Management of Clients with Diabetes Mellitus

Diabetes mellitus is a chronic, progressive disease characterized by the body’s

inability to metabolize carbohydrates, fats, and protein, leading to hyperglycemia (high blood
glucose level). Diabetes mellitus is sometimes referred to as “High Sugars” by both clients
and health care providers. The nation of associating sugar with diabetes mellitus is
appropriate because the passage of large amounts of sugar-laden urine of characteristic of
poorly controlled diabetes mellitus. While hyperglycemia plays an important role the
development of diabetes- related complication, high levels of blood glucose are only one
component of the pathologic process and clinical manifestations associated with diabetes
mellitus. Other pathologic process and risk factors are just as important, and sometimes
independent factors. Diabetes mellitus can be associated with serious complications, but
people with diabetes mellitus can take preventive measures to reduce the likelihood of such
occurrences.

Diabetes mellitus has become an epidemic in the United States with 21 million people
(e.g. 70% of the U.S population) having this disease. Approximately 15 million people are
diagnosed with diabetes mellitus, with nearly an additional 6 million estimated to have
disease but who are undiagnosed. As a significant public health problem, diabetes mellitus is
the 6 leading cause of death in the United States. In addition, total estimated diabetes mellitus
coast in the United States 2002 were $132 billion (direct and indirect cost) with direct
medical cost (e.g., disability, work loss, and premature morality). While the increasing
burden of diabetes mellitus is alarming, much of the burden of this major public health
problem can be prevented by early detection, improved delivery of care, and better education
for diabetes self-management.

Classification of Diabetes Mellitus

Diabetes mellitus is a classified as one of four different clinical states including type
1, type 2, gestational, or other specific types of diabetes mellitus. Type 1 diabetes mellitus is
the result of autoimmune beta-cell destruction, leading to absolute insulin deficiency. Type 2
diabetes mellitus is the result of a progressive insulin secretory defect along with insulin
resistance, usually associated with obesity. Gestational diabetes mellitus is type diabetes
mellitus diagnosis during pregnancy. Other types of diabetes may occur as a result of genetic
defect in beta-cell function, disease of the pancreas (e.g., cystic fibrosis), or disease induced
by drugs.
 In 1979 the National Diabetes Data Group (NDDG) developed criteria for the
classification and diagnosis of diabetes mellitus. By 1977 and again in 2003, the Expert
Committee on the Diagnosis and Classification.

Types of Diabetes Mellitus and Abnormal Glucose Metabolism:

Diabetes Mellitus:

1. Type 1
2. Type 2
3. Causes of secondary diabetes mellitus
a. Genetic defect
b. Diseases of the pancreas (such as pancreatitis, neoplasia, trauma/
pancreatectomy)
c. Endocrinopathies (such as acromegaly, cushing’s syndrome,
pheochromocytoma, hyperthyroidism)
d. Drug/ chemical-induced (as from glucocorticoid, thyroid
hormone, diazoxide, thiazides, phenytoin sodium {Dilantin},
nicotinic acid
4. Gestational diabetes mellitus

Pre Diabetes Mellitus

1. Impaired glucose tolerance (IGT) (2 hours post-glucose load 140 to

199 mg/dl)
2. Impaired fasting glucose (IFG) (fasting blood glucose 100 to 125
Of diabetes mellitus proposed changes to the original NDDG classification.
Such changes were supported by the American Diabetes Association (ADA) and The
International Institute of Diabetes Mellitus and Kidney Disease (NIDKK). Previously,
diabetes mellitus was classified as either insulin-dependent diabetes mellitus (IDDM)
or non-insulin-dependent diabetes mellitus (NIDDM). With the use of insulin therapy
commonplace with both types of diabetes mellitus, IDDM is now referred to as type 1
diabetes mellitus and NIDDM is referred to as type 2 diabetes mellitus. The ADA also
recommended using Arabic numerals, type 1 and type 2, rather than Roman numerals
in referring in referring to the two types of diabetes mellitus/
 Client who do not have type 1 or type 2 diabetes mellitus. May be classified as
having an impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) an IFG
is a glucose concentration between 100 and 125 mg/dl while an IGT while an IGT is
defined as a 2-hour oral glucose tolerance test (>75-g glucose load) with a glucose
concentration between 140 and 199 mg/dl. Both IFG and IGT refer to a metabolic
state between normal and diabetes mellitus, referred to as prediabetes.

Diabetes mellitus may also result from other disorders or treatments. Genetic
defect in the beta cells can lead to the development of diabetes mellitus. Several
hormone, such as growth hormone, cortisol, glucagon, and epinephrine can
antagonize counteract insulin. Excess amount of these hormones (as in acromegaly,
Cushing’s syndrome, glucagonoma, and pheochromocytoma) cause diabetes mellitus.
Such types of secondary diabetes mellitus. In addition, certain drugs (e.g.,
glucocorticoid and thiazides) may cause diabetes mellitus. Such type of secondary
diabetes mellitus account for 1% to 2% of all diagnosed cases of diabetes mellitus.

Gestational diabetes mellitus is a diagnosis of diabetes mellitus that applies to

women in whom glucose intolerance develops or is first discovered during pregnancy.
Gestational diabetes mellitus develop in 2% to 5% of all pregnant women but usually
disappears when the pregnancy is over. It occurs more frequently in African
American, Hispanic Americans, Native Americans, and women with family history of
diabetes mellitus or bebies over 9 pounds at birth; obesity is also a risk factor.