Diabetes

Mellitus
By: Mendaza, Irene A.
BSN3-B
 Definition of the Disease
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic
disorders characterized by high blood sugar levels over a prolonged period.
This occurs either because the pancreas does not produce enough insulin or
because the cells of the body do not respond properly to the insulin that is
produced.
 Type 1 diabetes: This type results from the body's immune system mistakenly

01 attacking and destroying the insulin-producing cells in the pancreas, leading to little
or no insulin production. It often develops in children and young adults, and people
with this type of diabetes require lifelong insulin therapy.

Type 2 diabetes: This type occurs when the body becomes resistant to insulin or when the

02 pancreas does not produce enough insulin to maintain normal blood sugar levels. It is more
common in adults, particularly those who are overweight or obese, and can often be managed
through lifestyle changes such as diet and exercise, along with medications if necessary.

Gestational diabetes: This type occurs during pregnancy when the body is unable to produce

03 enough insulin to meet the increased needs, leading to high blood sugar levels. It usually
resolves after childbirth but increases the risk of developing type 2 diabetes later in life
for both the mother and the child.

Other types: There are also other, less common types of diabetes, such as

04 monogenic diabetes and secondary diabetes, which result from specific genetic or
medical conditions, respectively.
ANATOMY & PHYSIOLOGY
 PATHOPHYSIOLOGY

Due to any factor

Deficiency of insulin due to glucose enter the cells, remaining

glucose enter the blood.

Hyperglycemia, by the renal tubules and Diversion of water it leads to

osmotic changes.

Decreased water reabsorption

 PATHOPHYSIOLOGY

Polyuria

Dehydration takes place

Polydipsia

Muscle protein breakdown by it changes glucose to fatty acids

by gluconeogenesis
 PATHOPHYSIOLOGY

Hyperglycemia

Glucose is completely absent fat is act as a glucose and fat

broken down by fatty acids

Glycerol convert Ketone bodies

Ketoneuria
PATHOPHYSIOLOGY

Decreased pH level in the blood

Ketoacidosis

Cardiac Arrest
ASSESSMENT
MEDICAL HISTORY
PAST MEDICAL HISTORY
FAMILY HISTORY
MEDICATION HISTORY
LIFESTYLE FACTORS

PHYSICAL EXAMINATION
VITAL SIGNS
BODY HEIGHT AND WEIGHT
SKIN EXAMINATION
NEUROLOGICAL EXAMINATION
EYE EXAMINATION
DIAGNOSTIC TEST
Fasting Blood Sugar
(fbs)

01 Fasting blood sugar (FBS) refers to the

measurement of glucose levels in the
bloodstream after a period of fasting,
typically overnight or for at least 8
hours. It is one of the primary tests
used to diagnose diabetes and monitor
blood sugar levels in individuals at risk
for or already diagnosed with diabetes
mellitus.
DIAGNOSTIC TEST
RANDOM BLOOD SUGAR
(RBS)
Random blood sugar (RBS) refers to the measurement
of glucose levels in the bloodstream at any given
02 time, regardless of when the individual last ate.
Unlike fasting blood sugar tests, which require the
patient to fast for several hours before the test, a
random blood sugar test can be performed at any
time of the day, regardless of food intake.
DIAGNOSTIC TEST
Oral Glucose Tolerance Test
(OGTT)

The Oral Glucose Tolerance Test (OGTT) is a

03 diagnostic test used to assess how well the
body processes glucose. It is commonly
used to diagnose prediabetes and diabetes
mellitus, as well as gestational diabetes
during pregnancy.
DIAGNOSTIC TEST
Oral Glucose Tolerance Test
(OGTT)
Procedure:

The patient is asked to fast overnight (typically 8 to 12 hours) before the test.

A baseline blood sample is taken to measure fasting blood sugar levels.

The patient then drinks a glucose solution containing a standardized amount of glucose
(usually 75 grams for adults, 100 grams for pregnant women).

