DIABETES

Questions to Prepare for Simulation Experience: Complete prior to your simulation experience

1. What is pathophysiology of Diabetes Mellitus?

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop
responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the
body. The most common form of diabetes is Type II, like in our case study. It is sometimes called age-onset or
adult-onset diabetes, and this form of diabetes occurs most often in people who are overweight and who do not
exercise (Hinkle, n.d.).In NIDDM or Diabetes Mellitus Type II, a combination of peripheral insulin resistance
and inadequate insulin secretion by pancreatic beta cells leads to a progressive loss of beta-cell function and
mass. As stated in Lippincott Advisor, this will eventually elevate the levels of free fatty acids in plasma,
leading to decreased glucose transport into muscle cells, elevated hepatic glucose production, and increased
breakdown of fat. Consequently, abnormal glucose tolerance occurs, and postprandial blood glucose levels
increase; hepatic gluconeogenesis suppression fails, and fasting hyperglycemia develops. Several damages in
the body occurs in the capillary endothelial cells of the retina, the mesangial cells in the renal glomerulus
because of the inability of cells to regulate the absorption of glucose (2018).

2. How does DM Type 2 differ from DM Type 1?

Diabetes Mellitus Type 2 differs from DM Type 1 for the main reason that in Type 2, the pancreas
produces some amount of insulin, but the amount is not enough for the body. In other words, in Type 2, insulin
production is present but it is negligible and the cells are resistant to it. Type 2 can be controlled by exercise,
nutrition, and weight management. Type 2 DM is also known as Non-insulin dependent DM (NIDDM) or
Maturity-onset DM and is seen in middle age persons/adults.

In Type 1 however, the malfunctioning pancreas doesn’t produce insulin. In the treatment of Type 1,
the insulin is getting injected through the skin into fatty tissue. This is the reason why it is also known as
Insulin-dependent DM (IDDM) or Juvenile-onset DM and is seen in childhood. It results from absolute
deficiency of insulin due to destruction of beta-cells (Porth, n.d).

But regardless whether it is Type 1 or 2, their symptoms are generally the same which includes
excessively dry skin, bruises that heal slowly, sudden changes in vision particularly blurry vision, fatigue,
weight loss despite the increased appetite, increased thirst, excessive urination, among others.

3. What are risk factors for development of DM Type 2?

Regardless of its etiology, the risk factors for the development of DM Type 2 are mainly
hereditary and environmental in origin. Lippincott Advisor states that individuals whose age is over 45 years
old are more predisposed to having the disease plus the fact that they have been living a sedentary lifestyle and
 are overweight. Poor diet is also a contributory factor like eating too much red meat, high-fat dairy products,
sweetened beverages and desserts, and processed foods. Persons who have high cholesterol levels and are
hypertensive are at a greatest risk for acquiring the disorder (2018).

In women, having a history of gestational diabetes or delivering a baby with a birth weight equal to or
greater than 9 pounds and those who are suffering from polycystic ovarian syndrome are likely to develop
diabetes in the years ahead.

4. What are the signs and symptoms of DM Type 2?

Clinical manifestations of Diabetes Type 2 according to Lippincott Advisor may include excessive
urination, increased thirst, voracious appetite, weight loss, weakness, fatigue and frequent infections. Other
signs and symptoms suggesting an increased in blood sugar levels (blurred vision, numbness of the lower
extremity, yeast and skin infections) and sudden weight loss (Cellulitis, 2018).

5. What are some acute and chronic complications associated with DM?

Because of the persistently high or poorly managed blood sugar levels, patients with Diabetes Mellitus
may suffer from a wide range of complications that may arise from their condition. It includes acute and
chronic complications. Among the acute effects of DM, the most common are having hypoglycemia when your
blood sugar seem too low, hyperglycemia or the other way around, Hyperosmolar Hyperglycemic State (HHS)
wherein the patient has very high blood sugar levels plus severe dehydration and lastly, Diabetic Ketoacidosis
(DKA), a life-threatening emergency where the lack of insulin and high blood sugars leads to a build-up of
ketones.

Chronic complications, which develop gradually, can lead to serious damage if they go unchecked.
These complications affect different parts of the body particularly the nerves in the eyes (retinopathy), nerves
of the body (neuropathy), kidneys, (nephropathy), foot problems, sexual dysfunctions, gum and other dental
problems, and even heart attack and stroke (Hinkle, n.d).

6. Correlate the exemplar of DM to the concept of perfusion.

Over time, Diabetes mellitus produces a wide range of symptoms that affects the body’s circulation
and tissue perfusion. Persistent high levels of blood glucose can impair blood vessels and cause plaque to
build up. It is important for people with diabetes to correctly cope with their normal blood glucose levels,
blood pressure, and cholesterol levels to maintain healthy blood flow. In a study made by Cameron and Cutter,
Diabetes can also bring about nerve damage, and can also affect a person's blood pressure and heart rate.
Uncontrolled diabetes may show an increased tissue oxygen consumption and decreased ability of the
circulating blood to release oxygen to the tissues (1994). In my own understanding, this may be the reason why
diabetics have poor wound healing since the increased blood sugar levels destroys the microcirculation thus
creating different affectations to all major organs.
7. What are clinical manifestations of and risk factors for development of hypoglycemia (blood glucose less
than 70)?

