Diabetes Mellitus

Eldridge H. Esmalde, RN
 WHAT IS DIABETES?
Body does not make or properly use insulin:
– no insulin production
– insufficient insulin production
– resistance to insulin’s effects

No insulin to move glucose from blood into cells:

– high blood glucose means:
h fuel loss. cells starve
h short and long-term complications

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TYPES OF DIABETES
MELLITUS

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TYPE 1 DIABETES MELLITUS
• Type 1 diabetes is a chronic (lifelong) disease
that occurs when the pancreas produces too
little insulin to regulate blood sugar levels
appropriately.

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TYPE 1 DIABETES MELLITUS
occur at any age, but it usually
starts in people younger than 30.
ONSET: Symptoms are usually severe and
occur rapidly.
• increased thirst • vomiting
• increased urination• abdominal pain
SYMPTOMS: • weight loss despite • fatigue
increased appetite • absence of
• nausea menstruation

CAUSE: uncertain, likely both genetic and

environmental factors

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 TYPE 1 TESTS & DIAGNOSIS
• urinalysis
• fasting blood glucose
is 126 mg/dL or • random (nonfasting)
higher blood glucose
• insulin test exceeds 200 mg/dL
• C-peptide test (this must be
confimed with a
fasting test)

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 TYPE 1 TREATMENT
• Insulin
• Diet • Foot Care
• Physical Activity • Treat Low Blood
• Self-testing Sugar
• Treat High Ketones

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 TYPE 1 MONITORING
• Visit your physician and/or diabetes educator.
• Have your glycosylated hemoglobin (HbA1c) measured.
• Have your cholesterol and triglyceride levels and kidney
function evaluated.
• Visit your ophthalmologist.
• Every 6 months have a thorough dental cleaning and
examination.
• Monitor your feet every day.
• Stay up-to-date with all of your vaccinations.

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 TYPE 1 COMPLICATIONS
Emergency Complications
1. DIABETIC KETOACIDOSIS
2. HYPOGLYCEMIA

Long-term Complications
1. VASCULAR DISEASE
2. MICROVASCULAR DISEASE
3. EYE COMPLICATIONS
4. DIABETIC NEPHROPATHY (KIDNEY DISEASE)
5. DIABETIC NEUROPATHY(NERVE DAMAGE)
6. DIABETIC FOOT PROBLEMS
7. SKIN AND MUCUS MEMBRANE PROBLEMS

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TYPE 2 DIABETES MELLITUS
• Type 2 diabetes is a chronic, life-long disease
that results when the body's insulin does not
work effectively. Insulin is a hormone released
by the pancreas in response to increased levels
of blood sugar (glucose) in the blood.

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TYPE 2 DIABETES MELLITUS

ONSET: usually occurs gradually.

• frequent and/or slow-

• increased thirst healing infections
• increased urination (including bladder,
SYMPTOMS: • increased appetite vaginal, skin)
• Fatigue • erectile dysfunction
• blurred vision in men

CAUSE: a problem in the way your body makes or

uses insulin.

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 TYPE 2 TESTS & DIAGNOSIS
• Fasting blood glucose level
• Random (non-fasting) blood glucose level
• Oral glucose tolerance test

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 TYPE 2 TREATMENT
• SOME SKILLS TO LEARN
• SELF-TESTING
• DIET AND WEIGHT CONTROL
• REGULAR PHYSICAL ACTIVITY
• MEDICATION
• FOOT CARE
• CONTINUING CARE

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 TYPE 2 COMPLICATIONS
• Emergency Complications:
1. include diabetic coma.

• Long-term Complications:
1. diabetic retinopathy (eye disease)
2. diabetic nephropathy (kidney disease)
3. diabetic neuropathy (nerve damage)
4. peripheral vascular disease (damage to blood
vessels/circulation)
5. high cholesterol, high blood pressure, atherosclerosis, and
coronary artery disease
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 TYPE 2 PREVENTION
• Blood glucose check
• Maintain a healthy body weight and keep an
active lifestyle

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The Carpal & Tarsal Tunnel
Syndrome
Eldridge H. Esmalde, RN
 CARPAL TUNNEL
SYNDROME
Any condition that causes swelling or a change
in position of the tissue within the carpal
tunnel can squeeze and irritate the median
nerve. Irritation of the median nerve in this
manner causes tingling and numbness of the
thumb, index, and the middle finger – this is
the “carpal tunnel syndrome.”

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TARSAL TUNNEL SYNDROME
A condition where sensory nerve that passes
through the tarsal tunnel is irritated by
pressure in the tunnel, numbness and tingling
of the foot and the toes can be felt. This is
analogous to, but far less common, than the
carpal tunnel syndrome.

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CAUSES: CONDITIONS AND DISEASES

Carpal Tunnel ® Tendon inflammation

Syndrome ® Irritation triggered by:
• Amyloidosis
® Obesity
• Sarcoidosis
® Pregnancy
• Multiple Myeloma
® Hypothyroidism
• Leukemia
® Arthritis
® Diabetes
® Trauma

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 SIGNS & SYMPTOMS

Numbness and tingling of the hand/ankle.

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 DIAGNOSIS
• Examination of the neck, shoulder, elbow,
pulses, and reflexes. (Phalen’s maneuver)
• Electromyogram (EMG)
• Blood Test

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 TREATMENT
• Initial treatment: • Medications:
Rest Vitamin B6
Immobilization of the (pyridoxine)
wrist in a splint Nonsteroidal anti-
Occasional ice inflammatory drugs
application Corticosteroids
• Surgery
Carpal Tunnel
Release

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Meniere’s Disease
Eldridge H. Esmalde, RN
 DEFINITION
• Meniere’s Disease is a disorder of the inner ear
that can affect hearing and balance to a
varying degree. It can range from being a mild
annoyance to a chronic, lifelong disability.
• It is idiopathic.

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 CAUSES
• Endolymphatic fluids bursts from its normal
channels in the ear, causing damage to the
area.
• Membranous labyrinth in the ear containing
endolymph dilate and blocked the drainage.

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 SIGNS & SYMPTOMS
• Increased prevalence of migraine.
• Presence of a middle ear infection, head trauma, or an upper
respiratory tract infection, triggered by using aspirin,
smoking cigarettes, and drinking alcohol.
• Presence of:
• Cogan’s syndrome
• Autoimmune disease of the inner ear
• Dysautonomia
• Perilymph fistula
• Multiple sclerosis
• Acoustic neuroma
• Hypo- and hyperthyroidism

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 DIAGNOSIS
• Complaints from patients
• Patients’ medical history
• Otolaryngological examination
• Audiometry
• Head MRI scan

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 TREATMENT

Because Meniere’s Disease cannot be cured,

treatments focus more on treating and
preventing symptoms.

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 PREVENTION
• Lipoflavonoids
• Environmental and dietary changes
• Treatments aimed at lowering of the inner ear
includes:
– Antihistamines
– Anticholinergics
– Steroids
– Diuretics
• Acyclovir (antiherpes virus drug)
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 MANAGING ATTACKS
• Antihistamines
• Antiemetic drugs
• Antivertigo/antianxiety
• Herbal remedies
• Cannabis

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 SURGERY
• Nondestructive Surgery
– Do not actively remove any functionality.
– Chemical labyrinthectomy

• Destructive Surgery
– Irreversible
– Involve entire functionality of most, if not all, of the
affected ear.
– Labyrinthectomy
– Vestibular neurectomy

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THANK YOU FOR
LISTENING !