Diabetes Mellitus (DM): symptoms, Types, Diagnosis, management, Complications

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:

1.     IDDM: Insulin dependent diabetes mellitus.

2.     NIDDM: Non-Insulin dependent diabetes mellitus.

Etiology:

1.     Lack of insulin produced by the beta cell resulting in hyperglycemia.

2.     Defects of the cell receptor site, impaired secretary response of insulin (gluconeogenosis).

3.     Viral, autoimmuno, and environmental theories are under review (IDDM).

4.     Heredity/genetics and obesity plays a major role (NIDDM).

Signs and symptoms:

1.     Hyperglycemia:( Increase Of Blood Glucose)

2.     Weight loss, fatigue.

3.     Polyuria , polydipsia, poly phagia.

4.     Blurred vision.

5.     Poor wound healing.

6.     Recurrent infections, particularly of the skin.

Diagnosis:

1.     Random, fasting

2.     GTT may be done ( glucose tolerance test)

 Management:

1. Diet

2. Exercise

3. Medication.

4. Health education.

1. Diet:

Dietary control with calorie restriction of carbohydrates and saturated fats is to maintain ideal body weight.

Advise patient of 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.

2. Exercise:

Weight reduction is the primary treatment 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.

3. Medication:

Oral hypoglycemic agents for patient where NIDDM do not achieve glucose control with diet and exercise only.

Insulin therapy for patients with IDDM who require replacement. (May also be used for NIDDM when

unresponsive to diet, exercise and oral hypoglycemic agent therapy. Hypoglycemic may result, as well as rebound hyperglycemic 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 of pain from injection

Instruct patient in filling syringe when he or she expresses confidence in self-injection procedure.

Review dosage and time of injections in relation to meals,

activity, and bedtime based on patient' s individualized insulin regimen.

Health education:

Preventing injury secondary to Hypoglycemia:

1.     Closely monitor blood glucose levels to detect hypoglycemia.

2.     Asses   patient   for   the   signs   and   symptoms   of hypoglycemia.

3.     Sweating, cardiac  palpitation and nervousness

4.     Head ache, light-headedness, confusion, imtability, slurred speech, lack of co-ordination staggering gait from depression of central nervous system as glucose level progressively falls.

5.     Treat hypoglycemia promptly with 10-15 gms of fast acting carbohydrates.

6.     Half-cup juice, 3 glucose tablets, 4 sugar cubes, 5-6 pieces of sugar candy may be taken orally.

7.     Encourage patient to carry a portable treatment for hypoglycemia at all times.

8.     Encourage patients to wear an identification bracelet or card that may assist in prompt treatment in a hypoglycemia emergency.

9.     Identification bracelet  may be  obtained         from medic

10.            Alert foundation

11.            Identification card may be requested from the American Diabetes Association

12.            Between meal snacks as well as extra food taken before exercise should be encouraged to prevent hypoglycemia.

Improving activity tolerance:

1.    Advice patient to asses blood glucose level before strenuous exercise.

2.     Advice patient that prolonged strenuous exercise may require increased food at bedtime to avoid nocturnal hypoglycemia.

3.     Instruct patient to avoid exercise whenever blood glucose levels exceeds 250 mgs per day.

iii. Providing information about oral hypoglycemic agents.

1.     Identify any barriers to learning, such as visual, hearing, low literacy, distractive environment.

2.     Teach     the action,      use and side effects of oral

3.     hypoglycemic agents.

Maintain skin integrity:

1.     Maintain skin integrity

2.     Use-heal protection, special mattress, foot cradla, for patients on bed rest.

3.     Avoid drying agents to skin.(eg. Alchol)

4.     Apply skin moisturizers to maintain supplement and prevent cracking, fissures.

Improving coping strategies:

Encourage patient and family participation is diabetes self care regimen to foster confidence.

Complication:

1.     Hypoglycemia

2.     Diabetic  ketoacidocis

3.     Hyperglycemic syndrome.

4.     Micro vascular complication eg retinopathy, nephropathy, neuropathy

5.     Micro vascular complications in cardiovascular disease occurring both in NIDDM and IDDM.