Diabetes Mellitus (DM)
Diabetes mellitus is a metabolic disorder characterized by hyperglycemia (raised blood sugar level) and results from the defective insulin production, secretion, or utilization.
Types of DM
* IDDM: Insulin dependent diabetes mellitus
* NIDDM: Non-Insulin dependent diabetes mellitus
* Lack of insulin produced by the beta cell resulting in hyperglycemia
* Defects of the cell receptor site, impaired secretary response of insulin (glyconeogenosis)
* Viral, Autoimmuno, and environmental theories are under review (IDDM)
* Heredity/genetics and obesity plays a major role (NIDDM)
Signs and Symptoms
* Fasting Blood sugar (FBS)
* Post Prandial Blood sugar (PPBS)
* Health education.
• Dietary control with calorie restriction of carbohydrates and saturated fats are to maintain ideal body weight
• Advise patient about the importance of an individualized meals plan in meeting weight loss goals
• Explain the importance of exercise in maintaining / reducing body weight. Calorie expenditure for energy in exercise
• Strategise with the patient to address the potential social pitfalls of weight reduction
Weight reduction is the primary management for NIDDM regular scheduled exercise to promote the utilization of carbohydrate, assist with weight control, enhance the action of insulin, and improve cardio vascular fitness.
• Oral hypoglycaemic agents for patient where NIDDM do not achieve glucose control with diet and exercise only
• Insulin therapy for patients with IDM who require replacement. (May also be used for NIDDM when unresponsive to diet, exercise and oral hypoglycaemic agent therapy. Hypoglycemic may result, as well as rebound hyperglycaemic effect
• Demonstrate and explain thoroughly the procedure for insulin self-injection
• Help [patient to master technique by taking a step-by-step approach
• Allow patient time-to-time handle insulin and syringe to become familiar with the equipment
• Teach self-injection first to alleviate fear from injection
• Instruct patient in filling the syringe when he or she expresses confidence in self-injection procedure
• Review dosage and time injections in relation to meals activity, and bedtime based on patient’s individualized insulin regimen
*Preventing injury secondary to Hypoglycemia:
• Closely monitor blood glucose levels to detect hypoglycaemia.
• Asses patient for the signs and symptoms of hypoglycaemia.
• Sweating, cardiac palpitation and nervousness.
• Head ache, light-headedness,. Confusion, irritability, slurred speech, lack of co-ordination staggering gait from depression of central nervous system as glucose level progressively falls.
• Treat hypoglycaemia promptly with 10-15 gms of fast acting carbohydrates.
• Half-cup juice, 3 glucose tablets, 4 sugar cubes, 5-6 pieces of sugar candy may be taken orally.
• Encourage patient to carry a portable management for hypoglycaemia at all times.
• Encourage patients to wear an identification bracelet opr card that may assist in prompt management in a hypoglycaemia emergency.
• Identification bracelet may be obtained from Medic Alert Foundation.
• Identification card may be requested from the Indian Diabetes Association.
• Between meal snacks as well as extra food taken before exercise should be encouraged to prevent hypoglycaemia.
* Improving activity tolerance:
• Advice patient to asses blood glucose level before strenuous exercise.
• Advice patient that prolonged strenuous exercise may require increased food at bedtime to avoid nocturnal hypoglycaemia.
• Instruct patient to avoid exercise whenever blood glucose levels exceeds 250 mgs per day.
* Providing information about oral hypoglycaemic agents:
• Identify any barriers to learning, such as visual, hearing, low literacy, distractive environment.
• Teach the action, use and side effects of oral hypoglycemic agents.
* Maintain skin integrity:
• Maintain skin integrity.
• Use-heal protection, special mattress, foot cradles, for patients on bed rest.
• Avoid drying agents to skin.(e.g. Alcohol)
• Apply skin moisturizes to maintain supplement and prevent cracking, f issures.
* Improving coping strategies:
• Encourage patient and family participation is diabetes self care regimen to foster confidence.
* Diabetic ketoacidocis
* Hyperglycemic syndrome.
* Micro vascular complication e.g. Retinopathy, Nephropathy, Neuropathy.
* Micro vascular complications in Cardiovascular disease occurring both in NIDDM and IDDM.