DIABETES

Gladys T.
Cruz
Diabetes Mellitus
 Isa disorder of the endocrine system
that causes alterations in glucose
metabolism.
Diabetes Mellitus: Type
 Type 1 – an absolute lack of insulin
 Type 2 – relative lack of insulin

Diabetes Mellitus
 Pancreasis an organ with both
endocrine and exocrine functions
- Exocrine function is to release a juice

full of enzymes and other components
that helps with the process of
digestion
Diabetes Mellitus
- Endocrine function (islets of
langerhans)
Beta cells produce insulin
Alpha cells produce glucagon
Delta cells produce somatostatin
Diabetic Ketoacidosis
1. Beta cells have the inability to
produce insulin
2. Hyperglycemia – hyperosmolar state
3. Electrolyte shifts and total body
dehydration
4. Formation of ketones because of
breakdown of fats and protein
Diabetic Ketoacidosis: Clinical
Manifestations
 Dehydration  Weakness
 Ketosis  Anorexia
 Metabolic  Altered mental
acidosis status
 Tachycardia
 Kussmaul
respirations
Diabetic Ketoacidosis: Goals of
Treatment
 Correction of acidosis
 Correction of electrolyte and fluid
disturbances
 Insulin to lower serum glucose levels
 Prevention of ketosis
 Prevention of complications
Diabetic Ketoacidosis:
Treatments
 Closely monitor blood glucose levels
and acidosis
 Replace fluids and electrolytes
 Administer insulin
 Monitor cardiac, pulmonary,
neurologic systems
Diabetic Ketoacidosis:
Treatments
 Identify
and correct precipitating event
 Educate the patient and the patient ’s
family
Diabetic Ketoacidosis
 Rapid insulin
0.1 to 0.2 U/kg/hr
Hyperosmolar Nonketotic Coma
A serious metabolic complication,
usually seen in type 2 diabetes
 Results in dehydration and electrolyte

disturbances without acidosis
Hyperosmolar Nonketotic
Coma: Clinical Manifestation
 Profound  Dry mucous
dehydration membrane
 Hypotension  Poor skin turgor
 Tachycardia  Neurologic
 Diminished CVP impairments
including
confusion,
seizures and
coma
Hyperosmolar Nonketotic Coma
 Treatment goals are similar to the
interventions of DKA
Hypoglycemia
 Occurswhen the blood sugar levels
drop rapidly
Hypoglycemia
 Sweating,  Anxiety,
tremors paresthesia and
 Blurred vvision, poor
hunger, coordination
weakness  Slurred speech,
 Behavior headache
changes, and  Palpitation,
confusion nausea
Hypoglycemia: Treatment
 Fast acting carbohydrates (if client is
conscious)
- ½ cup orange juice
- 4 oz cola
- 4 oz orange juice
Syndrome of Inappropriate
Secretion of Antidiuretic Hormone
 Patienthas an excess of antidiuretic

hormone secreted into the
bloodstream, more than amount
needed to maintain normal blood
volume and serum osmolality
Syndrome of Inappropriate
Secretion of Antidiuretic Hormone
 Excessivewater is resorbed at the

kidney tubule, leading to dilutional
hyponatremia
Assessment
Early Clinical Manifestation:
- dilutional hyponatremia include
lethargy, anorexia, nausea and
vomiting
Assessment
Symptoms of Severe Hyponatremia:
- inability to concentrate, mental
confusion, apprehension, seizures,
decreased level of consciousness,
coma and death
Nursing Diagnoses
 Excess Fluid Volume related to
comprised regulation mechanism
 Anxiety related to lack of control over
current situation or disease
progression
 Deficient Knowledge: Discharge
Regimen related to lack of previous
exposure to information
Medical Management
 Fluidrestriction
 Sodium replacement
 Medications that increase renal water
excretion (Demeclocycline)
Nursing Management
 Restriction of Fluids
- accurate intake and output
- mouth care for fluid restriction
- weigh patient to gauge fluid retention
or loss of body fluid
Diabetic Insipidus
Caused by a deficiency in the
production or release of ADH by the
posterior pituitary gland
Diabetic Insipidus:
 Neurogenic
 Nephrogenic
 Psychogenic
Diabetic Insipidus: Clinical
Manifestations
 Polyuria  Seizures
 Polydipsia  Constipation
 Hypotension
 Tachycardia
 Weight loss
 Dehydration
 Mental status
changes
Diabetic Insipidus: Medication
 Vasopressin
 Desmopressin acetate ( for chronic

neurogenic)
Diabetic Insipidus: Nursing
Management
 Monitor intake and output
Thyroid Storm
 Alsocalled Thyroid Crisis

 A complication of pre - existing
hyperthyroidism
Thyroid Storm
 Increase
in cellular oxygen
consumption
Thyroid Storm: Medical
Management
 Preventcardiovascular collapse
 Reduce hyperthermia
 Reverse dehydration
Thyroid Storm: Pharmacologic
Management
A. Drugs that block thyroid synthesis
Propylthiouracil (PTU) = blocks
conversion of T4 to T3
B. Drugs that block release of thyroid
hormone
Iodides = decreases thyroid hormone
production
Thyroid Storm: Pharmacologic
Management
C. Drugs that block catecholamine
effect
Propanolol
Thyroid Storm: Nursing
Management
 Medication administration
 Normalize temperature
 Rehydration and correction of
metabolic derangements
Myxedema Coma
 Progressive worsening or terminal
stage of hypothyroidism
Myxedema Coma
 Cell is unable to maintain processes
necessary to sustain life
- protein synthesis is curtailed
- carbohydrates and fat metabolism is
incomplete
- lipolysis is ineffective, and cholesterol
collects in the blood stream
Myxedema Coma: Clinical
Manifestation
 Dull and mask-like face
 Damaged cardiac myocytes due to
interstitial edema
 Pleural effusions
 ADH levels is increased
 Decreased gastric motility
 Heat production decreases
Myxedema Coma:
Pharmacologic Management
 Levothyroxine
Myxedema Management:
Nursing Management
 Ventilatorysupport
 ABG’s measurement
 ECG monitoring
 Measures to avoid skin breakdown
 Manage constipation
 Monitor I and O
Education ’s
purpose is to
replace an
empty mind
with an open
one.

DIABETES

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DIABETES

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Gladys T.

 Type 2 – relative lack of insulin

- Exocrine function is to release a juice

 Results in dehydration and electrolyte

 Patienthas an excess of antidiuretic

 Excessivewater is resorbed at the

 Desmopressin acetate ( for chronic

 Alsocalled Thyroid Crisis

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