DIABETES MELLITUS

UNDER SUPERVISION : DR \ AMINA

 PREPARED BY GROUP C 1 :

• 1. Shehab Maher Abdelaziz 11. Shahd Mohamed Elsayed 21. Shaimaa Hany Ramadan
• 2. Shehab Mahmoud Abdelrahman 12. Shahd Mohamed Ali 22. Safia Shrief Fouad
• 3. Shahd Ahmed Mohamed 13. Shahd Mohamed Fawzi 23. Salah Mohamed Abdallah
• 4. Shahd Ashraf Sayed 14. Shahd Mohamed Mohamed 24. Doha Adel Abdelsamad
• 5. Shahd Ashraf Mohamed 15. Shahd Mosaad Mohamed 25. Doha Ahmed Atia
• 6. Shahd Tamer Elsayed 16. Shahd Hesham Mandour 26. Taha Abdelsadek Eid
• 7. Shahd Shawqy Fahim 17. Shreen Gamal Abdrabo 27. Adel Gamal Adel
• 8. Shahd Abdallah Nagib 18. Shaimaa Abdallah Ali 28. Adel Hossam Eldien
• 9. Shahd Mabrouk Mohamed 19. Shaimaa Mohamed Ahmed 29. Adel Khaled Farouk
• 10. Shahd Magdy Mohamed 20. Shaimaa Mahmoud Sayed 30. Atef Mostafa Atef
 OUT LINES :

• Introduction
• definition
• Types
• Sign & Symptoms
• Causes
• Complications
• Medical Management
• Nursing Management
• Prevention Management
• Health teaching Management
 INTRODUCTION :

• Diabetes is a chronic medical condition that affects how the body processes blood
sugar (glucose). Glucose is a key energy source for the body’s cells, but in people
with diabetes, the body either doesn’t produce enough insulin or doesn’t use insulin
effectively. Insulin is a hormone produced by the pancreas that helps regulate glucose
levels by allowing it to enter cells for energy.
 DEFINITION :

• Diabetes is a chronic health condition characterized by the body’s inability to

properly regulate blood sugar (glucose) levels, either due to insufficient
production of insulin or the body’s inability to use insulin effectively. Insulin is a
hormone produced by the pancreas that helps glucose from food enter cells to be
used for energy. Without effective insulin action, glucose remains in the
bloodstream, leading to elevated blood sugar levels, which over time can result in
damage to various organs and systems in the body.
 TYPES :

• There are several types of diabetes, with the most common being:
1. Type 1 Diabetes:
An autoimmune condition where the body's immune system attacks insulin-producing cells
in the pancreas.
Typically diagnosed in children and young adults, though it can occur at any age. People
with Type 1 diabetes need to take insulin daily.
2. Type 2 Diabetes:
The most common form of diabetes, often related to obesity and lifestyle factors.
The body becomes resistant to insulin or doesn't produce enough.
Managed through lifestyle changes, oral medications, and sometimes insulin.
 TYPES :

3. Gestational Diabetes:
Develops during pregnancy and typically goes away after childbirth.
Increases the risk of developing Type 2 diabetes later in life for both the mother and child.
4. Prediabetes:
A condition where blood sugar levels are higher than normal but not yet high enough to be
diagnosed as Type 2 diabetes.
It’s a warning sign and can often be reversed with lifestyle changes.
 TYPES :

5. Monogenic Diabetes:
A rare form of diabetes caused by a single gene mutation.
Includes conditions like Maturity Onset Diabetes of the Young (MODY).
6. Secondary Diabetes:
Caused by other medical conditions or treatments, such as pancreatic diseases, hormonal
disorders, or medication use (like corticosteroids).
 SIGNS & SYMPTOMS :

• SIGNS AND SYMPTOMS :

• Type 1 diabetes can start at any age. But it often starts during childhood or teen years.
• Type 2 diabetes, the more common type, can develop at any age. Type 2 diabetes is more common
in people older than 40. But type 2 diabetes in children is increasing

• The classic symptoms of untreated diabetes are :

