Diabetes Mellitus. Physiology of Energy Metabolism . All body cells use glucose for energy. To maintain this constant source of energy, blood glucose levels must be kept between 3.3-6.1 mmol/L. Several hormones, help to maintain this level between 3.3-6.1mmol/L, include insulin, glucagon.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
DM is indicated by typical S&S and confirmed by measurement of plasma glucose.
Diagnostic criteria for DM and impaired glucose regulation
Regular Blood Glucose Monitoring
6 oz. lean meat/protein 6 servings bread/starch 4 servings fruit 5 or more servings vegetables 2 servings dairy (low fat preferred) 3 servings fat
Name: J.P . Age: 68
Sex: Male Ethnicity: Algonquin Canadian
Ht: 5’7” Wt: 276 lb (BMI 43.2, obese)
V/S: T: 38.5°C ; HR: 145bpm; RR: 21; BP: 80/45 mmHg (lying) SaO2: 88% RA
CBG: 34.0 mmmol/L
Integumentary: poor skin turgor, cracked lips and very dry mucosa membrane; very dry and flaky skin on both feet and up to knees, the skin on the lower leg and feet is red and shiny in characteristics. One pea-size lesion on the side of baby toe of right foot.
Mental Status: Lethargy, confused and disoriented, audio and visual hallucination
poor on people, place and time.
Neurology: unable to feel left side of body, sensation of right side of body present.
c/o dizziness and mild generalized headache. Blurry vision.
Pulmonary: respiration shallow. Lungs clear. Decreased AE to both lower lobes of lungs.
Cardiovascular: rapid, thready and irregular pulse, cool extremities; peripheral
pulses present and weak.
GI: Abd distended and firm. No c/o pain on palpation. Decreased and faint bowel sounds . Last BM unknown.
**Doctor ordered diagnostic tests: CT scan of brain, Cardiac marks, BUN, Creatinine,
Chemical Routines, Electrolytes, CBC, and UA STAT.
Gastrointestinal absorption of glucose
Impaired insulin secretion
Increased basal hepatic
- Blood glucose levels
- Complete blood count
- Serum osmolarity
- Arterial blood gas analysis
- Mental status changes
Pts most commonly affected Type I or II, but more common in type I Type I or II, but
more common in type II
Precipitating event Omission of insulin Infection, surgery, CVA,
Physiologic stress MI
(infection, surgery, CVA, MI)
Onset Rapid (<24h) Slower (over several days)
S & S -Acetone breath (a fruity odor) -no change in breath ordor
-Dehydration -Profound dehydration
-Anorexia, nausea, vomiting, & abd pain -nausea, vomiting, distended abd
-Blurred vision -Blurred vision
-Kussmaul’s respiration -shallow respiration
-Polydipsia, Polyuria, & Polyphagia -lethagy, mental status
-Weak, rapid pulse changes
-Neurological deficits, -seizures
Treatment -Insulin - Insulin (play a less critical
-Rehydration role in tx of HHNS. -Correct metabolic acidosis -Rehydration & electrolyte imbalance -correct electrolyte imbalance
Urinary tract infection
Calcium channel blockers
Total parenteral nutrition
Undiagnosed diabetesPrecipitating Factors in Hyperosmolar Hyperglycemic State
Involves five approaches:
Prevention, prevention and prevention…
Two hours later…
continuous infusion. IV solution may change to 2/3 &1/3 with 40mEq KCL
@125ml/hr when CBG <10 mmol/L.
V/S q8h if Temp V/S q4h, and CBG (30 min before B,L,S, HS)
Diet: Diabetic diet and snacks
Diagnostic Tests: Repeat Electrolyte, CBC, BUN, Creatinine, ECG, PT, INR, and Urinalysis.
Mr. J.P. isnow transferred to 4 West NBGH…
Client Teaching (also involve J.P.’s daughter) re:
Referral to CCAC
Referral to Kipawa Reserve Health Center, Diabetes Clinic
of Diabetes Mellitus
Paresthesias (prickling, tingling, or hightened sensation) on feet and fingers.
Burning sensations (especially at night)
The feet become numb as the neuropathy progress.
Decreased sensations of pain and temperature. (risk for injury and undetected foot infection)
A decrease in proprioception (awareness of posture and mov’t of body and of position and wt. of objects in relatio to the body)
A decrease sensation of light touch (may lead to unsteady gait)Diabetic Neuropathies (con’t)
Affecting almost every organ system of the body
(This is especially in pt. with poorly controlled diabetes, because hyperglycemia impairs resistance to infection)
Blood vessel walls thicken, atherosclerosis, and become occluded by plaque.
** S&S of CVA may be similar to symptoms of acute diabetic complications e.g. HHNS. It is important to rapidly assess the CBG so that testing and tx of CVA can be initiated if indicated.
microvascular changes in the kidney.
The individual with DM is at increased risk for infection throughout the body:
Avoid hyperglycemia during hospitalization
Avoid hypoglycemia during hospitalization
** Administering insulin to the patient with type I diabetes who is NPO is an important nursing intervention.
Beers, M., Porter, R., Jones, T., Kaplan, J., & Berkwits, M. (2006). The Merck Manual of Diagnosis and therapy. Eighteenth Edition. Merck Research laboratories.
Canadian Diabetes Association (nd). Diabetes Facts. Retrieved on Oct 2, 2007 from
Canadian Diabetes Association (n.d). Foot care: A step toward good health. Retrieved on Oct 12, 2007 from http://www.diabetes.ca/Section_About/feet.asp
Demir, I., Ermis, C., Altunbas, H.,& Balci, M. K.(2001). Serum HbA1c Levels and Exercise Capacity in Diabetic Patients. Jpn Heart J. 42 (5), 607-616. Retrieved on Oct. 12, 2007 from http://sciencelinks.jp/j-east/article/200207/000020020702A0062021.php
Malarkey, L., & McMorrow M. (2005). Saunders Nursing Guide to Laboratory and Diagnostic Tests. Elsevier Saunders
Mayhall, R. (n.d.) Diabetes and the risk of blood clots. Retrieved on Oct. 20, 2007 from http://www.helium.com/tm/201996/thrombosis-blood-clots-known
McCance, K, & Huether, S.E. (2002). Pathophysiology the biologic basis for disease in adults &children. Mosby.
Lippincott Williams & Wilkins.