Diabetes
Diabetes Mellitus

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Diabetes Mellitus

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Group 4 Diabetes
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WHAT IS DIABETES?

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

Over time, having too much glucose in your blood can cause health problems. Although diabetes has no cure, you can take steps to manage your diabetes and stay healthy. Sometimes people call diabetes “a touch of sugar” or “borderline diabetes.” These terms suggest that someone doesn’t really have diabetes or has a less serious case, but every case of diabetes is serious.

What are the different types of diabetes?

The most common types of diabetes are type 1, type 2, and gestational diabetes.

Type 1 diabetes

If you have type 1 diabetes, your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.

Type 2 diabetes

If you have type 2 diabetes, your body does not make or use insulin well. You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle- aged and older people. Type 2 is the most common type of diabetes.

Gestational diabetes

Gestational diabetes develops in some women when they are pregnant. Most of the time, this type of diabetes goes away after the baby is born. However, if you’ve had gestational diabetes, you have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.

Other types of diabetes

Less common types include monogenic diabetes, which is an inherited form of diabetes, and cystic fibrosis-related diabetes

Who is more likely to develop type 2 diabetes?

You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight. Physical inactivity, race, and certain health problems such as high blood pressure also affect your chance of developing type 2 diabetes. You are also more likely to develop type 2 diabetes if you have prediabetes or had gestational diabetes when you were pregnant. Learn more about risk factors for type 2 diabetes.

What health problems can people with diabetes develop?

Over time, high blood glucose leads to problems such as: Heart disease

  • Heart disease
  • Stroke
  • Kidney disease
  • Eye problems
  • Dental disease
  • Nerve damage
  • Foot problems

You can take steps to lower your chances of developing these diabetes-related health problems.

CAUSES OF DIABETES

What causes type 1 diabetes?

Type 1 diabetes occurs when your immune system, the body’s system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease. Studies such as TrialNet External link are working to pinpoint causes of type 1 diabetes and possible ways to prevent or slow the disease.

What causes type 2 diabetes?

Type 2 diabetes — the most common form of diabetes—is caused by several factors, including lifestyle factors and genes.

  • Overweight, obesity, and physical inactivity - You are more likely to develop type 2 diabetes if you are not physically active and are overweight or obese. Extra weight sometimes causes insulin resistance and is common in people with type 2 diabetes. The location of body fat also makes a difference. Extra belly fat is linked to insulin resistance, type 2 diabetes, and heart and blood vessel disease. To see if your weight puts you at risk for type 2 diabetes, check out these Body Mass Index (BMI) charts.

  • Insulin Resistance - Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin well. As a result, your body needs more insulin to help glucose enter cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time, the pancreas can’t make enough insulin, and blood glucose levels rise.

What causes gestational diabetes?

Scientists believe gestational diabetes, a type of diabetes that develops during pregnancy, is caused by the hormonal changes of pregnancy along with genetic and lifestyle factors.

  • Insulin resistance - Hormones produced by the placenta NIH external link contribute to insulin resistance, which occurs in all women during late pregnancy. Most pregnant women can produce enough insulin to overcome insulin resistance, but some cannot. Gestational diabetes occurs when the pancreas can’t make enough insulin. As with type 2 diabetes, extra weight is linked to gestational diabetes. Women who are overweight or obese may already have insulin resistance when they become pregnant. Gaining too much weight during pregnancy may also be a factor.

  • Genes and family history. Having a family history of diabetes makes it more likely that a woman will develop gestational diabetes, which suggests that genes play a role. Genes may also explain why the disorder occurs more often in African Americans, American Indians, Asians, and Hispanics/Latinas.

What else can cause diabetes?

Genetic mutations NIH external link, other diseases, damage to the pancreas, and certain medicines may also, cause diabetes.

  • Genetic mutations - Monogenic diabetes is caused by mutations, or changes, in a single gene. These changes are usually passed through families, but sometimes the gene mutation happens on its own. Most of these gene mutations cause diabetes by making the pancreas less able to make insulin. The most common types of monogenic diabetes are neonatal diabetes and maturity-onset diabetes of the young (MODY). Neonatal diabetes occurs in the first 6 months of life. Doctors usually diagnose MODY during adolescence or early adulthood, but sometimes the disease is not diagnosed until later in life.

Cystic fibrosis NIH external link produces thick mucus that causes scarring in the pancreas. This scarring can prevent the pancreas from making enough insulin. Hemochromatosis causes the body to store too much iron. If the disease is not treated, iron can build up in and damage the pancreas and other organs.

  • Hormonal diseases Some hormonal diseases cause the body to produce too much of certain hormones, which sometimes cause insulin resistance and diabetes.

SIGNS AND SYMPTOMS OF DIABETES

How can you tell if you have diabetes? Most early symptoms are from higher-than-normal levels of glucose, a kind of sugar, in your blood.

The warning signs can be so mild that you don’t notice them. That’s especially true of type 2 diabetes. Some people don’t find out they have it until they get problems from long-term damage caused by the disease.

