Diabetes Mellitus Type 2

Submitted by:
Maribel Lacerna Espinosa
Aileen Macuroy
Dave Jay Manriquez

Submitted to:
Len Griffith
Video Presentation:

Diabetes Mellitus Type 2

Diabetes Mellitus

 A heterogeneous group of disorders

characterized by an elevation in the
level of glucose in the blood.

 In Diabetes there may be a decrease in

the body’s ability to respond to insulin
and/or a decrease or absence of insulin
produced by the pancreas.
How will you know if you
are a diabetic?
 If you urinate frequently, experience excessive
thirst and unexplained weight loss.

 If your casual blood sugar (plasma glucose)

level is higher than 11 mmol/L.

 If you have fasting plasma glucose level of not

more than 7 mmol/L.
Who are at risk of diabetes?
 children of diabetics

 obese people

 people with hypertension

 people with high cholesterol levels

 people with sedentary lifestyles

Diabetes Mellitus Type 2

 Type 2: About 90% to 95% of people with

Diabetes. Cause by a decrease in the
sensitivity of the cells to insulin and the
decrease in the amount of insulin produced. It
can be treated with diet, oral hypoglycemic
agents and insulin injections. It occurs most
frequently in people who are over 30 years of
age and obese.
Pathophysiology

Pancrease

Indogenous Insulin

Obesity, Hereditary, Ethnic Group, History of Gestational Diabetes

Insulin Decrease in the Inappropriate Adipocytokines

Resistance ability of pancreas glucose (altercation in the
to produce insulin production by the production of hormones
liver and cytokines by
adipose tissue

Hyperglycemia

Diabetes Mellitus Type 2

There are drug therapies using oral hypoglycemic
agents. Your doctor can prescribe one or two agent,
depending on which is appropriate for you.

1. Sulfonylurea – Glibenclamide, Gliclazide,

Glipizide, Glimepiride, Repaglinide

2. Biguanide – Metformin

3. Alpha-glucosidase Inhibitors – Acarbose

4. Thiazolidindione – Troglitazone, Rosiglitazone,

Proglitazone.
Insulin Therapy….
ONSET PEAK DURATION CONSISTENCY
Short acting
insulin
• Regular ½ to 1 hour 2 to 4 hours 6 to 8 hours Clear

•Semilente 1 to 2 hours 4 to 6 hours 8 to 12 hours Clear

Intermediate
acting insulin
• NPH 3 to 4 hours 8 to 16 hours 20 to 24 Cloudy
hours
• Lente Same Same Same Cloudy
Long acting
insulin

• Ultralente 6 to 8 hours 14 to 20 30 to 36 Cloudy

hours hours or
greater
Signs and Symptoms of Hyperglycemia

 Blood glucose level greater than 7 mmol/L

 Blurry vision
 Difficulty concentrating
 Frequent urination
 Headache
 High blood glucose
 High levels of sugar in the urine
 Increase fatigue
Health Teachings/ Nursing Interventions:

 Assessing learning needs

 Assessing physical, cognitive, and emotional
limitations
 Counseling
 Psychosocial preparation
 Home care management
 Health care resources
 Complementary and alternative therapies
Expected Outcomes

 Patient Verbalizes key elements of the

therapeutic regimen, including knowledge of
disease and treatment plan.
 Describes self-care measures that may
prevent or decrease progression of chronic
complications.
 Maintains a balance of nutrition activity,
and insulin availability that results in normal
blood glucose levels and optimum weight.
Complications of Diabetes
 Macrovascular (large vessel) disease
 Cardiovascular disease
 Cerebrovascular disease

 Microvascular (small vessel) disease

 Retinopathy (vision problems)
 Diabetic nephropathy

 Neuropathic diseases
 Diabetic neuropathy
 Impotence (Male erectile dysfunction)
Foot and Leg Problems in Diabetes
55% to 75% of lower extremity amputations are performed
on people with Diabetes. 50% of these amputations are
preventable, provided patients are taught preventive
foot care measures and practice preventive foot care on
a daily basis.

Three diabetic complications contribute to the increased

risk of foot infections. They are:

A. Neuropathy – Sensory neuropathy leads to loss of pain

and pressure sensation, and autonomic neuropathy leads
to increased dryness and fissuring of the skin (secondary
to decreased sweating).
Foot and Leg Problems in Diabetes
B. Peripheral vascular disease – Poor circulation of the lower
extremities contributes to poor wound healing and the
development of gangrene.

C. Immunocompromise – Hyperglycemia impairs the ability of

specialized leukocytes to destroy bacteria. Thus, in poorly
controlled diabetes there is a lowered resistance to
certain infections.

