulation, leading to complications such as hypertension and hyperlipidemia.

The main problem in DM is chronic hyperglycemia (high blood glucose level) due to problems with insulin secretion, insulin action, or both.
The pancreas has both exocrine and endocrine functions, with the endocrine portion producing insulin and other hormones.
Insulin allows cells to use and store glucose, fat, and protein, and helps keep blood glucose levels from becoming too high.

Hyperglycemia can lead to dehydration, polyuria, polydipsia, and polyphagia, as well as cell starvation and metabolic acidosis.
Three glucose-related emergencies that can occur in patients with diabetes are diabetic ketoacidosis, hyperglycemic-hyperosmolar state, and hypoglycemia.
Diabetes can lead to macrovascular and microvascular complications, including coronary heart disease, cerebrovascular disease, peripheral vascular disease, nephropathy, neuropathy, and retinopathy.

The focus of health promotion is on controlling hyperglycemia to reduce long-term complications.
Adopting a healthy lifestyle, including a low-calorie diet and regular physical activity, can improve metabolic and cardiac risk factors.
Yearly follow-up visits are encouraged for vision testing and to assess urine microalbumin levels.

Patients with diabetes should be asked about risk factors and symptoms, and evidence-based prevention studies should be used to identify those at risk.
Fasting plasma glucose is used to diagnose diabetes, and oral glucose tolerance testing is the most sensitive test for diagnosis.
Goals of nonsurgical management include A1C levels of 6.5% or below, preprandial blood glucose levels of 90-130 mg/dL, and peak after-meal blood glucose levels less than 180 mg/dL.

Antidiabetic drugs, including insulin secretagogues, sulfonylurea agents, meglitinide analogs, biguanides, and thiazolidinediones, are used to control blood glucose levels.
Combination agents, including insulin and oral antidiabetic agents, may be used in some cases.
Patients should be taught to adjust insulin doses and understand nutrition therapy for dietary flexibility and target blood glucose values.

Patients should be able to adjust insulin doses, understand nutrition therapy, and monitor blood glucose levels regularly.
Common errors in self-monitoring of blood glucose include failure to obtain a sufficient blood drop, poor storage of test strips, and not changing the code number on the meter.
Infection control measures are needed for self-monitoring of blood glucose, especially good handwashing and not reusing lancets or sharing equipment.

The most effective surgical interventions for diabetes include transplantation of the pancreas, which improves quality of life and eliminates the need for insulin injections.
Complications of pancreas transplantation include thrombosis, pancreatitis, anastomosis leak with infection, and rejection of the transplanted pancreas.

Teaching for diabetic patients is intensive and comprehensive, and should include self-adjustment of insulin, blood glucose monitoring, and foot assessment.
Patients should be able to describe the meal plan, explain the effects of diet, drugs, and activity on blood glucose, and report subtle indications of ischemia.
Patients should be taught to report symptoms of pancreatitis and to wear a medical alert bracelet.
Reinforcement of the importance of tight control over blood glucose levels is essential for preventing complications.

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