With type 1 diabetes, the symptoms usually happen quickly, in a matter of days or a few weeks. They’re much more severe, too.

Early Signs of Diabetes

Both types of diabetes have some of the same telltale warning signs.

  • Hunger and fatigue. Your body converts the food you eat into glucose that your cells use for energy. But your cells need insulin to take in glucose. If your body doesn’t make enough or any insulin, or if your cells resist the insulin your body makes, the glucose can’t get into them and you have no energy. This can make you hungrier and more tired than usual.
  • Peeing more often and being thirstier. The average person usually has to pee between four and seven times in 24 hours, but people with diabetes may go a lot more. Why? Normally, your body reabsorbs glucose as it passes through your kidneys. But when diabetes pushes your blood sugar up, your kidneys may not be able to bring it all back in. This causes the body to make more urine, and that takes fluids. The result: You’ll have to go more often. You might pee out more, too. Because you’re peeing so much, you can get very thirsty. When you drink more, you’ll also pee more.
  • Dry mouth and itchy skin. Because your body is using fluids to make pee, there’s less moisture for other things. You could get dehydrated, and your mouth may feel dry. Dry skin can make you itchy.
  • Blurred vision. Changing fluid levels in your body could make the lenses in your eyes swell up. They change shape and can’t focus.

Symptoms of Type 1 Diabetes

You might notice:

  • Unplanned weight loss. If your body can’t get energy from your food, it will start burning muscle and fat for energy instead. You may lose weight even though you haven’t changed how you eat. See which foods are high in trans fatty acids.
  • Nausea and vomiting. When your body resorts to burning fat, it makes ketones. These can build up in your blood to dangerous levels, a possibly life-threatening condition called diabetic ketoacidosis. Ketones can make you feel sick to your stomach.

Symptoms of Type 2 Diabetes

These tend to show up after your glucose has been high for a long time.

  • Yeast infections. Both men and women with diabetes can get these. Yeast feeds on glucose, so having plenty around makes it thrive. Infections can grow in any warm, moist fold of skin, including between fingers and toes, under breasts, and in or around sex organs

  • Slow-healing sores or cuts. Over time, high blood sugar can affect your blood flow and cause nerve damage that makes it hard for your body to heal wounds.

  • Pain or numbness in your feet or legs. This is another result of nerve damage.

Symptoms of Gestational Diabetes

High blood sugar during pregnancy usually has no symptoms. You might feel a little thirstier than normal or have to pee more often.

Warning Signs of Diabetes Complications

Signs of type 2 diabetes complications may include:

  • Slow-healing sores or cuts
  • Itchy skin (usually around the vaginal or groin area)
  • Frequent yeast infections
  • Recent weight gain
  • Velvety, dark skin changes of the neck, armpit, and groin, called acanthosis nigricans
  • Numbness and tingling of the hands and feet
  • Decreased vision
  • Impotence or erectile dysfunction (ED)

Hypoglycemia Hypoglycemia, or low blood sugar, happens when the level of sugar or glucose in your blood drops too low to fuel the body. You might feel:

  • Shaky
  • Nervous or anxious
  • Sweaty, chilly, or clammy
  • Cranky or impatient
  • Confused
  • Lightheaded or dizzy
  • Hungry
  • Sleepy
  • Weak
  • Tingly or numb in your lips, tongue, or cheeks

You might notice:

  • Fast heartbeat
  • Pale skin
  • Blurred vision
  • Headache
  • Nightmares or crying when you sleep
  • Coordination problems
  • Seizures

Hyperglycemia Hyperglycemia, or high blood sugar, causes many of the warning signs of diabetes listed above, including:

  • Heavy thirst
  • Blurry vision
  • Peeing a lot
  • More hunger
  • Numb or tingling feet
  • Fatigue
  • Sugar in your urine
  • Weight loss
  • Vaginal and skin infections
  • Slow-healing cuts and sores
  • Blood glucose over 180 milligrams per deciliter (mg/dl)

Diabetic Coma

Its official name is hyperosmolar hyperglycemic nonketotic syndrome (HHNS). This serious complication can lead to diabetic coma and even death with either type of diabetes, though it’s more common in type 2. It happens when your blood sugar gets too high and your body gets severely dehydrated. Symptoms include:

  • Blood sugar over 600 mg/dl
  • Dry, parched mouth
  • Extreme thirst
  • Warm, dry skin that doesn’t sweat
  • High fever (over 101 F)
  • Sleepiness or confusion
  • Vision loss
  • Hallucinations
  • Weakness on one side of your body

MEDICAL SURGICAL MANAGEMENT

Diabetes surgery is the most effective treatment for type 2 diabetes and may result in remission (being able to stop taking all medications) or improvement in nearly all cases.

For patients with type 2 diabetes and even milder degrees of obesity, bariatric surgery should be recommended. It is the single most effective way to resolve the condition and stop the need for medication.

Diabetes surgery is very safe with complication rates as low as common procedures such as knee replacement and gallbladder surgery.

