Diabetes Mellitus & its Management

1. DIABETES MELLITUS
Presented by :
Dr. Pallavi Pathania.

3. What is diabetes Mellitus?
 The term diabetes mellitus describes a metabolic disorder of multiple
aetiology characterized by chronic hyperglycaemia with disturbances
of carbohydrate, fat and protein metabolism resulting from defects in
insulin secretion, insulin action, or both.
 Middle-aged and elderly age groups are most commonly affected by
diabetes. Diabetes is one of the four major types of non-communicable
diseases (cardiovascular disease, diabetes, cancer and chronic
respiratory diseases).

8. Definition
 Diabetes mellitus (DM) is a group of diseases characterized by high
levels of blood glucose resulting from defects in insulin
production, insulin action, or both.
Or
 A disease in which the body’s ability to produce or respond to the
hormone insulin is impaired, resulting in abnormal metabolism of
carbohydrates and elevated levels of glucose in the blood.

13. RISK FACTORS

14. Who are prone ...?

15. Classification / Etiology of diabetes mellitus
1. Type 1 diabetes
2. Type 2 diabetes
3. Secondary diabetes
4. Gestational diabetes

16. Type 1 diabetes
• Occur at any age, but usually <30 years
• Usually thin at diagnosis
• Can be due to genetic, immunologic or
environmental factors
• Can have islet cell antibodies
• No endogenous insulin , so require
exogenous insulin
• Diabetic ketoacidosis prone

17. Type 2 Diabetes
• Onset at age , usually >30 years
• Usually obese at diagnosis
• Can be due to hereditary or
environmental factors
• No islet cell antibodies
• Decreased insulin production or
decreased sensitivity to insulin
• Oral anti-diabetic agents may
improve blood glucose levels
• Diabetic keto-acidosis is rare

19. Gestational Diabetes
• Onset usually in 2nd or 3rd trimester
•Placental hormones reduces action of
insulin
• Treated with diet or insulin

21. PATHOPHYSIOLOGY

23. SIGN AND SYMPTOMS

25. Diabetes -1

29. Diagnostic Investigation

30. Health History

35. Diagnostic Criteria
• Polyuria, Polyphagia , Polydipsia plus plasma
glucose concentrations > 200 mg/dl
• Fasting plasma glucose concentrations > 126
mg/dl
• 2- hour post-parandial plasma glucose
concentration > 200 mg/dl
•Glycosylated hemoglobin

36. Fasting Plasma Glucose

41. Urinalysis
Glycosuria
Ketone bodies

42. Management of Diabetes Mellitus

43. Management
Nutrition
Exercise
MonitoringDrugs
Education

44. Management of DM
 The major components of the treatment of diabetes are:
• Diet and ExerciseA
• Oral hypoglycaemic
therapy
B
• Insulin TherapyC

45. Dietary Considerations
• BMI
• Activity level
• Age / Sex
• Present food habits
• Economic status
• Complications in Diabetes
• Treatment of Diabetes

46. A. Diet
 Diet is a basic part of management in every case.
 Dietary treatment should aim at:
◦ Ensuring weight control
◦ Providing nutritional requirements
◦ Allowing good glycaemia control with blood glucose levels as
close to normal as possible

48. A. Diet (cont.)
The following principles are recommended as dietary guidelines for
people with diabetes:
 Dietary fat should provide 25-35% of total intake of calories but saturated
fat intake should not exceed 10% of total energy.
 Cholesterol consumption should be restricted and limited to 300 mg or less
daily.
 Protein intake can range between 10-15% total energy (0.8-1 g/kg of
desirable body weight).
 Excessive salt intake is to be avoided. It should be particularly restricted in
people with hypertension and those with nephropathy.

49. Exercise
• Provides physical fitness
• Carbohydrate metabolism
• Weight & insulin sensitivity
• Risk factors for cardio-
vascular disease
• Blood pressure & Cardiac
work

50. Exercise
 Physical activity promotes weight reduction and improves
insulin sensitivity, thus lowering blood glucose levels.

51. Considerations during exercise
• Use proper footwear during
exercise
• Avoid exercise in extremes of
temperature
• Inspect feet daily
• Avoid exercise in periods of
poor metabolic control
• Do not exercise empty or full
stomach

52. Monitoring
A – A1C Levels {estimated average
BS level}
B – Blood pressure
C – Cholesterol
D – Diabetic education
E – Eye Examination
F – Foot Examination
G – Blood Glucose Examination
H – Health
I – Indications & Referral

53. Drugs
Oral Hypoglycemic
Agents Insulin

54. B. Oral Anti-Diabetic Agents
 There are currently four classes of oral anti-diabetic agents:
i. Biguanides
ii. Sulphonylureas
iii. Non-sulphonylureas
iv. α-glucosidase inhibitors
v. Thiazolidinediones (TZDs)

55. Nursing Diagnosis
Anxiety
•Unfamiliar environment
•Lack of understanding of
diagnosis & management
•Possible changes in life-
style & roles

60. C. Insulin THERAPY
Used in treatment of –
• Type 1 Diabetes
• Acute Conditions of Type 2
Diabetes

62. Delivery Methods
 Insulin Syringe
 Insulin Pen
 Insulin Pump
 Jet Injector
62

63. Insulin Injection sites

64. Nursing Management

65. Nursing Diagnosis
1) Imbalanced Nutrition Less Than Body Requirements R/T reduction of carbohydrate
metabolism due to insulin deficiency, inadequate intake due to nausea and vomiting.
2) Fluid Volume Deficit related to osmotic diuresis from hyperglycemia, polyuria, decreased
fluid intake.
3) Impaired Skin Integrity related to decreased sensory sensation, impaired circulation,
decreased activity / mobilization, lack of knowledge of skin care.
4) Activity Intolerance related to weakness due to decreased energy production.
5) High risk of injury associated with decreased sensation sensory (visual), weakness, and
hypoglycemia.
6) Anxiety related to a lack of knowledge (diabetes management), the ability to remember the
less, diagnosis or treatment of a new way, cognitive limitations.
7) Risk for ineffective management of therapeutic rules at home due to a lack of knowledge
about the condition of the therapeutic management, inadequate support systems.

66. Nursing diagnosis ……(Contd.)
Altered nutrition : less than
body requirements
•Abnormal glucose
metabolism
•Depletion of fat stores,
cellular proteins
•Decreased oral intake –
dislike of prescribed diet,
anorexia gastric fullness

67. Nursing diagnosis ……(Contd.)
Altered fluid –volume deficit
•Osmotic diuresis
•Vomiting
•Diarrhea
•Diabetic Keto-acidosis

68. Education
• Diabetes Mellitus
• Approaches Of Management
• Dietary Requirements
• Exercise Regimen
• Oral Hypoglycemic Drugs
• Insulin therapy
• Complications
• Foot care
• Adherence to treatment & Follow-up

70. Self-Care
 Patients should be educated to practice self-care. This allows the patient to assume
responsibility and control of his / her own diabetes management. Self-care should include:
◦ Blood glucose monitoring
◦ Body weight monitoring
◦ Foot-care
◦ Personal hygiene
◦ Healthy lifestyle/diet or physical activity
◦ Identify targets for control
◦ Stopping smoking

76. “Of course too
much is bad for
you”