DIABETES MELLITUS
DISEASE HISTORY Diabetes is first recorded in English, in the form diabete, in a medical text written around 1425. In 1675,
Thomas Willis
added the word
mellitus,
from the
Latin
meaning "honey", a
reference to the sweet taste of the urine. This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians. In 1776, Matthew Dobson confirmed that the sweet taste was because of an excess of a kind of sugar in the urine and blood of people with diabetes.
Diabetes mellitus is a chronic insulin deficiency or resistance, diabetes mellitus is characterized by disturbances of carbohydrate, protein, and fat metabolism. It is a major risk factor for myocardial infarction, cerebrovascular accident, renal failure, peripheral vascular disease. It is also the leading cause of blindness in adults.
The cause of DM is unknown Though there are predisposing factors as follows: 1.) Stress- it stimulates secretion of epinephrine, norepinephrine and glucocorticoids, glucocorti coids, these hormones elevate glucose levels by glycogenesis and glucogenesis 2.) HeredityHeredity - it is strongly associated with Type II DM 3.) Obesity- Adipose tissues are resistant to insulin, therefore, glucose uptake by the cells is poor 4.) Viral Infection- Increase risk to autoimmune disorders that may affect the pancreas 5.) AutoimmunityAutoimmunit y- it is more associated with Type II DM, This is because it is the children children who are more prone to viral infection
DEFINITION The term
d iabetes iabetes,
without qualification, usually refers to diabetes mellitus, which
roughly translates to excessive sweet urine (known as "glycosuria"). Several rare conditions are also named diabetes. The most common of these is diabetes insipidus in which large amounts of urine are produced (polyuria), which is not sweet (insipidus meaning "without taste" in Latin). The term "type 1 diabetes" has replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent insulin-dependent diabetes mellitus (IDDM). (IDDM). Likewise, the term "type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesityrelated diabetes, and non-insulin-dependent diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature. Various sources have defined "type 3 diabetes" as: gestational diabetes insulin-resistant type 1 diabetes (or "double diabetes"), type 2
diabetes which has progressed to require injected insulin, and latent autoimmune diabetes of adults (or LADA or "type 1.5" diabetes) CLASSIFI LASSIFIC CATION Most cases of diabetes mellitus fall into three broad categories: type 1, type 2, and gestational diabetes. A few other types are described. TYPE 1 DIABETES Type 1 diabetes mellitus is characterized characterized by loss of the insulin-producing insulin-producing beta cells of the islets of Langerhans in the pancreas leading to insulin deficiency. This type of diabetes can be further classified as immune-mediated immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, where beta cell loss is a T-cell mediated autoimmune attack. Autoimmunity is also attributed to the development of Human Leukocyte Antigens due to an previous viral infection (HLA)Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children child ren or adults but was traditionally tradit ionally termed "juvenile " juvenile diabetes" because it represents a majority of the diabetes cases in children. TYPE 2 DIABETES Type 2 diabetes mellitus is characterized by insulin resistance which may be combined with relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus due to a known defect are classified separately. Type 2 diabetes is the most common type. GESTATIONAL DIABETES Gestational Gestationa l diabetes mellitus mellitu s (GDM) resembles resemb les type 2 diabetes in several respects, involving a combination combination of relatively inadequate insulin secretion and responsiveness. responsiveness. It occurs in about 2%±5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%±50% of affected women develop type 2 diabetes later in life. Signs and symptoms
The classical symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or months) in type 1 diabetes while in type 2 diabetes they usually develop much more slowly and may be subtle or absent. Prolonged high blood glucose causes glucose absorption, which leads to changes in the shape of the lenses of the eyes, resulting in vision changes; sustained sensible glucose control usually returns the lens to its original shape. Blurred vision is a common complaint leading to a diabetes diagnosis; diagno sis; type 1 should always alway s be suspected in i n cases of rapid vision change, whereas with type 2 change is generally more gradual, but should still be suspected. People (usually (usuall y with type 1 diabetes) may also present pre sent with diabetic diabeti c ketoacidosis, a state of metabolic dysregulation characterized by the smell of acetone; a rapid, deep breathing known as Kussmaul breathing; nausea; vomiting and abdominal pain; and an altered states of consciousness. A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration. Often, the patient has been drinking extreme amounts of sugar-containing drinks, leading to a vicious circle in regard to the water loss. A number of skin rashes can occur in diabetes that are collectively known as diabetic dermadromes.
