Table of content

Diabetes…………………………………………………………3

Diabetes insipidus………………………………………………3

Causes of diabetes insipidus …………………………………...3

Signs and symptoms……………………………………………3

Classification……………………………………………………3

Pathophysiology3……………………………………………….3

Treatment………………………………………………………..4

Nursing management…………………………………………….4

Complications…………………………………………………….4

Diabetes type one…………………………………………………4

Causes……………………...………………………………………4

Pathophysiology…………………………………………………..4

Signs and symptoms………………………………………………5

Diagnosis…………………………………………………………..5

Treatment……………………………………………………………5

Complication…………………………………………………………5

Type two diabetes……………………………………………………..5

Definition…………………………………………………………5

Causes…………………………………………………………….6

Pathophysiology……………………………………………………6

Signs and symptoms…………………………………………………6

Diagnosis…………………………………………………………6
Treatment………………………………………………………….6

Gestational diabetes……………………………………………….6

Causes…………………………………………………………..6

Pathophysiology………………………………………………..7

Signs and symptoms……………………………………………7

Diagnosis and treatment…………………………………………7

Complications……………………………………………………7

RELATION BETWEEN DIABETES AND PSYCHIATRIC

DISORDERS…………………………………………………….8

Delirum…………………………………………………………..9

Nursing care plan ………………………………………………10

INTRODUCTION

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough
insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone
that regulates blood glucose. Hyperglycaemia, also called raised blood glucose or raised
blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious
damage to many of the body's systems, especially the nerves and blood vessels.

In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2019, diabetes was the
direct cause of 1.5 million deaths and 48% of all deaths due to diabetes occurred before the
age of 70 years. Another 460 000 kidney disease deaths were caused by diabetes, and raised
blood glucose causes around 20% of cardiovascular deaths (1).

Between 2000 and 2019, there was a 3% increase in age-standardized mortality rates from
diabetes. In lower-middle-income countries, the mortality rate due to diabetes increased
13%.

By contrast, the probability of dying from any one of the four main noncommunicable
diseases (cardiovascular diseases, cancer, chronic respiratory diseases or diabetes) between
the ages of 30 and 70 decreased by 22% globally between 2000 and 2019. 

In other words, Diabetes is a chronic heterogeneous metabolic disorder with complex

pathogenesis. It is characterized by elevated blood glucose levels or hyperglycemia, which
results from abnormalities in either insulin secretion or insulin action or both.
Hyperglycemia manifests in various forms with a varied presentation and results in
carbohydrate, fat, and protein metabolic dysfunctions. Long-term hyperglycemia often
leads to various microvascular and macrovascular diabetic complications, which are
mainly responsible for diabetes-associated morbidity and mortality. Hyperglycemia serves
as the primary biomarker for the diagnosis of diabetes as well. In this review, we would be
focusing on the classification of diabetes and its pathophysiology including that of its
various types,coupled with Diabetes insipidus (DI) which is a disease process that results in
either decreased release of antidiuretic hormone (ADH, also known as vasopressin or AVP)
or decreased response to ADH, causing electrolyte imbalances. There are two types of
diabetes insipidus, central and nephrogenic, and each has congenital and acquired causes.
This activity reviews the etiology, presentation, evaluation, and management of diabetes
insipidus and the role of the interprofessional team in evaluating, diagnosing, and
managing this condition.( Fenske W, Allolio B. Clinical review: Current state and future
perspectives in the diagnosis of diabetes insipidus: a clinical review. J Clin Endocrinol
Metab. 2012)

B: PHARMACOLOGICAL MANAGEMENT.

 Diabetes medications. They are several medications use especially in the treatment of
type 2diabetes which includes;

o Metformin (Fortamet, Glumetza, others) is generally the first medication

prescribed for type 2 diabetes. It works primarily by lowering glucose production
in the liver and improving your body's sensitivity to insulin so that your body uses
insulin more effectively.

