CARE PATIENT WITH DIABETIC

MELLITUS
PRESENTER: JULIA JAMES
REG NO:2020-04-14464
COURSE:BScNA4
FACILITATOR:DR MWASAPI
Learning objectives
At the end of the session students should be able
 1.To define diabetic mellitus
 2.To explain types of diabetic mellitus
 3. To mention causes and risk factors of
diabetic mellitus
 4. To explain pathological changes to patient
with diabetic mellitus
 6. To explain medical and nursing
management of patient with diabetic mellitus
 Diabetes mellitus
 Diabetes mellitus (DM) is characterized by
alteration in carbohydrate metabolism,
 Leading to hyperglycemia and increased
perioperative morbidity and mortality,
 Lack of insulin is associated with
hyperglycaemia, osmotic diuresis, dehydration,
hyperosmolarity, hyperviscosity predisposing to
thrombosis, and increased rates of wound
infection.
 Type 1 diabetes Mellitus
 Autoimmune beta-cell destruction,
 known as insulin-dependent diabetes, is a chronic
condition.

 Accountabout 10% and associated with Diabetic

ketoacidosis,

 Treatment is directed toward managing the amount

of sugar in the blood using insulin, diet and lifestyle
to prevent complications.
 Type II Diabetes Mellitus
 DM type 2 is a consequence of peripheral
resistance to insulin action.
 Commonly occurs in adulthood (adult onset
diabetes)
 Insulin secretion and/or insulin action are thought
to be deficient with excessive hepatic glucose
production
 It is frequently associated with dysfunction in
pancreatic β-cells responsible for insulin secretion.
 It account about 90%.
RISK FACTORS FOR DIABETIC PATIENT
 exact cause of type 1 diabetes is unknown
 Risk factors
 genetic factors
 . Your risk of developing type 1 diabetes increases if you have
a parent or sibling who has type 1 diabetes.
 Environmental factors, such as exposure to a viral illness, also
likely play some role in type 1 diabetes. Other factors that may
increase your risk include:
 The presence of damaging immune system cells that
make autoantibodies. Sometimes family members of people
with type 1 diabetes are tested for the presence of diabetes
autoantibodies. If you have these autoantibodies, you have an
increased risk of developing type 1 diabetes. But, not everyone
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 Dietary factors.
 A number of dietary factors have been linked to an increased risk of
type 1 diabetes, such as low vitamin D consumption; early exposure to
cow's milk or cow's milk formula; or exposure to cereals before 4
months of age. However, none of these factors has been shown to
cause type 1 diabetes.
 Race. Type 1 diabetes is more common in whites than in other
races.
 Geography. Certain countries, such as Finland and Sweden,
have higher rates of type 1 diabetes
 RISK FACTOR FOR DIABETIC MELLITUS

 Weight. The more fatty tissue you have, the more resistant
your cells become to insulin.
 Inactivity. The less active you are, the greater your risk.
Physical activity helps you control your weight, uses up
glucose as energy and makes your cells more sensitive to
insulin. Exercising less than three times a week may increase
your risk of type 2 diabetes.
 Family history. Your risk increases if a parent or sibling
has type 2 diabetes.
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 Race. Although it's unclear why, people of certain races

— including blacks, Hispanics, American Indians and
Asians — are at higher risk.
 Age. Your risk increases as you get older. This may be
because you tend to exercise less, lose muscle mass and
gain weight as you age. But type 2 diabetes is also
increasing dramatically among children, adolescents and
younger adults.
 Gestational diabetes. If you developed gestational
diabetes when you were pregnant, your risk of developing
type 2 diabetes later increases.
 If you gave birth to a baby weighing more than 9 pounds
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 Polycystic ovary syndrome. For women, having polycystic ovary
syndrome — a common condition characterized by irregular
menstrual periods, excess hair growth and obesity — increases the
risk of diabetes.
 · High blood pressure. Having blood pressure over
140/90mm Hg is linked to an increased risk of type 2 diabetes
 Abnormal cholesterol levels. If you have low levels of
high-density lipoprotein (HDL), or "good," cholesterol, your
risk of type 2 diabetes is higher. Low levels of HDL are
defined as below 35 mg/dL.
 High levels of triglycerides. Triglycerides are a fat carried
in the blood. If your triglyceride levels are above 250 mg/dL,
your risk of diabetes increases.
Pathophysiological changes
Autonomic neuropathy
 Diabetic autonomic neuropathy
 Resting tachycardia
 Orthostatic hypotension
 Intestinal constipation
 Gastroparesis
 Bladder dysfunction
 Impaired neurovascular function
 Loss of autonomic response to Hypoglycemia
Pathophysiological changes
 Renal →Diabetic nephropathy
 Retinal →Diabetic retinopathy
 Cardiovascular system
 Hypertension
 Coronary artery disease
 Silent myocardial ischemia
 Systolic and diastolic heart failure
 Congestive heart failure
 Peripheral vascular disease
 Pathophysiological changes
Neurological system
 Increased risk of cerebrovascular accident (CVA)
 Nerve fibers at risk for ischemic injury
 Peripheral neuropathies

Musculoskeletal system
 Muscle pain, joint pain and stiffness,
 Joint deformity, pins and needle sensation.
 Diagnostic Criteria (ADA)
1 Glycosylated ≥ 6.5%
hemoglobin (HbA1c)
2 Fasting glucose ≥ 7mmol/L (no caloric
intake for at least 8 h)
3 Glycemia after 2 h – ≥11.1mmol/L
oral GTT
4 Patient with classic Hyperglycemia or
symptoms hyperglycemic crisis,
with random glycemia ≥
11.1mmol/L
 NURSING MANAGEMENT
 To teach the patient the important of diet, exercise, and self
care.
 Monitoring of blood sugar.
 Monitoring of vital signs.
 To teach the family member the specific patient
condition ,needs and care.
Management of diabetes
mellitus type II
 Diet
 Exercise
 Medications:
 Sulphonylureas (e.g. gliclazide),
 Biguanides (e.g metformin).
 Glitazone (e.g. pioglitazone, rosiglitazone)
 Meglinitides (e.g. repaglinidine, nateglinide)
 Alpha-glucosidase inhibitors (e.g. acarbose,
miglitol)
 Incretin mimetics: GLP-1 agonists (e.g exanatide,),
 References.
 Evaluation and perioperative management of
patients with diabetes mellitus, Joao Paulo Jordao
Pontes, 2017.
 Pollard BJ, Kitchen, G. Handbook of Clinical
Anaesthesia, Fourth Edition. CRC Press. 2018.
 NYSORA, Diabetes mellitus and anesthesia, 2023.
 Uptodate, Anesthesia for patients with diabetes
mellitus.
THANKS