What is Diabetes Mellitus?
Diabetes mellitus (DM) is a chronic condition characterized by inadequate pancreatic insulin synthesis or the body’s inability to effectively utilize the insulin it generates. As a result, there is a rise in blood glucose levels (hyperglycemia). Disturbances in the metabolism of fat, protein, and carbohydrates are its defining characteristics. It has been shown that almost every tissue in the body is affected by chronic hyperglycemia. It is linked to serious difficulties in several organ systems, including the kidneys, blood vessels, eyes, nerves, and nervous system.
Types Of Diabetes Mellitus Are Divided Into
- The beta cells in the pancreas are destroyed in type 1 diabetes.
- Insulin resistance and reduced insulin production are features of type 2 diabetes.
- When a pregnant woman develops any level of glucose intolerance at the start of her pregnancy, she has gestational diabetes mellitus.
- When some forms of diabetes develop due to other disorders, it is known as diabetes mellitus, linked with other ailments (e.g., pancreatic diseases, hormonal abnormalities, medications).
- A new categorization of diabetes called prediabetes (impaired glucose tolerance or impaired fasting glucose) denotes a metabolic stage between healthy glucose homeostasis and diabetes.
Nursing Care Plans for Diabetes Mellitus
Using insulin replacement, a healthy diet, and exercise, nursing care planning objectives for diabetic patients should include successful therapy to normalize blood glucose levels and reduce complications. Through efficient patient education, the nurse should emphasize how crucial it is for patients to follow the recommended treatment plan. Consider the patient’s requirements, skills, and developmental stage while developing your lesson plan. Underline how controlling blood sugar affects long-term health.
Below Are Diabetic Mellitus (DM) Nursing Care Plans And Nursing Diagnoses
- Unstable Blood Pressure Glucose Level, Inadequate Knowledge of the Risk of Infection
- Sensory Perception Impairment Risk
- Powerlessness
- Treatment of Ineffective Therapeutic Regimens
- Injury Possibility
- Nutritional Imbalance: Less Than Body Needs
- The danger of Inadequate Fluid Volume
- Fatigue as a Risk Factor for Poor Skin Integrity
Risk for Unstable Blood Glucose Level
Normalizing insulin activity and blood glucose levels is the aim of diabetes care in order to stop or delay the onset of neuropathic and vascular consequences. The onset and progression of problems may be significantly slowed down with proper glucose control and treatment.
Nursing Diagnosis: Inability to control diabetes and insufficient blood glucose monitoring indicates a risk for unstable blood sugar levels.
Risk Factors
- Insufficient blood glucose monitoring
- noncompliance with diabetes management
- medication administration
- inadequate diabetes management knowledge
- Developmental level
- refusal to accept the diagnosis
- Stress and sedentary behavior
- Insulin deficit or excess
May Be Evidenced By
Symptoms and indications do not support a risk diagnosis. The goal of interventions is prevention.
Desired Outcomes
The patient’s hemoglobin A1C level is less than 7%, and their fasting blood glucose levels are fewer than 140 mg/dL.
The patient will reach and maintain a good glucose range (specify).
The patient will be aware of important elements that might cause their blood sugar levels to fluctuate.
Nursing Assessment and Rationale
1. Check for hyperglycemia symptoms.
When the ratio of glucose to insulin is insufficient, hyperglycemia develops. An osmotic reaction caused by too much blood glucose causes increased appetite, thirst, and urine. Moreover, the patient may complain of impaired vision and other vague symptoms like weariness.
2. Check blood sugar levels before meals and before going to bed.
Results from a random blood glucose test should range from 140 to 180 mg/dL. Those who don’t need critical care should be kept at pre-meal levels under 140 mg/dL.
3. Keep track of the patient’s hemoglobin HbA1c-glycosylation.
This gauges blood sugar levels throughout the past two to three months. 6.5% to 7% is ideal as a level.
4. Daily weight.
Can aid in evaluating if nutritional intake is enough.
5. Check for nervousness, tremors, and slurred speech. Use 50% dextrose to treat hypoglycemia.
These hypoglycemia warning symptoms are treated with D50.
6. Examine the temperature, pulse, color, and feel of the feet.
Should keep an eye on neuropathy and peripheral perfusion.
7. Use auscultation to listen for bowel sounds and take note of any complaints of nausea, vomiting, bloating, or abdominal discomfort.
The choice of interventions may be impacted by hyperglycemia, which impairs the stomach, duodenum, and jejunum’s gastric motility.
8. To check for renal failure, compare urine albumin to serum creatinine.
Creatinine levels above 1.5 mg/dL indicate renal failure. The initial symptom of diabetic nephropathy is microalbuminuria.
9. Evaluate the physical activity trends.
Blood glucose levels are lowered by exercise. Frequent exercise lowers the risk of cardiovascular problems and is an essential component of diabetes therapy.
