Diabetes Mellitus

Chapter II Diabetes Mellitus

PATHOGENESIS OF DIABETIC KETODACIDOSIS

INSULIN DEFICIENCY

FIG. 1 Glucagon

Cortisol	Cortisol Catecholamines	Increased protein breakdown
Decreased glucose utilization	Increased gluconeogenesis	Increased amino acids
Hyperglycemia	Lipolysis
Glycosuria	Increased free fatty acids	Increased blood lipids
Osmotic dieresis	Free Fatty Acid Oxidation
Polyuria		Increased triglycerides
	Ketonemia
Loss of water, sodium, Potassium and Phosphate	Ketouria	Increased very low density Lipoproteins
Dehydration
	Ketoacidosis
Hypovolemia

Circulatory collapse shock	Coma	Death

TABLE 1: CLINICAL PICTURES AND TREATMENT
OF THE DKA PATIENT

SIGNS AND SYMPTOMS	LABORATORY FINDINGS	TREATMENT
Insidious onset. Fatigue, muscle weakness	Serum glucose less than 800 mg/ml	Fluid regulation Electrolyte replacement
Nocturia Polyuria Polydipssia	Positive serum ketones Serum sodium usually low	Fluid regulation Electrolyte replacement
Polyghagia Weight loss	Serum potassium-elevated Normal or low
Dehydration	Less than 10 mEq potassium
Nausea, vomiting, diarrhea, blurred vision	Blood Ph less than 7.32
Acetone breath Hot, dry flushed skin Sunken eyeball Tachycardia Hypotension Kussmaul respirations Coma Death	Serum osmolarity less than 300 mOsm/l Urine glucose 2+ or greater Urine Ketones, large

TREATING TYPE I DIABETES

A regimen of insulin injections, diet, exercise and monitoring f blood glucose levels is used in treating Type I diabetes. The diabetic must learn to balance insulin, food and exercise.

Successful treatment of diabetes mellitus requires a combined effort by:

The physician having a complete understanding of the particular problems in each case.

The nurse educator, and how well the patient has been instructed

The patient’s conscientious following instructions

Diabetics can lead a relatively normal life if they are well informed concerning their disease and how it should be managed.

TREATMENT GOALS FOR THE TYPE I DIABETES

Nursing implications

Insulin injections are necessary for Type I, since the body is unable to produce insulin to transport glucose into the cells.

Diet for the diabetic is well balanced, and controls the types and amounts of food eaten.

Exercise improves muscle tone, strength, and the feeling of well-being, while reducing insulin requirements.

Monitoring blood glucose is essential in order to design a diabetic care program and maintain good control.

PERSONAL GOALS FOR TYPE I DIABETES

Increase self-reliance and self-sufficiency

Lead an active life that is as close to normal as possible

Balance diet, exercise, and insulin

Control blood glucose levels, thereby increasing protection of the heart, nerves, blood vessels, eyes, and kidneys.

Maintain body weight within normal range.

Next: TYPE 2 DIABETES (NIDDM)