DIABETES MELLITUS

DISEASE HISTORY

Diabetes is first recorded in English, in the form diabete, in a medical text written around
1425. In 1675, Thomas Willis added the word mellitus, from the Latin meaning "honey", a
reference to the sweet taste of the urine. This sweet taste had been noticed in urine by the
ancient Greeks, Chinese, Egyptians, Indians, and Persians. In 1776, Matthew Dobson
confirmed that the sweet taste was because of an excess of a kind of sugar in the urine and
blood of people with diabetes.

Diabetes mellitus is a chronic insulin deficiency or resistance, diabetes mellitus is

characterized by disturbances of carbohydrate, protein, and fat metabolism. It is a major risk
factor for myocardial infarction, cerebrovascular accident, renal failure, peripheral vascular
disease. It is also the leading cause of blindness in adults.

● The cause of DM is unknown Though there are predisposing factors as follows:

1.) Stress- it stimulates secretion of epinephrine, norepinephrine and glucocorticoids,

these hormones elevate glucose levels by glycogenesis and glucogenesis
2.) Heredity- it is strongly associated with Type II DM
3.) Obesity- Adipose tissues are resistant to insulin, therefore, glucose uptake by the cells
is poor
4.) Viral Infection- Increase risk to autoimmune disorders that may affect the pancreas
5.) Autoimmunity- it is more associated with Type II DM, This is because it is the children
who are more prone to viral infection

DEFINITION

The term diabetes, without qualification, usually refers to diabetes mellitus, which
roughly translates to excessive sweet urine (known as "glycosuria"). Several rare conditions are
also named diabetes. The most common of these is diabetes insipidus in which large amounts
of urine are produced (polyuria), which is not sweet (insipidus meaning "without taste" in Latin).

The term "type 1 diabetes" has replaced several former terms, including childhood-onset
diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term
"type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-
related diabetes, and non-insulin-dependent diabetes mellitus (NIDDM). Beyond these two
types, there is no agreed-upon standard nomenclature. Various sources have defined "type 3
diabetes" as: gestational diabetes insulin-resistant type 1 diabetes (or "double diabetes"), type 2
diabetes which has progressed to require injected insulin, and latent autoimmune diabetes of
adults (or LADA or "type 1.5" diabetes)

CLASSIFICATION

Most cases of diabetes mellitus fall into three broad categories: type 1, type 2, and
gestational diabetes. A few other types are described.

TYPE 1 DIABETES

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of

the islets of Langerhans in the pancreas leading to insulin deficiency. This type of diabetes can
be further classified as immune-mediated or idiopathic.

The majority of type 1 diabetes is of the immune-mediated nature, where beta cell
loss is a T-cell mediated autoimmune attack. Autoimmunity is also attributed to the development
of Human Leukocyte Antigens due to an previous viral infection (HLA)Most affected people are
otherwise healthy and of a healthy weight when onset occurs.

Sensitivity and responsiveness to insulin are usually normal, especially in the early
stages. Type 1 diabetes can affect children or adults but was traditionally termed "juvenile
diabetes" because it represents a majority of the diabetes cases in children.

TYPE 2 DIABETES

Type 2 diabetes mellitus is characterized by insulin resistance which may be combined

with relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin
is believed to involve the insulin receptor. However, the specific defects are not known.
Diabetes mellitus due to a known defect are classified separately. Type 2 diabetes is the most
common type.

GESTATIONAL DIABETES

Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects,

involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs
in about 2%–5% of all pregnancies and may improve or disappear after delivery. Gestational
diabetes is fully treatable but requires careful medical supervision throughout the pregnancy.
About 20%–50% of affected women develop type 2 diabetes later in life.

Signs and symptoms

 The classical symptoms of diabetes are polyuria (frequent urination), polydipsia
(increased thirst) and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or
months) in type 1 diabetes while in type 2 diabetes they usually develop much more slowly and
may be subtle or absent.

Prolonged high blood glucose causes glucose absorption, which leads to changes in the
shape of the lenses of the eyes, resulting in vision changes; sustained sensible glucose control
usually returns the lens to its original shape. Blurred vision is a common complaint leading to a
diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change,
whereas with type 2 change is generally more gradual, but should still be suspected.

People (usually with type 1 diabetes) may also present with diabetic ketoacidosis, a
state of metabolic dysregulation characterized by the smell of acetone; a rapid, deep breathing
known as Kussmaul breathing; nausea; vomiting and abdominal pain; and an altered states of
consciousness.

