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1、Diabetes Mellitus Teaching objectivesgrasp the definition and types of diabetes mellitus realize etiology and pathogenesisrealize diagnosis and classification grasp the clinical manifestation for the patient with diabetes mellitusbe aware of the main lab examinationrealize the treatment for the pati
2、ent with diabetes mellitusIntroductionThere are more and more people suffer from diabetes with the development of society, population aging and changes of life style. Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia which results from the defects of insulin
3、secretion or function, or both.Long-standing diabetes may lead to multisystem damage such as eye, kidney, nerve, heart, blood vessels and so on.Etiology Etiology and pathology are complex, and still unknown. But it is a syndrome results from compound etiological factor and has relation to inheritanc
4、e, autoimmune and environment. Factors associated with diabetes include obesity, aging, and ethnic group. ClassificationnType 1 diabetesuStage 1: genetics emotivityuStage 2: start autoimmuneuStage 3: immunology abnormality uStage 4: progressive dysfunction of beta cellsuStage 5: clinical diabetesuSt
5、age 6: beta cells of the clients who have longtime diabetes are damaged thoroughly, blood insulin level is very lownType 2 diabetesugenetics emotivityuhyperinsulinism and (or) insulin resistanceuimpaired glucose tolerance (IGT)uclinical diabetes nOther types uinclude beta cell genetic defects, endoc
6、rinopathies, and drug or chemical-induced diabetesugestational diabetes mellitusClinical manifestation nMetabolic disorders syndrome: polyuria, polydipsia, polyphagia and weight lossnAcute complications of diabetes: DKA, hyperosmolar nonketotic diabetic coma, infectionDKA uevocation factors surgery,
7、 stress, infection, deficiency of insulin dosage, pregnancy, delivery, anesthesia, or illness may trigger DKAuClinical featuresClassic symptoms of hyperglycemia (polyuria, polyphagia, polydipsia) precede DKA. Other symptoms: nausea, vomiting, abdominal pain, headache, weakness, fatigue, hyperpneauLa
8、b test Laboratory values will reveal blood glucose from 300 to 600 mg/dl(16.7-33.3mmol/l), and metabolic acidosis. Urine will be positive for glucose and ketones.hyperosmolar nonketotic diabetic comauevocation factors include illness or other stressor such as infection, cerebrovascular events, or so
9、me drugs.uClinical features lethargy, illusion, disorientation, seizure and coma.uLab test blood glucose is higher than 33.3 mmol/l, usually 33.3-66.6 mmol/l and serum osmolality 350 mmol/linfectionuSkin infection, septicaemia, pulmonary tuberculosis,infection of urinary systemnChronic complications
10、 of diabetes: cardiovascular diseases, nephropathy, diabetic neuropathy, retinopathy, diabetic foot infectionCardiovascular diseasespain, paresthesia of lower extremeties and intermittent claudicationheart failure, arrhythmia, cardiogenic shock,and sudden deathNephropathynephrosclerosis edema, prote
11、inuria, hypertensiondiabetic neuropathy numbness, pain and paresthesia of extremeties, muscular atrophyretinopathy : microangiopathydiabetic foot infection: gangrenous Lab test nurine glucose nblood glucose nIGTTreatment nDiet maintain as near-normal blood glucose level as possible, achieve optimal
12、serum lipid levels, provide adequate energy.nActivity: aerobic exercisenOral glucose-lowering agents: sulfonylurea, biguanides, glucosidasenInsulin therapy Insulin Therapynoticeadminister insulin as ordered, inject insulin on time with correct type and precise dosagetime, position and method of inje
13、ctionside effects of insulin therapy: hypoglycemia, insulin allergy, subcutaneous fat atrophy or proliferationnTransplantation of pancreas and islet nTreatment for gestational diabetes nTreatment for DKA : intravenous infusion, insulin therapy, keep balance of electrolyte and acid-base, prevent and
14、manage complicationsnHyperosmolar nonketotic diabetic comaNursing process nAssessment uSubjective datauObjective dataNursing diagnosis 1: Deficient Knowledge: Diabetes, medical regimen, diet, exercise, self-care management skills (insulin injection, SMBG) related to new diagnosis or changes in treat
15、mentNursing diagnosis 2: Imbalanced Nutrition: Less than body requirements related to imbalance between insulin, diet, and activity Nursing diagnosis 3: risk for infection related to hyperglycemia, fat metabolism disorderNursing diagnosis 4: potential complications hypoglycemia Nursing diagnosis 5: potential complications DKA, hyperosmolar coma