10. Keep an eye out for hypoglycemic symptoms.
A type 2 diabetic patient who utilizes insulin as part of their treatment plan is more likely to experience hypoglycemia. While hypoglycemia symptoms might differ from person to person, they always appear in the same person. Both increased adrenergic activity and reduced glucose transport to the brain contribute to the symptoms of hypoglycemia. The patient may therefore suffer changes in LOC, tachycardia, diaphoresis, headaches, weariness, cold and clammy skin, hunger, shakiness, and changes in vision.
11. Examine the patient’s health views towards exercise, and go through the suggestions for an activity program with them.
Remind the patient to exercise every day at the same time and intensity. It is best to exercise while blood glucose levels are at their ideal range. In order to get the most out of their fitness routine, patients should start off slowly and build up their intensity over time.
12. Before working out, check the patient’s blood sugar levels.
If the patient’s blood glucose levels are more than 250 mg/dL and their urine contains ketones, they shouldn’t start exercising. Exercise-induced blood glucose elevations boost glucagon release, which in turn causes the liver to generate more glucose and cause blood glucose levels to rise even higher.
13. Evaluate the patient’s competency with blood glucose self-monitoring.
The SMBG techniques must be appropriate for the patient’s level of expertise.
14. Evaluate the patient’s present comprehension of the recommended diet.
Hyperglycemia may occur as a consequence of dietary requirements not being followed. A customized nutrition program is advised.
Nurse Interventions and Their Justification
1. Provide insulin at basal and postprandial levels.
Following the recommended treatment plan encourages tissue perfusion. The microvascular disease progresses more slowly when glucose levels are kept within normal bounds.
2. Keep An Eye Out For Morning Hyperglycemia Symptoms.
Morning hyperglycemia, as the name indicates, is an increased blood glucose level that develops in the morning as a result of inadequate insulin. The dawn phenomena, insulin fading, and the Somogyi effect are some of the causes. The dawn phenomenon is characterized by normal blood glucose levels until three in the morning, at which point levels start to climb (nocturnal hypoglycemia then rebound hyperglycemia).
3. Show The Patient How To Check Their Blood Sugar At Home.
Before meals and before going to bed, blood glucose is checked. Insulin dosages are modified using glucose readings.
4. Report A BP of More Than 160 Mm Hg (Systolic). Provide Hypertensive Medication As Directed.
Diabetes and hypertension often go hand in hand. Coronary artery disease, stroke, retinopathy, and nephropathy are all prevented by blood pressure control.
5. Advice The Patient To Refrain From Using Heating Pads And To Always Wear Shoes While Walking.
Peripheral neuropathy causes patients to feel less in their extremities.
6. Tell The Patient To Take Oral Hypoglycemic Drugs Exactly As Prescribed:
6.1. Glipizide (Glucotrol), glyburide (DiaBeta), and glimepiride are sulfonylureas (Amaryl)
Sulfonylureas are mostly used in type 2 diabetes to manage blood glucose levels by stimulating the pancreas’ production of insulin. Moreover, they decrease the liver’s production of glucose from amino acids and glycogen reserves while increasing the sensitivity of cell receptors to insulin.
Meglitinides: repaglinide (6.2). (Prandin)
stimulates the pancreas to secrete insulin.
6.3. Metformin is a biguanide (Glucophage)
These medications increase insulin sensitivity while reducing the amount of glucose the liver produces. They increase the insulin receptor sensitivity of muscle cells.
6.4. Nateglinide, a phenylalanine derivative (Starlix)
Reduces spikes in blood glucose that happen just after eating by promoting fast insulin production.
6.5. Acarbose (Precose) and miglitol are alpha-glucosidase inhibitors (Glyset). Enhances the body’s sensitivity to insulin and inhibits the liver’s ability to produce glucose. Used to manage blood glucose levels in people with type 2 diabetes.
6.6. Pioglitazone (Actos) and rosiglitazone are thiazolidinediones (Avandia)
Lowers blood sugar levels and enhances the effects of insulin by sensitizing body tissues to the hormone and activating insulin receptor sites.
Incretin modifiers include vildagliptin and sitagliptin phosphate (Januvia) (Galvus)
extends and intensifies incretin’s activity, which raises insulin secretion and lowers glucagon levels.
7. Tell the patient to take their insulin as prescribed:
Rapid-acting insulin analogs include insulin as part and lispro (Humalog).
Has an apparent clarity. Within 15 minutes after administration, begin to work. With Humalog, the effect lasts 2 to 3 hours, while for part, it lasts 3 to 5 hours. To avoid hypoglycemia, the patient must eat shortly after the injection.
Regular Humulin R is an example of short-acting insulin (regular insulin).
