DIABETES

MELLITUS
DIABETES MELLITUS
 derived
from a Greek word meaning “going
through” and Mellitus from the Latin word
“honey”

 A disorder
of carbohydrate, protein and fat
metabolism resulting from an imbalance
between insulin availability and insulin need.
HISTORY OF DIABETES MELLITUS
 Reports of disorders can be traced back to the first
century when Aretaeus the coppadocian described the
disorder as a chronic affection characterized by the
intense thirst and voluminous, honey sweet urine. It is
then believed that it is the melting down of flesh into
urine.
 Diabetes mellitus type 1 (Type 1 diabetes, T1D, T1DM, IDDM,
juvenile diabetes) is a form of diabetes mellitus. Type 1 diabetes
is an autoimmune disease[that results in destruction of insulin-
producing beta cells of the pancreas.

 Type 1 is lethal unless treated with exogenous insulin. In recent

years, pancreas transplants have also been used to treat type 1
diabetes.

 Type 1 diabetes (formerly known as "childhood", "juvenile" or

"insulin-dependent" diabetes) is not exclusively a childhood
problem; the adult incidence of type 1 is noteworthy—many
adults who contract type 1 diabetes are misdiagnosed with type 2
due to confusion on this point.
DIABETES TYPE 1
 Diabetes mellitus type 2 or type 2 diabetes (formerly
called non-insulin-dependent diabetes mellitus
(NIDDM), or adult-onset diabetes) is a disorder that is
characterized by high blood glucose in the context of
insulin resistance and relative insulin deficiency.

 There are an estimated 23.6 million people in the U.S.

(7.8% of the population) with diabetes with 17.9 million
being diagnosed,90% of whom are type 2. With
prevalence rates doubling between 1990 and 2009, CDC
has characterized the increase as an epidemic.
GESTATIONAL DIABETES

 Gestational diabetes (or gestational diabetes mellitus,

GDM) is a condition in which women without
previously diagnosed diabetes exhibit high blood glucose
levels during pregnancy.
RISK FACTORS:
Type 1
 Genetics and family history

 Disease of the pancreas

 Infection or illness

Type 2
 Obesity

 Impaired fasting glucose

 Insulin resistance

 Ethnic background

 Hypertension

 Age

 Sedentary lifestyle

 Family history
 CLINICAL
Clinical Manifestations
MANIFESTATIONS
Pathologic Basis Type 1 Diabetes
OFType 2 Diabetes
Polyuria DIABETES
Water not absorbed fromMELLITUS
renal tubules secondary to
++ +
osmotic activity of glucose

Polydipsia Dehydration secondary to ++ +

polyuria causes thirst

Polyphagia Starvation secondary to ++ +

tissue breakdown causes
hunger

Weight loss Initial loss secondary to ++ _

depletion of water,
glycogen, triglyceride
stores; chronic loss
secondary to decreased
muscle mass as amino acid
are diverted to glucose and
ketone bodies.
Clinical Pathologic Basis Type 1 Diabetes Type 2 Diabetes
Manifestations

Blurred vision Secondary to chronic + ++

exposure of ocular lens
and retina to hyperosmolar
fluids

Ketonuria When glucose cannot be ++ -

used for energy in insulin
dependent cells, fatty
acids are used for energy;
fatty acids are broken
down into ketones in the
blood and excreted in the
kidneys; in type 2
diabetes, sufficient insulin
is present to depress
excessive use of fatty
acids, but not enough to
permit use of glucose.
Weakness and Decreased plasma volume ++ +
fatigue leads to postural
hypotension; potassium
loss and protein
catabolism contribute to
weakness

Often The body can adapt to a _ ++

asymptomatic slow rise in blood glucose
to a greater extent than I
can to a rapid rise.
 DISTINGUISHING THE DIFFERENCE OF
DM TYPE 1 AND TYPE 2
Feature Type 1 Type 2
Synonyms Insulin dependent DM, juvenile Non-Insulin dependent DM,
diabetes, labile diabetes adult- onset diabetes, mild
diabetes