Patients with hypoglycemia may complain of having headache, exhaustion, racing heart, nausea,
mental fogginess, blurred vision, confusion and extreme hunger. Other objective cues may include confusion,
trembling, cold and clammy skin, excessive sweating, tachycardia or cardiac arrhythmia, hypertension, loss of
coordination, gastrointestinal symptoms like vomiting, abdominal pain, and cramping.

Risk factors that may aggravate the development of low to very low blood sugar levels may include
one or more of the following conditions: poorly timed oral hypoglycemic agents /insulin administration, too
much alcohol intake, fasting, strenuous exercise, familial tendency, renal insufficiency combined with
advanced age and certain medications and those undergoing gastric surgery (Hypoglycemia, 2018).

8. What are nursing interventions for the management of hypoglycemia?

It is very important to initially check the blood glucose level of the patient before doing some
intervention. Once that hypoglycemia has been detected, immediate early treatment to raise the patient’s blood
sugar level should be done and then treating the underlying condition that's causing the hypoglycemia to
prevent recurrence. The usual recommendation is the administration of 15 grams of a fast-acting concentrated
source of carbohydrate like glucose tablets or gel, fruit juice, regular soda, and sugary candy.

If symptoms are more severe, say, the patient became unconscious or has an impaired ability to take
sugar by mouth, they may need an injection of glucagon or intravenous glucose. It is important to remember
not to give food or drink to someone who is unconscious, as he or she may aspirate these substances into the
lungs. Usually this is done by an injection of 1 milligram of glucagon that can be given either subcutaneously
or intramuscularly (Hinkle, n.d.).

It is also important to recheck the blood glucose levels after 15 minutes to know that the glucose levels
returns to normal.

9. What is cellulitis and how is it treated?

Cellulitis is the acute inflammation of the dermis and subcutaneous tissue usually caused by infection
(Porth, n.d.). It occurs when bacteria penetrate in the normal or lesions skins and begin to spread underneath
your skin and soft tissue, which leads to infections and inflammations. They can cause swelling, red spot and
pain. When conservative management like having an adequate intake of fluids, a balanced diet, applying moist
heat compress and elevating the affected extremity are ineffective, the best option is to treat it
pharmacologically. Drugs of choice include antibiotics, topical antifungals and corticosteroids possibly to help
decrease inflammation.
 10. What are some important teaching points for the patient with diabetes?

Proper education and patient support can affect a change in lifestyle that may affect progression or
complications of Diabetes Mellitus. It is the role of the nurse to educate the patient regarding the disease
process, risk factors, diagnostic testing, disease management, goals, lifestyle modifications, and long-term
complications that come with diabetes.

The patient should also be taught to know the signs and symptoms of hypoglycemia and ways to
manage it. The patient should also be aware of his/her medication regimen, including drug names, dosages,
frequency of administration, expected results, possible adverse effects, and signs and symptoms of toxicity.
The need for regular exercise and weight reduction or maintenance, as well as specific diet-control measures
based on the patient's needs should be implemented. The need to examine the feet regularly should also be
properly demonstrated to the patient and how to prevent other infection. And lastly, the diabetic should also be
reminded about the importance of adhering to the follow-up schedule for evaluation and laboratory testing to
determine the effectiveness of therapy.

REFERENCES:

Cameron, N. E., & Cotter, M. A. (1994). The relationship of vascular changes to metabolic factors in diabetes
mellitus and their role in the development of peripheral nerve complications. Diabetes/metabolism reviews, 10(3), 189-
224.

Cellulitis. (2018). Retrieved from https://advisor-

edu.lww.com/lna/document.do?bid=4&did=678503&searchTerm=cellulitis&hits=cellulitis

Diabetes Mellitus (Type 2). (2018). Retrieved from https://advisor-

edu.lww.com/lna/document.do?bid=4&did=714995&searchTerm=diabetes&hits=diabetes

Hinkle, J. L., Cheever, K. H. Lippincott’s CoursePoint for Hinkle & Cheever: Brunner & Suddarth’s Textbook
of Medical-Surgical Nursing. [CoursePoint]. Retrieved
from https://coursepoint.vitalsource.com/#/books/9781496379054/

Hypoglycemia. (2018). Retrieved from https://advisor-

edu.lww.com/lna/document.do?bid=4&did=714805&searchTerm=hypoglycemia&hits=hypoglycemia

Porth, C. Essentials of Pathophysiology: Concepts of Altered States. [CoursePoint]. Retrieved

from https://coursepoint.vitalsource.com/#/books/9781469898087/