CLINICAL MANIFESTATIONS:
Blood glucose level from 600- 2000mg/dl
Hypotension Dehydration Tachycardia Mental status changes Neuralgic deficits Seizures
ASSESSMENT FINDINGS: Look for fatigue, polyuria related to hyperglycemia, polydipsia, dry mucous membranes and poor skin turgor. In type II, weight loss and polyphagia. y
y
DIAGNOSTIC DIAGNOSTIC TEST: Several blood tests are used to measure blood glucose levels, the primary test for diagnosing diabetes. Additional tests can determine the type of diabetes and its severity.
Random blood glucose test ² for a random blood glucose test, blood can be drawn at any time throughout the day, regardless of when the person last ate. A random blood glucose level of 200 mg/dL (11.1 mmol/L) or higher in persons who have symptoms of high blood glucose (see ³Symptoms´ above suggests a diagnosis of diabetes.
Fasting blood glucose test ² fasting blood glucose testing involves measuring blood glucose after not eating or drinking for 8 to 12 hours (usually overnight). A normal fasting blood glucose level is less than 100 mg/dL. A fasting blood glucose of 126 mg/dL (7.0 mmol/L) or higher indicates diabetes. The test is done by taking a small sample of blood from a vein or fingertip. It must be repeated on another day to confirm that it remains abnormally high.
Hemoglobin A1C A1C test (A1C) (A1C) ² The A1C blood test measures the average blood glucose level during the past two to three months. It is used to monitor blood glucose control in people with known diabetes, but is not normally used to diagnose diabetes. Normal values for A1C are 4 to 6 percent. The test is done by taking taking a small sample of blood from a vein or fingertip.
Oral glucose tolerance test ² Oral glucose tolerance testing (OGTT) is the most sensitive test for diagnosing diabetes and pre-diabetes. However, the OGTT is not routinely recommended because it is inconvenient compared to a fasting blood glucose test.
NURSING INTERVENTIONS:
Advice patient about the importance of an individualized meal plan in meeting weekly weight loss goals and assist with compliance. compliance.
Assess patients for cognitive or sensory impairments, which may interfere with the ability to accurately administer insulin.
Demonstrate and explain thoroughly the procedure for insulin self-injection. Help patient to achieve mastery of technique by taking step by step approach.
Review dosage and time of injections in relation to meals, activity, and bedtime based on patients individualized insulin regimen.
Instruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia.
Explain the importance of exercise in maintaining or reducing weight.
Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack before exercising to avoid hypoglycemia.
Assess feet and legs for skin temperature, sensation, sensation, soft tissues injuries, corns, calluses, dryness, hair distribution, pulses and deep tendon reflexes.
Maintain skin integrity by protecting feet from breakdown.
Advice patient who smokes to stop smoking or reduce if possible, to reduce vasoconstriction and enhance peripheral flow.
TERMINOLOGIES 1. HeredityHeredity - it is strongly assoc. with Type II DM 2. Obesity- Adipose tissues are resistant to insulin, therefore, glucose uptake by the cells is poor 3. Viral Infection- Increase risk to autoimmune autoimmune disorders that may affect the pancreas 4. AutoimmunityAutoimmunit y- it is more associated with Type II DM, This is because it is the children who are more prone to viral infection 5. Polyuria ± excessive exces sive urination 6. Polyphagia ± excessive ex cessive hunger 7. Polydipsia ± excessive thirst 8. Random blood glucose test - for a random blood glucose test, blood can be drawn at any time throughout the day 9. Fasting blood glucose test - fasting blood glucose testing involves measuring blood glucose after not eating or drinking for 8 to 12 hours (usually overnight). 10. Hemoglobin A1C A1C test (A1C) (A1C) ² The A1C blood test measures the average blood glucose level during the past two to three months. 11. Oral glucose tolerance test - Oral glucose tolerance testing (OGTT) is the most sensitive test for diagnosing diabetes and pre-diabetes.