Short-acting insulins are clear-looking, start working within 30 minutes after ingestion, and last 4 to 8 hours. The only insulin that may be used intravenously is regular insulin.
7.3 Neutral protamine Hagedorn (NPH), insulin zinc suspension, and intermediate-acting insulin (Lente)
They have protamine or zinc added to them to postpone their activity, and they have a hazy appearance. The intermediate-acting drug starts working an hour after injection and lasts 18 to 26 hours. Check the container of this kind of insulin for flocculation, which appears as a frosted, white covering. It shouldn’t be used if it is frosty.
7.4 Long-acting insulin does not need to be injected with food and has a clear look. Examples are Ultralente and insulin glargine (Lantus). Since insulin is delivered into the circulation at a fairly steady rate, long-acting insulins start working an hour after administration and don’t have a peak activity. With Ultralente, the duration of action is 36 hours, whereas glargine’s duration of action is at least 24 hours. As they are in a pH-4 suspension and cannot be combined with other insulin, doing so will result in precipitation.
Rapid and intermediate: NPH: 70%; regular: 30%
Premixed concentration acts with an onset akin to rapid-acting insulin and a duration akin to intermediate-acting insulin.
8. Explain to the patient how to inject insulin correctly.
When insulin is consistently delivered at the same anatomical place, the absorption is more predictable. Following the belly in order of speed of absorption are the arms, thighs, and buttocks. The American Diabetes Association advises using insulin syringes to inject insulin into the subcutaneous tissue of the belly.
9. Inform the patient about the proper order in which to rotate the injection sites while giving insulin.
Insulin administration at the same place over time will cause lipoatrophy and lipohypertrophy, along with decreased insulin absorption. When an injection site is used repeatedly, it may acquire fatty deposits known as lipohypertrophy, which may hinder the absorption of insulin when it is reapplied.
10. Explain to the patient how to store insulin properly.
Insulin should be kept in the refrigerator, kept from freezing, kept away from severe temperatures, and kept out of direct sunlight. Vials may be kept at temperatures between 15o and 30oC (59o and 86oF) for a month without causing irritation due to “cold insulin.” After that period, unsealed vials must be thrown; however, unopened vials may be kept until the expiry date. Tell the patient to maintain an extra vial of each kind of prescription insulin on hand. Before drawing the solution, cloudy insulins should be properly stirred by rolling the vials between the palms.
11. Explain to the patient that the used insulin vial has to be maintained at room temperature.
Insulin should be stored at room temperature to assist in lessening injection site discomfort.
12. Reiterate how crucial it is to achieve blood glucose control.
The onset and progression of problems may be considerably slowed down by maintaining blood sugar levels within the nondiabetic range.
13. Educate individuals with diabetes who are obese on the significance of weight loss.
Losing weight is crucial to the management of diabetes. A 5–10% drop in body weight may considerably lower blood glucose levels and minimize or eliminate the requirement for medication.
14. Describe the value of maintaining regular mealtimes or a consistent eating plan.
Three equal-sized meals, spaced five to six hours apart, together with one or two snacks, are advised. The pancreas is subjected to more manageable demands when food consumption is spread out throughout the day.
15. Direct the patient to therapy, diet and nutrition instruction, and support groups.
to assist the patient in adopting a weight-management plan and discovering new eating practices.
16. Inform the patient about keeping consistency in food and the corresponding times between meals.
Consistency in food intake and meal spacing helps avoid hypoglycemia episodes and maintain stable blood sugar levels.
17. Inform the patient of the advantages to health and the significance of exercise in the control of diabetes.
For diabetic individuals, exercise helps reduce blood glucose levels and lower cardiovascular risk factors. By boosting glucose absorption and optimizing insulin utilization, exercise reduces blood glucose levels.
18. Go through the workout guidelines for insulin users.
The patient must consume a snack at the conclusion of the exercise session since hypoglycemia might happen hours after the activity.
19. Explain to patients how to use a blood glucose meter (SMBG).
Another crucial element in the treatment of diabetes is regular SMBG. Patients may modify their treatment plan and achieve the best blood glucose control when they are aware of their SMBG findings. Moreover, SMBG encourages patients to continue receiving therapy. It may also be useful for keeping track of how well oral antidiabetic medications, diet, and exercise are working.
20. Examine the patient’s method for self-monitoring blood sugar (SMBG).
Identifies faults in SMBG caused by poor approach (e.g., blood drop too small, improper cleaning and maintenance, improper application of blood, damage to reagent strips). When the patient uses improper SMBG procedures, the blood glucose readings may be inaccurate. The patient should also assess the accuracy of the device’s readout by contrasting it with lab-measured blood glucose levels.
21. Discuss the significance of maintaining an insulin pump’s patency with patients who are using it.
Due to battery drain or insulin depletion, the needle or tubing of an insulin pump may occlude, increasing the patient’s risk for DKA.
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