Diabetes mellitus-Types, sign and symptoms and management of Diabetes mellitus microbiologystudy


  • Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia resulting from impaired insulin secretion

Classification of Diabetes

I. Type 1 Diabetes

  1. Insulin- dependent diabetes mellitus
  2. Juvenile- onset diabetes

Characteristics of Type I Diabetes

  • Hypoinsulinemia
  • 10% of diabetes case
  • Patient require insulin
  • Age onset is childhood
  • Ketoacidosis

Etiology of Type I Diabetes

  • Autoimmune disease
  • Selective destruction of beta cells by T cells
  • Several circulating antibodies against beta cells
  • Cause of autoimmune attack
  • Both genetic and environmental factor are important

II. Type 2 Diabetes

  • Non- insulin- dependent diabetes mellitus
    Adult- onset diabetes

Characteristics of Type 2 Diabetes

  • Impaired insulin action
  • Insulin secretion is normal or increased
  • 90% 0f diabetes cases
  • Age of onset is adulthood
  • Associated with obesity
  • Ketoacidosis but rare
  • Most cases don’t require insulin

Etiology of Type 2 Diabetes

  • Response to insulin is decreased
  • The mechanism of insulin resistance is unclear
  • Both genetic and environmental factor are responsible
  • Post insulin receptor defect

Mechanism of hyperglycemia in diabetes

  1. Increase in hepatic glucose output

  • Decrease insulin secretion in Liver
  • Decrease homeostatic effect on glucagon secretion resulting in increased glucagon
  • Gluconeogenesis and glycogenolysis occurs in Liver
  • Results in increased plasma glucose

2. Decrease in uptake of glucose in Muscles

  • Decrease in insulin in muscles
  • Decreased uptake of glucose and amino-acids in muscles
  • Increased breakdown of proteins
  • Results in increased plasma glucose and plasma amino acids

3. Decrease in uptake of glucose in adipose tissue

  • Decrease in insulin
  • Increased lipolysis and decreased lipogenesis
  • Results in increased plasma fatty acids

Sign and symptoms of Diabetes

  • thirst and frequent drinking
  • most frequent urination particularly at night
  • unexplained weight loss
  • fatigue
  • blurred vision
  • frequent infection of skin, genital

Diagnostic evaluation of Diabetes

  • history taking
  • physical examination
  • symptoms + random plasma glucose > 11.1 Mm (200mg/ dl )
  • fasting plasma glucose >7Mm (126mg/dl)
  • oral glucose tolerance test (OGTT) 2 hour plasma glucose >11.1Mm (200mg/dl)

1. Medical management of Diabetes

Type 1 Diabets

  • insulin injection should be given as per needed by analyzing blood sugar level
  • frequent blood sugar check
  • carbohydrate counting should be done

Type 2 Diabetes

  • 7,5 % monotherapy ( metformin unless contraindicated)
  • 5 – 9,0% dual therapy ( metformin + other medication)
  • If the patient have diabetic complication then we must go for insulin therapy
  • As Metformin is contraindicated in-case of renal failure, liver, or lung disease

2. Surgical management of Diabetes

  • Gastric bypass and biliopancreatic diversion
  • Pancreatic transplantation
  • Islet cell transplantation

3. Nursing management of Diabetes

  1. Nursing assessment of Diabetes A

  • History taking, history of family and past medical history
  • Past surgical history and other treatment
  • Information about medication and insulin therapy
  • Assessment of nutritional status
  • Assess the blood sugar level
  • Assess for sign and symptoms

2. Nursing diagnosis of Diabetes

  • Imbalanced nutrition less than body requirement related to reduction of carbohydrate metabolism due to insulin deficiency
  • Fluid volume deficit related to polyuria, decreased fluid intake
  • Impaired skin integrity related to decreased sensory sensation, impaired circulation
  • Risk for infection related to high glucose level reduction in leukocyte function
  • Deficit knowledge about the disease the process related to lack of information

3. Nursing intervention of Diabetes

  • Monitor vitals sign of the patient
  • Provide medication as per cardex , administer insulin or an oral anti diabetic drug
  • Analysis blood glucose level
  • Maintain fluid and electrolyte balance
  • Increase knowledge about diabetes management
  • Monitoring and managing potential cmplications
  • Provide skin care especially to the feet and legs
  • Assist the client for coping mechanism
  • Teach patient self- care and about disease condition

Complications of Diabetes mellitus

1. Acute complications of Diabetes

  • Glucosuria ( glucose appear in urine)
  • Polyuria( frequent urination)
  • Polydipsia( excessive thirst)
  • Polyphagia(excessive food intake)
  • Ketoacidosis

2. Chronic complications of Diabetes

  • Neuropathy ( loss of sensation due to damage of nerve fibres )
  • Retinopathy ( damage of retina)
  • Cataract ( damage of lens)
  • In cardiovascular there may be atherosclerosis, hypertension, myocardial infraction
  • In nephropathy there may be severe kidney failure and follow- up proteinuria

 

 

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