PATHOPHYSIOLOGY STATEMENT Medical Condition: Diabetes Mellitus

Effects on Body Organ/Functioning Signs and Symptoms Treatment Nursing Interventions Complications

Diabetes (Type II) results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. In type 2 diabetes, the pancreas usually continues to produce some endogenous insulin. However, the insulin that is produced is either insufficient for the needs of the body and/or is poorly utilized by the tissues. Insulin resistance in glucose and lipid metabolism, which is a condition in which body tissues do not respond to the action of insulin. Most insulin receptors are located on skeletal muscle, fat, and liver cells. When insulin is not properly used, the entry of glucose into the cell is impeded, resulting in hyperglycemia. In the early states of insulin resistance, the pancreas responds to high blood glucose by producing greater amounts of insulin (beta-cell function is normal). This creates a temporary state of hyperinsulinemia that coexists with the hyperglycemia. Marked decrease in the ablity of the pancreas to produce insulin, as the beta cells

Polyuria and polydipsia Nausea; anorexia (common) or polyphagia (occasional) Weight loss (usually 10% to 30%; persons with type 1 diabetes often have almost no body fat at diagnosis) Headaches, fatigue, lethargy, reduced energy levels, impaired school or work performance Muscle cramps, irritability, emotional lability Vision changes such as blurring Numbness and tingling Abdominal discomfort and pain; diarrhea or constipation Recurrent vaginal candidiasis Hyglycemia

Insulin replacement, meal planning, and exercise (current forms of insulin replacement include mixeddose, split mixed-dose, and multiple daily injection regimens and continuous subcutaneous insulin infusions) Pancreas transplantation currently requires chronic immunosuppression

Assess patient weight

regularly and review blood glucose history Establish goals with the patient for weight loss; glucose, lipids, and HbA1c, measurement and exercise Monitor blood glucose levels Assess current eating habits Assess for signs of hyperglycemia Assist the patient to identify eating patterns that need changing Instruct the patient to take oral hypoglycemic medications as directed Instruct the patient to take insulin medications as directed Instruct the patient to carry medical identification at all times Teach the patient to inspect feet daily for cuts, scratches, and blisters. Use a mirror if necessary to examine the bottom of the foot. Instruct the patient to use both visual inspection and touch Instruct the patient to always wear protective footwear; never go barefoot

Cardiovascular disease Nephropathy Retinopathy Neuropathy Ketoacidosis and hyperosmolar coma Infections Peripheral Vascular Disease Hypoglycemia Amputation of lower extremities (gangrene)

Oral antidiabetic drugs to

stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, suppress hepatic gluconeogenesis, and delay GI absorption of carbohydrates (drug combinations may be used) oSecond generation sulfonylureas (glipizide, glyburide, glimepiride), Meglitinides (repaglinide), D-Phenylalanine derivatives (nateglinide), Biguanides (metformin), o -Glucosidase inhibitors (acarbose, miglitol), Thiazolidinediones (pioglitazone, rosiglitazone) Exogenous insulin, alone or

PATHOPHYSIOLOGY STATEMENT Medical Condition: Diabetes Mellitus

become fatigued from the compensatory overproduction of insulin or when beta cell mass is lost. The underlying basis for the failure of beta cells to adapt is unknown. However, it may be linked to the adverse effects of chronic hyperglycemia or high circulating free fatty acids. Also, liver produces inappropriate glucose. Instead of properly regulating the release of glucose in response to blood levels, the liver does so in a haphazard way that does not corespond to the bodys needs at the time. with oral antidiabetic drugs, to optimize glycemic control Individualized meal plan designed to meet nutritional needs, control blood glucose and lipid levels, and reach and maintain appropriate body weight Weight reduction (obese patient with type 2 diabetes mellitus)

Patient Specific

Patient Specific

Patient Specific

Patient Specific

Patient Specific

PATHOPHYSIOLOGY STATEMENT Medical Condition: Diabetes Mellitus

PATHOPHYSIOLOGY STATEMENT Medical Condition: Diabetes Mellitus