Incidence 10% 90%

Age onset Usually before age of 30 years Usually after age of 30 years

Type of onset Usually abrupt, rapid onset of Insidious, may be asymptomatic

hyperglycemia

Body weight Ideal body weight or thin 85% of clients are obese

Ketosis Prone to ketosis Resistant to ketosis

Exogenous insulin Dependent on insulin for 20%-30% may r4quire insulin

survival
administration
Feature DM type 1 DM type 2

Oral hypoglycemic Not effective Effective

agents

Endogenous insulin Little or none Below normal, normal,

production above normal
PATHOPHYSIOL
OGY
 Medical Treatment For Diabetes

 
Medical treatment for diabetes mellitus involves insulin as the basic constituent.
Insulin regulation is pre-requisite for cure of diabetes mellitus. In case of Type 1
mellitus, insulin is the basic medicine and it's taken by patients through injections.

Medical treatment for diabetics usually revolves around insulin regulation. In case of
Type 1mellitus, insulin works as the basic medicine and is injected in the patient.
But, insulin intake should be complimented by proper meal and physical activity.
Frequency of insulin injection depends upon severity of the disease or level of blood
glucose. A patient with moderate level of disease requires one injection a day and it
should be better given before breakfast. Regular reassessment of dosage is must.
 
Apart from insulin, various other drugs are available to treat diabetes mellitus of all
types. Now, its possible to produce synthetic insulin that enables to keep blood sugar
in control. Sulfa medicines such as sulfanylureas have proved beneficial in curing
Type 2 diabetes. Tolbutamide, tolazamide, glucotrol are the medicines of this group.
 
 For type 2 diabetes, Sulfa medicines such as sulfaonylureas
has proved effective Glucotrol, tolazamide. Tolbutam are
medicines of this group. Insulin sensitizers are recent
introduction in the field of diabetes cure. Troglitazone is one
such medicine. It is used in case of hypoglycemia.

 With addition of these oral medication, a shift in emphasis

from insulin has been noticed. Diabetes medication must be
complimented with diabetes diet and proper diabetes
nutrition. Diabetes education is must for proper insulin usage.
 
LABORATORY AND DIAGNOSTIC FINDINGS

 Urine sugar test

 Urine ketones test

 OGTT-Oral Glucose Tolerance Test,(also called

glucose challenge test)
 Blood glucose tests

 FPG-Fasting plasma glucose Test

 Random plasma glucose Test

TESTS FOR ONGOING MONITORING OF DIABETES
CONTROL:
 HbA1c blood test - an average blood sugar measure over about 3
months.

 Fructosamine blood test - an average blood sugar measure over

about 2 weeks.

 THE FASTING BLOOD GLUCOSE (SUGAR) TEST

 For diagnosing Diabetes Mellitus one must have this test because

it is best, easy and comfortable to perform. You should have

overnight fast (at-least 8 hours) before performing this test. If
fasting blood glucose is below 100mg/dl, then you don't have
diabetes. Between 100mg/dl to 125mg/dl is called a Pre-diabetes
or Impaired fasting glucose condition. If fasting blood glucose is
above 126mg/dl on more than two occasions then you are
suffering from diabetes.
 ORAL GLUCOSE TOLERANCE TEST (OGTT):
Though this test is not commonly used these days but it is still a gold standard
for diagnosing diabetes. For diagnosing gestational diabetes this is best test.

 C-RANDOM (NON-FASTING) BLOOD GLUCOSE TEST

It is also a good test for diagnosing diabetes. In this test we take sample of
blood shortly after taking a meal and then check glucose level in blood. If this
level is above 200mg/dl, then there are much chances that you are suffering
from diabetes. But diagnosis should be confirmed the very next day by
fasting blood glucose or by glucose tolerance test

 Glycated hemoglobin (A1C) test

This test is not for diagnosing diabetes, but it shows you how well you have
controlled your sugar in last 2 or 3 months. Normal value is less than 7%,
however if it is more than 7 then you and your doctor should think of
changing your treatment of diabetes.
PREVENTION AND REHABILITATION
 Prevention of diabetes mellitus includes lifestyle changes
for those who are high-risk by eating a healthy diet and
regular exercise leading to weight loss.
 Exercise
 Oral medication
 Insulin
 Herbals
 Wormwood
 Gurmar

 Bitter melon
NURSING INTERVENTIONS
 Advice patient about the importance of an individualized
meal plan in meeting weekly weight loss goals and assist
with 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, 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.
THANK YOU

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