1. weight loss
2. polyuria (increased urination)
3. polydipsia (increased thirst)
4. polyphagia (increased hunger).
• Symptoms may develop rapidly (weeks or months) in type 1 DM, while they usually develop
much more slowly and may be subtle or absent in type 2 DM
 SIGNS & SYMPTOMS :
• In addition they also include:
1. Blurry vision
2. Headache
3. Fatigue
4. Slow healing of cuts
5. Itchy skin
6. Feeling more thirsty than usual.
7. Urinating often.
8. Losing weight without trying.
9. Presence of ketones in the urine.
10. Feeling tired and weak.
11. Having slow-healing sores
 CAUSES :

• Causes of Type 1 Diabetes :

The cause of Type 1 diabetes is not fully known, but there are some factors associated with it, such as:
1. The body's immune cells attack and destroy the insulin-producing pancreatic cells.
2. Genetic factors.
3. Stimulation of the immune system by a specific virus, which attacks the pancreatic cells
 CAUSES :

• Causes of Type 2 Diabetes :

Type 2 diabetes is usually linked to genes and environmental factors together, such
as:
the patient's lifestyle, and some groups are more susceptible to Type 2 diabetes than
others.
Factors that increase the risk of Type 2 diabetes include:
1. Being overweight.
2. Advancing age (patient's age is over 45 years).
3. Having diabetes in the family.
4. Inactivity and lack of movement.
5. Having gestational diabetes in the past.
6. Having high blood pressure, high cholesterol, or high triglycerides
 COMPLICATIONS :

• Diabetes complications are generally categorized into :

macrovascular and microvascular complications:
1)Macrovascular Complications : These involve large blood vessels and include:
1. Coronary Artery Disease: Increased risk of heart attacks and other heart-related issues.

2. Peripheral Vascular Disease: Reduced blood flow to limbs, which can lead to pain and, in severe
cases, amputation.

3. Stroke: Higher risk of cerebrovascular accidents due to atherosclerosis and other vascular changes
 COMPLICATIONS :
2)Microvascular Complications : These affect small blood vessels and include:
1. Diabetic Retinopathy : Damage to the blood vessels in the retina, leading to vision problems and
potentially blindness.
2. Diabetic Nephropathy: Kidney damage that can progress to kidney failure.
3. Diabetic Neuropathy: Nerve damage, often resulting in pain, tingling, or loss of sensation, particularly
in the feet and hands
4.Foot Damage: Nerve damage and poor blood flow increase the risk of various foot complications,
including infections and ulcers, which can lead to amputations
Other complications such:
5. Skin Conditions: Diabetes can make you more susceptible to skin problems, including bacterial and
fungal infections
6. Hearing Impairment: Diabetes can lead to hearing problems
7.Alzheimer's Disease: Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease
 MEDICAL MANAGEMENT :

Medical management of diabetes typically involves a combination of lifestyle modifications,

medication, and regular monitoring. Here’s a breakdown:

1. Lifestyle Modifications Diet:

A balanced diet rich in whole grains, fruits, vegetables, and lean proteins. Carbohydrate counting may
be beneficial. Exercise: Regular physical activity, aiming for at least 150 minutes of moderate
exercise weekly.
 MEDICAL MANAGEMENT :

2. Medications :
1) Type 1 Diabetes: Requires insulin therapy (multiple daily injections or insulin pump).
 Types of insullin :
1. Rapid-Acting Insulin:
Examples: Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra) Onset: 10-30 minutes Peak: 30
minutes to 3 hours Duration: 3-5 hours
2. Short-Acting Insulin: Example: Regular insulin (Humulin R, Novolin R) Onset: 30 minutes to 1 hour
Peak: 2-5 hours Duration: 5-8 hours
3. Intermediate-Acting Insulin: Example: NPH insulin (Humulin N, Novolin N) Onset: 1-3 hours Peak:
4-12 hours Duration: 12-18 hours.
 MEDICAL MANAGEMENT :

 Types of insullin :
4. Long-Acting Insulin: Examples: Glargine (Lantus, Toujeo), Detemir (Levemir) Onset: 1-2 hours
Peak: Minimal or no peak Duration: 24 hours or more .

5. Ultra-Long-Acting Insulin: Example: Degludec (Tresiba) Onset: 30-90 minutes Peak: No

significant peak Duration: Up to 42 hours.