Some people experience B-12 deficiency and may need to take supplements.

o Sulfonylureas help your body secrete more insulin. Examples include glyburide

(DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side
effects include:

Low blood sugar

Weight gain

o Glinides stimulate the pancreas to secrete more insulin. They're faster acting than
sulfonylureas, and the duration of their effect in the body is shorter. Examples
include repaglinide and nateglinide. Possible side effects include:

Low blood sugar

Weight gain

o Thiazolidinediones make the body's tissues more sensitive to insulin. Examples

include rosiglitazone (Avandia) and pioglitazone (Actos). Possible side effects
include:

Risk of congestive heart failure

 Insulin therapy;
- There are different types of insulin depending on how quickly they work, when they
peak and how long they last.
- Insulin is available in different strengths; the most common is U-100.
- There are different types of insulin which include;
 Rapid-acting insulin, begins to work about 15 minutes after injection, peaks in about
one or two hours after injection, and last between two to four hours. Types: insulin
aspart (Fiasp, NovoLog) Insulin glulisine (Apidra), and insulin lispro (Admelog,
Humalog, Lyumjev)
 Regular or short-acting insulin usually reaches the bloodstream within 30 minutes
after injection, peaks anywhere from two to three hours after injection, and is
effective for approximately three to six hours. Types: Human Regular (Humulin R,
Novolin R, Velosulin R) Mixtard which is a combination of Nph(neutral protamine
Hagedorn insulin) given subcutaneously and last for 24H.
 Intermediate-acting insulin generally reaches the bloodstream about two to
four hours after injection, peaks four to 12 hours later, and is effective for about 12 to
18 hours. Types: NPH (Humulin N, Novolin N, ReliOn)
 Long-acting insulin  reaches the bloodstream several hours after injection and tends
to lower glucose levels up to 24 hours. Types: degludec (Tresiba), detemir (Levemir),
and glargine (Basaglar, Lantus)
 Ultra long-acting reaches the blood stream in six hours, does not peak, and lasts
about 36 hours or longer. Types: glargine U-300 (Toujeo)
 N B: once your glycerate heamoglobin has being regulated, the use of HbA1C to
check glycemic level if it within normal then they take you back to tablet met
Forman.

 Continues Glucose monitoring: using the finger prick testing kids. First wash your hand
with clean water and soap , use an alcohol swab to disinfect the tip of the finger where it
will be prick then insert the test trip in the meter and prick the tip of the finger using a
lancet or a sharp needle ,gently squeeze the tip of the finger so that you have a one drop
 of blood on the tip of the kid , use a dry cotton to stop bleeding by placing on the finger
tip then read an record the glucose
level .

Nursing Goal Nursing interventions Rationale Evaluation

diagnosis
Unstable Clients blood glucose to Monitoring the capillary blood To identify the After 2 hours
blood glucose be decreased and glucose levels at regular imbalance of of nursing
related to maintained at normal intervals as prescribed glucose levels interventions,
insulin levels after 2hours of the clients
resistance or nursing interventions blood
decreased glucose
production or levels is
utilosation of decreased as
insulin as evidenced by
evidenced by the normal
hyperglycemia capillary
blood
glucose
levels
Daily weight recording To determine
any weight
loss or weight
gain
 Advise the client to reduce To prevent
carbohydrate like direct sugars hyperglycemia
diets

monitor the intake and output To identify the

chart daily fluid volume
status
advise the client to take Activity can
adequate bed rest especially increase the
when blood glucose level is need if more
more than 250 milligrams per glucose to the
deciliter tissues where
as in diabetic
patients, the
glucose
uptake by
tissues is
decreased due
to slowed
insulin action
Administer insulin therapy or To decrease
hypoglycemic agents as blood glucose
prescribed levels
Administer Ivy fluids for To improve
hospitalise clients if necessary fluid volume
status and
prevent
increasing the
blood glucose
 levels
Advice client on the need otlf To prevent
regular treatment any
complication
of the disease