Who is a Candidate for Diabetes Surgery?

A great deal of scientific evidence supports the use of diabetes surgery in patients with BMI of 30 and greater. If you have type 2 diabetes and a BMI of 30 and above, you may qualify for diabetes treatment through surgery. The decision to pursue surgery is made on an individual basis and you can work with your doctors to determine if surgery is a good choice to treat your diabetes.

Types of Surgery for Diabetes The following are the most commonly utilized and approved operations performed in the United States and their known impact on type 2 diabetes.

Roux-En-Y Gastric Bypass (Gastric Bypass):

The gastric bypass has now been performed for over 50 years. This operation alters the gastrointestinal (GI) tract allowing food to avoid (bypass) most of the stomach and the upper portion of the small intestine. The operation results in significant weight loss, remission of type 2 diabetes in nearly 80 percent of patients, and improvement of diabetes in an additional 15 percent. Improvement of diabetes after gastric bypass surgery occurs within days to weeks after surgery, even before much weight is lost. Most importantly, this surgery results in changes to the metabolism and hormones produced in the intestines that affect the body’s ability to achieve and maintain a healthy weight.

Sleeve Gastrectomy (Sleeve):

The sleeve is an operation that removes a portion of the stomach. The remaining stomach is narrow and provides a much smaller reservoir for food. The procedure also changes the metabolism and hormones produced by the intestines. These metabolic and hormonal changes result in an improvement in diabetes. Over 60 percent of patients will have remission of their type 2 diabetes after sleeve gastrectomy.

Biliopancreatic Diversion With Duodenal Switch (Duodenal Switch):

The Duodenal Switch is a malabsorptive procedure performed far less frequently than the gastric bypass, sleeve gastrectomy or the adjustable gastric band due to the complexity of the procedure and the greater risk of complications. Studies find, however, that the operation is most effective in inducing early and sustained remission or improvement of T2DM (more than 85 percent remission rates with weight-loss independent effects)

Single Anastomosis Duodeno-Ileal Bypass With Sleeve Gastrectomy (Sadi-S):

The SADI-S is the latest procedure to be endorsed by the American Society for Metabolic and Bariatric Surgery. This procedure makes the stomach into a tube just as with the sleeve gastrectomy. The small intestine just below the sleeve is then cut and reconnected to a loop of intestine further down-stream. Results for this operation are extremely promising, demonstrating excellent weight loss and type 2 diabetes remission.

NURSING MANAGEMENT

Nurses should provide accurate and up-to-date information about the patient’s condition so that the healthcare team can come up with appropriate interventions and management.

Nursing Diagnoses

The following are diagnoses observed from a patient with diabetes mellitus.

  • Risk for unstable blood glucose level related to insulin resistance, impaired insulin secretion, and destruction of beta cells.
  • Risk for infection related to delayed healing of open wounds.
  • Deficient knowledge related to unfamiliarity with information, lack of recall, or misinterpretation.
  • Risk for disturbed sensory perception related to endogenous chemical alterations.
  • Impaired skin integrity is related to delayed wound healing.
  • Ineffective peripheral tissue perfusion related to too much glucose in the bloodstream

Nursing Care Plans for Diabetes

Nursing care planning goals for patients with diabetes include effective treatment to normalize blood glucose levels and decrease complications using insulin replacement, a balanced diet, and exercise. The nurse should stress the importance of complying with the prescribed treatment program through effective patient education. Tailor your teaching to the patient’s needs, abilities, and developmental stage. Stress the effect of blood glucose control on long-term health. Here are 17 nursing care plans (NCP) and nursing diagnoses for diabetes:

  • Risk for Unstable Blood Glucose Level
  • Deficient Knowledge
  • Risk for Infection
  • Risk for Disturbed Sensory Perception
  • Powerlessness
  • Risk for Ineffective Therapeutic Regimen Management
  • Risk for Injury
  • Imbalanced Nutrition: Less Than Body Requirements
  • Risk for Deficient Fluid Volume
  • Fatigue
  • Risk for Impaired Skin Integrity
  • 6 Additional Nursing Care Plans

Health Teaching

Diabetes Self-Management Education and Support (DSMES) services help people with diabetes learn how to take the best care of themselves. Ask your doctor for a referral to DSMES services to help you manage your diabetes.

How will DSMES help me? When you learn that you have diabetes, your first question might be, “What can I eat?” DSMES will answer this question and many others. Your first step should be ask your doctor to refer you for DSMES. If your doctor does not talk to you about these services, bring it up during your visit. DSMES services include a health care team who will teach you how to stay healthy and how to make what you learn a regular part of your life.

DSMES services will help you:

  • Make better decisions about your diabetes.
  • Work with your health care team to get the support you need.
  • Understand how to take care of yourself and learn the skills to:
  • Eat healthily.
  • Be active.
  • Check your blood sugar (glucose).
  • Take your medicine.
  • Solve problems.
  • Cope with the emotional side of diabetes.
  • Reduce your risk of other health problems.