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Assessment and Management of Patients With Diabetes Mellitus Prepared by Dr. ImanAbdullah.

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Presentation on theme: "Assessment and Management of Patients With Diabetes Mellitus Prepared by Dr. ImanAbdullah."— Presentation transcript:

1 Assessment and Management of Patients With Diabetes Mellitus Prepared by Dr. ImanAbdullah

2 Out Line  Definition of diabetes mellitus  Risk factors for diabetes mellitus  Diabetes and its classification  Overview in type I and 2 diabetes  Pathophysiology of diabetes  Clinical manifestations of diabetes  Diagnostic findings of diabetes  Management of diabetes  Monitoring glucose levels and ketones  Pharmacologic therapy  Insulin therapy

3 Out Line  Complications of insulin  Oral antidiabetic agents  Nursing management  Patient education  Acute complications of diabetes  Nursing process for patient newly diagnosed with diabetes mellitus  Patient education (foot care)  Long-term complications of diabetes  Special issues in diabetes care  Nursing process for patient with diabetes as a secondary diagnosis

4 Learning Objectives On completion of this lecture, the student will be able to:  Differentiate between type I and type 2.  Describe etiologic factors associated with diabetes.  Relate the clinical manifestations of diabetes to the associated pathophysiologic alterations.  Explain the dietary modifications used for management of people with diabetes.  Describe the relationships among diet, exercise, and medication.  Differentiate between hyperglycemia with DKA and HHNS

5 Cont.  Describe management strategies for a person with diabetes to use during “sick days”.  Describe the major macrovascular, microvascular, and neuropathic complications of diabetes.  Use the nursing process as a framework for care of patients with diabetes.

6 Diabetes Mellitus Definition:  Is a group of metabolic diseases characterized by increased levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. Risk Factors for Diabetes Mellitus

7 Diabetes and its Classification Type I diabetes: Insulin-dependant diabetes (IDDM). Type II diabetes: non Insulin-dependant diabetes (NIDDM). Gestational diabetes mellitus. Diabetes mellitus associated with other conditions or syndrome.

8 Overview  In type I diabetes  In type 2 diabetes

9 Pathophysiology of Diabetes  Type I diabetes  Type 2 diabetes  Gestational Diabetes

10 Clinical Manifestations Clinical manifestations of all types of include:  “Three Ps”: polyuria, polydipsia, and polyphagia  Fatigue and weakness  Sudden vision changes  Tingling or numbness in hands or feet  Dry skin  Skin lesions or wounds that are slow to heal  Recurrent infections

11 Diagnostic Findings Criteria for the diagnosis of diabetes mellitus:  Symptoms of diabetes plus casual plasma glucose concentration equal to or greater than 200mg/dl.  Fasting plasma glucose greater than or equal to 126mg/dl (7.0mmol/L).  Two-hour postload glucose equal to or greater than 200mg/dl during an oral glucose tolerance test.  If fasting glucose level are normal, the diagnosis must be based on a Glucose Tolerance test.

12 Management Nutritional therapy Exercise Monitoring Pharmacologic therapy Education

13 Monitoring Glucose levels and Ketones  Self-Monitoring Blood Glucose (SMBG)  Continuous Glucose Monitoring System (CGMS)  Glycated Hemoglobin  Urine Glucose Testing  Testing for Ketones

14 Pharmacologic Therapy  Insulin Therapy and Insulin Preparations  Insulin preparations vary according to three main characteristics:  Time course of action  Species ( source)  Manufacturer

15 Insulin Regimens  There are two general approaches to insulin therapy:  Conventional  And intensive

16 Complications of Insulin  Local Allergic Reactions  Systemic Allergic Reactions  Insulin Lipodystrophy  Resistance to Injected Insulin  Morning Hyperglycemia

17 Alternative methods of Insulin Delivery II nsulin Pens JJ et injectors

18 Cont. II nsulin Pumps II mplantable and inhalant insulin delivery TT ransplantation of pancreatic cells II mplantable and inhalant insulin delivery TT ransplantation of pancreatic cells

19 Oral Antidiabetic Agents  Sulfonylureas  Biguanides Nursing Management Patient Education

20 Acute Complications of Diabetes There are three major acute complications of diabetes related to short-term imbalances in blood glucose levels: Hypoglycemia Diabetic ketoacidosis (DKA) Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

21 Gerontologic Considerations  In elderly patients with diabetes, hypoglycemia is a particular concern for many reasons:  Elderly people frequently live alone and may not recognize the symptoms of hypoglycemia.  With decreasing renal function, it takes longer for oral hypoglycemic agents to be excreted by the kidneys.  Skipping meals may occur because of decreased appetite or financial limitations.  Decreased visual acuity may lead to errors in insulin administration.


23 Nursing Process The patient newly diagnosed with diabetes mellitus:  Assessment  Nursing Diagnosis.  Potential Complications  Planning and Goals  Nursing Intervention  Evaluation

24 Patient education (foot care)  Take care of your diabetes

25 Cont. II nspect your feet every day WW ash your feet every day

26 KK eep the skin soft & smooth

27 SS mooth corns and calluses gently TT rim your toenails each week or when needed

28 WW ear shoes and socks at all times PP rotect your feet from hot and cool KK eep the blood flowing to your feet CC heck with your health care provider.

29 Long-Term Complications of Diabetes  The general categories of long- term diabetic complications are:  Macro vascular  Micro vascular  Neuropathy

30 Foot and Leg Problem Three diabetic complications contribute to the increased risk of foot problems and infections include:  Neuropathy  Peripheral vascular disease  Immunocompromise  Management (teaching proper foot care )

31 Special Issues in Diabetes Care  Patient with diabetes who are undergoing surgery  Management of Hospitalized Patients With Diabetes  Hyperglycemia During Hospitalization  Hypoglycemia During Hospitalization  Common Alteration in Diet  Hygiene  Stress

32 Nursing Process The Patient With Diabetes as a Secondary Diagnosis  Assessment  Nursing Diagnosis  Potential Complications  Planning and Goals  Nursing Intervention  Evaluation

33 Reference Brunner, L. and Suddarath, D. (2010). Text Book of Medical Surgical Nursing. 12 th Edition. J.B. Lippincott Williams & Wilikins, Library of Congress Catalging-in- Publication Data.]

34 Thank You

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