Question

A 16-year-old is admitted for a workup because of symptoms of excessive weight loss, fatigue, inability to maintain grades in school, and constant hunger. The symptoms began rather suddenly, and the mother did not recognize how severe the weight loss had become until trying on clothes. Admitting lab work was all within normal limits except glucose 425mg/dL, and a urine test was positive for glucose and ketones. There is no family history of diabetes mellitus (DM). The healthcare provider prescribes blood glucose monitoring before meals and at bedtime and a combination of long acting insulin daily with rapid acting insulin according to blood glucose results.

1. When the healthcare provider confirms the diagnosis of DM, how should the nurse explain the pathophysiology of the disease?
2. What are the most important symptoms the client should be taught?
3. How should the nurse explain the importance of the combination of diet, exercise, and insulin in controlling DM?
4. What instructions should the client be given about hypoglycemia and hyperglycemia? Why do we need to include teaching on both conditions?
5. What are the other complications related to DM?

Answer 1

Pathophysiology

Due to the destruction of the pancreatic beta cells thought that combined genetic, immunologic, and possibly environmental factors or due to insulin resistance and impaired insulin secretion an abnormal response in which antibodies are directed against normal tissues of the body.

Leads to decreased insulin production

In addition, glucose derived from food cannot be stored in the liver but instead remains in the bloodstream.

If the concentration of glucose in the blood exceeds the renal threshold for glucose, usually 180 to 200 mg/dL (9.9 to 11.1 mmol/L), the kidneys may not reabsorb all of the filtered glucose; the glucose then appears in the urine leads to hyperglycemia.

Symptoms

• Polyuria
• Polydipsia
• Polyphagia
• Sudden weight loss
• Nausea
• Vomiting
• Abdominal pains,
• Fatigue and weakness
• Sudden vision changes
• Tingling or numbness in hands or feet
• Dry skin
• Skin lesions or wounds that are slow to heal
• Recurrent infections.
  

Importance of diet, exercise and insulin

Nutrition, diet, and weight control are the foundation of diabetes management. The most important objective in the dietary and nutritional management of diabetes is control of total caloric in-take to attain or maintain a reasonable body weight and control of blood glucose levels.Consume caloric and fat controlled diet ,lifestyle, usual eating times.Increasing fiber in the diet may also improve blood glucose levels and decrease the need for exogenous insulin. Consume diet with low glycemic index,

Exercise is extremely important in managing diabetes because of its effects on lowering blood glucose and reducing cardiovascular risk factors. Exercise lowers the blood glucose level by increasing the uptake of glucose by body muscles and by improving insulin utilization. Exercise also alters blood lipid levels, increasing levels of high-density lipoproteins and decreasing total cholesterol and triglyceride levels.Precaution must be taken for patients who have blood glucose levels exceeding 250 mg/dL (14 mmol/L) and who have ketones in their urine should not begin exercising until the urine tests negative for ketones and the blood glucose level is closer to normal.In your case start exercise once ketone gets normal,

For patients using intensive insulin therapy, there may be greater flexibility in the timing and content of meals by allowing adjustments in insulin dosage for changes in eating and exercise habits.

Hypoglycemic instructions

Closely watch signs and symptoms of hypoglycemia such as nervousness,irritability, diaphoresis ,hunger, weakness, tachycardia,fatigue, hypotension, palpitations, tachypnea, tremors or shaking Pallor, blurred or double vision, incoherent speech, headache Numbness of tongue and lips, confusion Coma,seizures. In this case use use raidly absorbed glucose source

Hyperglycemic instruction,

Closely watch signs and symptoms of confusion, nausea, irritability, vomiting, fatigue, anorexia, weakness, abdominal cramping, numbness, tachycardia, lethargy, hypotension, Küssmall breathing, decreased level of consciousness, fruity breath.In this case lower glucose with regular insulin and seek medical attention if necessary.

Teaching about hyper and hypoglycemia patient can manage it initally by taking any rapid acting glucose souce and hyperglycemic patient can manage by regular insulin, if necessary medical attention also by the presence of these symptoms also.

Complication

• cardiovascular disease
• Neuropathy
• Nephropathy
• Retinopathy
• Hearing impairements
• Alzheimers disease
• Depression
• Sores in foot