Blood samples are taken at specific intervals (usually 1 hour, 2 hours, and sometimes
3 hours) after drinking the glucose solution to measure blood sugar levels.
DIAGNOSTIC TEST
Fasting Plasma Glucose (FPG) Test:

This test measures blood glucose levels after

an overnight fast of at least 8 hours.
04 A blood sample is taken in the morning before
the person has eaten anything.
Fasting plasma glucose levels of 126
milligrams per deciliter (mg/dL) or higher on
two separate occasions usually indicate
diabetes mellitus.
NURSING MANAGEMENT
Education and Empowerment:

Teach self-management skills, including blood glucose monitoring, medication

administration, healthy eating habits, physical activity, foot care, and stress
management.

Provide comprehensive education to individuals and their families about DM,

including its causes, symptoms, complications, and management strategies.
NURSING MANAGEMENT
Monitoring and Assessment:

Perform regular assessments of blood glucose levels, blood pressure, weight, and
other relevant parameters to monitor disease progression and treatment
effectiveness.

Medication Management:
Administer prescribed medications accurately and timely, including insulin, oral
hypoglycemic agents, and other adjunctive medications for managing comorbid
conditions.
NURSING MANAGEMENT
Nutritional Counseling:
Collaborate with dietitians to develop personalized meal plans that
emphasize balanced nutrition, portion control, carbohydrate counting,
and glycemic index management.
Educate individuals about the importance of healthy eating habits in
managing blood glucose levels and preventing complications.

Promotion of Physical Activity:

Encourage regular physical activity tailored to the individual's preferences,
fitness level, and medical condition.
NURSING MANAGEMENT
Wound Care and Foot Management:

Perform regular foot assessments to detect early signs of foot ulcers,

infections, and peripheral neuropathy.
Provide education on proper foot care practices, including daily inspection,
gentle washing, moisturizing, wearing appropriate footwear, and avoiding
high-impact activities.

Psychosocial Support:
Offer emotional support and counseling to address the psychosocial challenges
associated with living with DM, such as stress, anxiety, depression, and adjustment
difficulties.
 MEDICAL
MANAGEMENT
Healthy Eating: Encourage individuals to adopt a balanced diet rich in
01 fruits, vegetables, whole grains, lean proteins, and healthy fats.
Emphasize portion control, carbohydrate counting, and moderation of
sugar and refined carbohydrates intake.

Regular Physical Activity: Recommend regular aerobic exercise, such as

02 brisk walking, cycling, or swimming, for at least 150 minutes per week,
supplemented with strength training exercises at least twice a week.
 MEDICAL
MANAGEMENT
Weight Management: Support weight loss efforts through calorie

03 control, increased physical activity, and behavioral modifications,

aiming for a gradual and sustainable weight loss of 5-10% of body
weight.

Smoking Cessation: Provide smoking cessation counseling and

04 resources to individuals who smoke, as smoking can exacerbate insulin
resistance and increase the risk of cardiovascular complications.
 MEDICAL MANAGEMENT

pharmacotheraphy
Metformin: Considered first-line therapy for most
01 individuals with type 2 diabetes, metformin improves
insulin sensitivity and reduces hepatic glucose production.

Sulfonylureas, Meglitinides, DPP-4 Inhibitors, SGLT2 Inhibitors, and

02 GLP-1 Receptor Agonists: These medications may be used alone or in

combination with metformin to lower blood glucose levels through
various mechanisms.
 MEDICAL MANAGEMENT

pharmacotheraphy
Insulin Therapy:
03 Basal Insulin: Long-acting insulin analogs (e.g., insulin glargine, insulin
detemir) provide basal insulin coverage to control fasting blood
glucose levels.

Bolus Insulin: Rapid-acting insulin analogs (e.g., insulin

04 lispro, insulin aspart) are used before meals to control
postprandial blood glucose levels.
THANK YOU