 Diabetic foot ulcer begins with a soft tissue injury of the

foot, the injury or fissure may go unnoticed until a serious
infection has developed. Drainage, swelling, redness (from
cellulitis) of the leg, or gangrene may be the first sign of
foot problems that the patient notices
Foot and Leg Problems in Diabetes
 Treatment of foot ulcers involves bed rest, antibiotics, and
debridement.

 Preventive foot care includes properly bathing, drying, and lubricating

feet (care must be taken not to allow moisture to accumulate from
water or lotion between the toes.)

 Feet must be inspected on a daily basis for any redness, blisters,

fissures, calluses or ulcerations.

 Feet should be examined on a regular basis by a podiatrist, physician,

or nurse.

 Patients should be taught to wear well-fitting, closed toe shoes.

 High risk behaviors should be avoided, such as walking barefoot, using

heating pads on the feet, wearing open toed shoes, and shaving
calluses.
A Gangrene Foot….
Risk for injury related to sensory alterations

 Interventions and foot care practices:

 Cleanse and inspect the feet daily

 Wear properly fitting shoes
 Avoid walking barefoot
 Trim toenails properly
 Report non-healing breaks in the skin
What can you do to control your blood
sugar? Non-pharmacological Interventions

1. Diet Therapy
2. Exercise
3. Control your weight
4. Quit smoking.
5. Maintain a normal blood
pressure
6. Keep cholesterol normal
Cultural Diversity and Traditional Healing Practices:

It is important that patients with diabetes consult with their

health care provider before using herbs or nutritional
supplements.

Hypoglycemic herbs and supplements: aloe, fish, oils, goldenseal,

bilberry eleuthero, ginseng, milk thistle, Chinese cinnamon, and
sage

Hyperglycemic herbs and supplements: St. John’s wort, celery

seeds, rosemary, and melatonin.
 Remember
If you have the classic symptoms of diabetes:

* See your doctor for blood sugar testing

* Start dieting
* Eat plenty of vegetables
* Avoid sweets such as chocolates and cakes
* Cut down on fatty foods
* Exercise regularly
* If you are obese, try to lose some weight
* Avoid alcohol drinking and stop smoking
* If you are hypertensive, consult your doctor
for advice and management
Review Questions

1.What are polydipsia and polyuria related to diabetes mellitus

primarily caused by?

a.The release of ketones from the cells during fat metabolism.

b.Fluid shifts resulting from the osmotic effect of hyperglycemia.
c.Damage to the kidneys from the exposure to high levels of glucose.
d.Changes in red blood cells resulting from attachment of excessive
glucose to hemoglobin.

Answer: Fluid shifts resulting from the osmotic effect of

hyperglycemia.
2. The nurse is responsible for counselling the person with
diabetes regarding lifestyle changes. Which of the following
would be appropriate for the nurse to discuss?

a.The use of the same diabetes diet for all people with diabetes.
b.The importance of calorie restriction to control blood sugars.
c.The use of Canada’s Food Guide to support a well balanced
nutrition plan.
d.The importance of carbohydrate counting and insulin
adjustment for all people with diabetes.

Answer: The use of Canada’s Food Guide to support a well

balanced nutrition plan.
3. Which of the following is an appropriate therapy for patients
with diabetes mellitus?

a.Use of diuretics to prevent and treat renal problems.

b.Use of angiotensin-converting enzyme inhibitors to prevent
and treat renal problems.
c.Use of commercial remedies or sharp blades to remove
calluses or corns.
d.Use of sugar-free drinks to treat hypoglycemia.

Answer: Use of angiotensin-converting enzyme inhibitors to

prevent and treat renal problems.
4. What does effective collaborative management of diabetes
include?

a.Using insulin with all patients to achieve glycemic goals.

b.Relying on the health care provider as the central figure in the
program for good control.
c.Relying solely on nutritional therapy as the initial treatment
modality for all patients with diabetes.
d.Aiming for a balance of nutrition, activity, and medications together
with appropriate monitoring and patient and caregiver teaching.

Answer: Aiming for a balance of nutrition, activity, and

medications together with appropriate monitoring and patient and
caregiver teaching.
Bibliography
Psaltopoulou, T., Ilias, I., Alevizaki, M. (2010). The role of diet and lifestyle in primary,
secondary, and tertiary diabetes prevention: A review of meta-analysis. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923378/

Deng, F., Zhang, A., Chan, C. (2013). Acculturation, Dietary Acceptability, and Diabetes
Management among Chinese in North America. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753561/

Barry, M., Goldsworthy, S., Goodridge, D. (2014). Medical-Surgical Nursing in Canada:

Assessment and management of clinical problems. Third Canadian Edition. p. 1429-1432,
1448, 1453-1454.

Nanda Nursing Intervention. (2009). Nursing Intervention for Diabetes. Retrieved from
http://nanda-nursinginterventions.blogspot.ca/2011/05/nursing-intervention-for-
diabetes.html