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iabetes mellitus Diabetes mellitus is the name given to a group of conditions linked by the patient's inability to produce and/or utilize insulin. Definition A chronic mellitus disease is of absolute or by

Risk factors Antagonizing of insulin effects caused by some medications, including thiazide diuretics, adrenal corticosteroids, and hormonal contraceptives Obesity Physiologic or emotional stress elevating stress hormone thereby levels and raising (cortisol, growth blood epinephrine, hormone), glucose levels. Pregnancy-related increased levels of estrogen and placental hormones, which antagonize insulin. Signs and Symptoms Ketoacidosis or insidious onset in type 1 Most commonly, fatigue from energy deficiency and a catabolic state Occasionally, no symptoms (in patients with type 2 diabetes) Osmotic diuresis evident with polyuria, dehydration, polydipsia, dry mucous membranes, and poor skin turgor In ketoacidosis and hyperglycemic state, to leading hyperosmolar dehydration nonketotic potentially glucagon,

relative insulin deficiency or resistance, diabetes characterized disturbances in carbohydrate, protein, and fat metabolism. This condition occurs in two forms: type 1, characterized by absolute insulin insufficiency, and type 2, characterized by insulin resistance with varying degrees of insulin secretory defects. Onset of type 1 usually occurs before age 30 (although it may occur at any age); the patient is usually thin and requires exogenous insulin and dietary management to achieve control. Conversely, type 2 usually occurs in obese adults after age 40, although it's commonly seen in North American youths. Nearly two-thirds of people with diabetes will die of cardiovascular disease. It's also the leading cause of renal failure and new blindness. Causes Type 1A: autoimmune beta-cell

hypovolemia and shock. Weight loss and hunger in uncontrolled type 1 diabetes, even if the patient eats voraciously Diagnostic and Laboratory Procedures A diagnosis of diabetes mellitus is

destruction, resulting in insulin deficiency Type 1B: same immunologic markers as type 1A, but results in insulin deficiency and kerosis

confirmed in nonpregnant adults by:

 at least two occasions of a fasting mg/dl typical symptoms of uncontrolled diabetes and a random blood glucose level greater than or equal to 200 mg/dl blood glucose level greater than or equal to 200 mg/dl at 2hours after ingestion of 75 grams of oral dextrose. Two tests are required to confirm the diagnosis; however, it isnt necessary to perform two different teststhe same tests may be performed twice. The second test is typically performed at least 24 hours after the first. Ophthalmologic examination may reveal diabetic retinopathy Urine samples may be assessed for the presence of acetone Blood samples may reveal glycosylated hemoglobin, which reflects glucose control over the past 2 to 3 months. Medical Management Effective treatment for both types of diabetes normalizes blood glucose and decreases complications. In type 1 diabetes, insulin replacement; human insulin may be rapid-acting (regular), intermediate-acting (NPH or Lente), long-acting (Ultralente, Lantus), plasma glucose level greater than or equal to 126

or a combination of rapid-acting and intermediate-acting (70/30 or 50/50 of NPH and regular). Type 2 diabetes may require oral antidiabetic drugs. Islet cell or pancreas transplantation may be done in Type 1 diabetes; requires chronic immunosuppression. Treatment of both types of diabetes requires nutritional glucose a diet needs, levels, planned to and to to meet blood and control reach

maintain appropriate body weight. Weight reduction may be included in the care plan for an obese patient with type 2 diabetes. Treatment or dialysis of long-term for renal diabetic failure, complications includes transplantation photocoagulation for retinopathy, and vascular surgery for large-vessel disease. Meticulous blood glucose control is essential. Health teachings Testing blood glucose levels pre-meal and post-meal can help the patient with diabetes make better food choices, based on how their bodies are responding to specific foods. Patients should be taught specific directions for obtaining an adequate blood sample and what to do with the numbers that they receive.

The patient needs to be reminded to record the blood glucose values on a log sheet with the date and time and any associated signs and symptoms that he/she is experiencing at the time the specimen was obtained. The patient with diabetes needs to be reminded that the addition of medications to help manage his/her diabetes is not because they are failing at diet management. Teach the patient about selfadministration of insulin or oral agents as prescribed, and the importance of taking (Davis, provided symptoms medications 2001). with of Patients a list of exactly should signs as be and and prescribed, in the appropriate dose

decrease weight, and improve quality of life and self-esteem. Patients with diabetes need to maintain a healthy diet consisting of multiple servings of fruits, vegetables, whole grains, low-fat dairy products, fish, lean meats, and poultry.

hypoglycemia

hyperglycemia and actions to take in each situation. Patients with diabetes should also receive education on the importance of smoking cessation, cholesterol and lipid management, and of blood other pressure and disease SOURCES Book: Schilling McCann, J.A. (2008). Nursing understanding diseases. Lippincott Williams and Wilkins. Internet: [Link] [Link] monitoring processes. Encourage client and family about regular exercise. Regular exercise can improve and the functioning improve of the levels, help cardiovascular system, improve strength flexibility, lipid improve glycemic control, management

management