Diabetes Mellitus 1Teaching objectivesgrasp the definition and types of diabetes mellitus realize etiology and pathogenesisrealize diagnosis and classification grasp the clinical manifestation for the patient with diabetes mellitusbe aware of the main lab examinationrealize the treatment for the patient with diabetes mellitus2IntroductionThere are more and more people suffer from diabetes with the development of society, population aging and changes of life style. 3Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia which results from the defects of insulin secretion or function, or both.4Long-standing diabetes may lead to multisystem damage such as eye, kidney, nerve, heart, blood vessels and so on.5Etiology Etiology and pathology are complex, and still unknown. But it is a syndrome results from compound etiological factor and has relation to inheritance, autoimmune and environment. 6Factors associated with diabetes include obesity, aging, and ethnic group. 7ClassificationnType 1 diabetesuStage 1: genetics emotivityuStage 2: start autoimmuneuStage 3: immunology abnormality 8uStage 4: progressive dysfunction of beta cellsuStage 5: clinical diabetesuStage 6: beta cells of the clients who have longtime diabetes are damaged thoroughly, blood insulin level is very low9nType 2 diabetesugenetics emotivityuhyperinsulinism and (or) insulin resistanceuimpaired glucose tolerance (IGT)uclinical diabetes 10nOther types uinclude beta cell genetic defects, endocrinopathies, and drug or chemical-induced diabetesugestational diabetes mellitus11Clinical manifestation nMetabolic disorders syndrome: polyuria, polydipsia, polyphagia and weight loss12nAcute complications of diabetes: DKA, hyperosmolar nonketotic diabetic coma, infection13DKA uevocation factors surgery, stress, infection, deficiency of insulin dosage, pregnancy, delivery, anesthesia, or illness may trigger DKA14uClinical featuresClassic symptoms of hyperglycemia (polyuria, polyphagia, polydipsia) precede DKA. Other symptoms: nausea, vomiting, abdominal pain, headache, weakness, fatigue, hyperpnea15uLab test Laboratory values will reveal blood glucose from 300 to 600 mg/dl(16.7-33.3mmol/l), and metabolic acidosis. Urine will be positive for glucose and ketones.16hyperosmolar nonketotic diabetic comauevocation factors include illness or other stressor such as infection, cerebrovascular events, or some drugs.17uClinical features lethargy, illusion, disorientation, seizure and coma.18uLab test blood glucose is higher than 33.3 mmol/l, usually 33.3-66.6 mmol/l and serum osmolality 350 mmol/l19infectionuSkin infection, septicaemia, pulmonary tuberculosis,infection of urinary system20nChronic complications of diabetes: cardiovascular diseases, nephropathy, diabetic neuropathy, retinopathy, diabetic foot infection21Cardiovascular diseasespain, paresthesia of lower extremeties and intermittent claudicationheart failure, arrhythmia, cardiogenic shock,and sudden death22Nephropathynephrosclerosis edema, proteinuria, hypertension23diabetic neuropathy numbness, pain and paresthesia of extremeties, muscular atrophy24retinopathy : microangiopathydiabetic foot infection: gangrenous 252627Lab test nurine glucose nblood glucose nIGT28Treatment nDiet maintain as near-normal blood glucose level as possible, achieve optimal serum lipid levels, provide adequate energy.29nActivity: aerobic exercisenOral glucose-lowering agents: sulfonylurea, biguanides, glucosidasenInsulin therapy 30Insulin Therapynoticeadminister insulin as ordered, inject insulin on time with correct type and precise dosagetime, position and method of injectionside effects of insulin therapy: hypoglycemia, insulin allergy, subcutaneous fat atrophy or proliferation31nTransplantation of pancreas and islet nTreatment for gestational diabetes nTreatment for DKA : intravenous infusion, insulin therapy, keep balance of electrolyte and acid-base, prevent and manage complicationsnHyperosmolar nonketotic diabetic coma32Nursing process nAssessment uSubjective datauObjective data33Nursing diagnosis 1: Deficient Knowledge: Diabetes, medical regimen, diet, exercise, self-care management skills (insulin injection, SMBG) related to new diagnosis or changes in treatmentNursing diagnosis 2: Imbalanced Nutrition: Less than body requirements related to imbalance between insulin, diet, and activity34 Nursing diagnosis 3: risk for infection related to hyperglycemia, fat metabolism disorderNursing diagnosis 4: potential complications hypoglycemia Nursing diagnosis 5: potential complications DKA, hyperosmolar coma3536