A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more
common in type 2 diabetes and is mainly the result of dehydration. Often, the patient has been
drinking extreme amounts of sugar-containing drinks, leading to a vicious circle in regard to the
water loss.

A number of skin rashes can occur in diabetes that are collectively known as diabetic
dermadromes.

CLINICAL MANIFESTATIONS:

 Blood glucose level from 600- 2000mg/dl

  Hypotension
 Dehydration
 Tachycardia
 Mental status changes
 Neuralgic deficits
 Seizures

ASSESSMENT FINDINGS:
 Look for fatigue, polyuria related to hyperglycemia, polydipsia, dry mucous membranes
and poor skin turgor.
 In type II, weight loss and polyphagia.

DIAGNOSTIC TEST:
Several blood tests are used to measure blood glucose levels, the primary test for
diagnosing diabetes. Additional tests can determine the type of diabetes and its severity.
 Random blood glucose test — for a random blood glucose test, blood can be drawn at
any time throughout the day, regardless of when the person last ate. A random blood
glucose level of 200 mg/dL (11.1 mmol/L) or higher in persons who have symptoms of high
blood glucose (see “Symptoms” above suggests a diagnosis of diabetes.
 Fasting blood glucose test — fasting blood glucose testing involves measuring blood
glucose after not eating or drinking for 8 to 12 hours (usually overnight). A normal fasting
blood glucose level is less than 100 mg/dL. A fasting blood glucose of 126 mg/dL (7.0
mmol/L) or higher indicates diabetes. The test is done by taking a small sample of blood
from a vein or fingertip. It must be repeated on another day to confirm that it remains
abnormally high.
 Hemoglobin A1C test (A1C) — The A1C blood test measures the average blood
glucose level during the past two to three months. It is used to monitor blood glucose control
in people with known diabetes, but is not normally used to diagnose diabetes. Normal
values for A1C are 4 to 6 percent. The test is done by taking a small sample of blood from a
vein or fingertip.
 Oral glucose tolerance test — Oral glucose tolerance testing (OGTT) is the most
sensitive test for diagnosing diabetes and pre-diabetes. However, the OGTT is not routinely
recommended because it is inconvenient compared to a fasting blood glucose test.

NURSING INTERVENTIONS:
 Advice patient about the importance of an individualized meal plan in meeting weekly
weight loss goals and assist with compliance.
 Assess patients for cognitive or sensory impairments, which may interfere with the ability
to accurately administer insulin.
 Demonstrate and explain thoroughly the procedure for insulin self-injection. Help patient
to achieve mastery of technique by taking step by step approach.
 Review dosage and time of injections in relation to meals, activity, and bedtime based on
patients individualized insulin regimen.
 Instruct patient in the importance of accuracy of insulin preparation and meal timing to
avoid hypoglycemia.
 Explain the importance of exercise in maintaining or reducing weight.
 Advise patient to assess blood glucose level before strenuous activity and to eat
carbohydrate snack before exercising to avoid hypoglycemia.
 Assess feet and legs for skin temperature, sensation, soft tissues injuries, corns,
calluses, dryness, hair distribution, pulses and deep tendon reflexes.
 Maintain skin integrity by protecting feet from breakdown.
 Advice patient who smokes to stop smoking or reduce if possible, to reduce
vasoconstriction and enhance peripheral flow.

TERMINOLOGIES

1. Heredity- it is strongly assoc. with Type II DM

2. Obesity- Adipose tissues are resistant to insulin, therefore, glucose uptake by the
cells is poor
3. Viral Infection- Increase risk to autoimmune disorders that may affect the
pancreas
4. Autoimmunity- it is more associated with Type II DM, This is because it is the
children who are more prone to viral infection
5. Polyuria – excessive urination
6. Polyphagia – excessive hunger
7. Polydipsia – excessive thirst
8. Random blood glucose test - for a random blood glucose test, blood can be
drawn at any time throughout the day
9. Fasting blood glucose test - fasting blood glucose testing involves measuring
blood glucose after not eating or drinking for 8 to 12 hours (usually overnight).
10. Hemoglobin A1C test (A1C) — The A1C blood test measures the average
blood glucose level during the past two to three months.
11. Oral glucose tolerance test - Oral glucose tolerance testing (OGTT) is the most
sensitive test for diagnosing diabetes and pre-diabetes.