6. Pre-Mixed Insulin: Examples: 70/30 (70% NPH, 30% regular), 75/25, 50/50 Onset, Peak,
Duration: Varies based on components.
 MEDICAL MANAGEMENT :

• 2) Type 2 Diabetes: May include:

• Metformin: First-line oral medication.
• Sulfonylureas: Increase insulin production.
• DPP-4 inhibitors: Help lower blood sugar levels.
• GLP-1 receptor agonists: Promote insulin release and slow gastric emptying.
• SGLT2 inhibitors: Help the kidneys remove glucose.
• Insulin therapy: May be necessary as the disease progresses.
 MEDICAL MANAGEMENT :

3. Blood tests :
1. Fasting Blood Sugar (FBS):
• Purpose: Measures blood glucose levels after fasting for at least 8 hours.
• Normal Range: Below 100 mg/dL.
• Prediabetes: 100-125 mg/dL.
• Diabetes: 126 mg/dL or higher on two separate tests.
2. Hemoglobin A1c (HbA1c) :
• Purpose: Measures average blood sugar levels over the past 2-3 months.
• Normal Range: Below 5.7%.
• Prediabetes: 5.7%-6.4%.
• Diabetes: 6.5% or higher.
 MEDICAL MANAGEMENT :

3. Oral Glucose Tolerance Test (OGTT):

Purpose: Measures blood sugar levels before and 2 hours after consuming a sugary drink.
Normal Range: Below 140 mg/dL after 2 hours.
Prediabetes: 140-199 mg/dL.
Diabetes: 200 mg/dL or higher.
4. Random Blood Sugar Test :
Purpose: Measures blood sugar at any random time without fasting.
Diabetes: A reading of 200 mg/dL or higher, especially with symptoms of diabetes.
5. C-Peptide Test :
Purpose: Assesses insulin production by measuring C-peptide levels.
Use: Helps differentiate between Type 1 and Type 2 diabetes.
 NURSING MANAGEMENT :

Nursing care for patients with diabetes mellitus focuses on managing blood glucose levels, preventing
complications, and promoting overall well-being. Key aspects include:
1. Blood Glucose Monitoring:
- Regular Monitoring: Teach patients to self-monitor blood glucose levels regularly
- Interpretation: Help patients understand their blood glucose readings and the importance of
maintaining them within target ranges.
- Documentation: Ensure proper documentation of blood glucose levels and any necessary adjustments
to treatment.
2. Medication Management:
- Oral Hypoglycemics: Ensure patients understand their oral medications, including dosage and timing.
- Monitoring for Side Effects: Watch for signs of hypoglycemia (e.g., sweating, dizziness) and
hyperglycemia (e.g., increased thirst, frequent urination)
 NURSING MANAGEMENT :

 2. Medication Management:
- Insulin Administration: Educate patients on correct insulin administration techniques if required.
 Sites of insullin injection :
1. Abdomen: The area around the belly, avoiding a 2-inch radius around the navel. This site allows
for consistent absorption and is the most commonly used.
2. Thighs: The front or outer part of the thighs. Injections here may result in slower absorption
compared to the abdomen.
3. Upper Arms: The back of the upper arms, in the fatty area between the shoulder and elbow.
4. Buttocks: The upper, outer area of the buttocks or hip.
To avoid lipodystrophy (lumps or indentations at the injection site), it’s important to rotate the
injection sites regularly. This means using a different spot within the same area or alternating
between different areas on the body.
 NURSING MANAGEMENT :
3. Dietary Management:
- Diet Education: Collaborate with dietitians to educate patients on carbohydrate counting and portion
control.
- Meal Planning: Encourage balanced meals with appropriate portions of carbohydrates, proteins, and
fats.
4. Exercise and Lifestyle Modifications:
- Exercise Education: Encourage regular physical activity tailored to the patient’s ability.
- Monitor Exercise Impact: Help patients understand how exercise affects blood sugar levels and how
to adjust insulin or food intake accordingly.
- Smoking Cessation: Encourage quitting smoking to reduce cardiovascular risks.
5. Preventing Complications:
- Foot Care: Inspect feet regularly, promote proper footwear, and educate patients on foot hygiene.
- Skin Care: Monitor for any cuts, infections, or sores, as diabetes increases susceptibility to infections.
- Vision Monitoring: Encourage regular eye exams to prevent complications like diabetic retinopathy.
 NURSING MANAGEMENT :

6. Monitoring for Acute and Chronic Complications:

- Hypoglycemia: Be vigilant for symptoms of low blood sugar and provide quick interventions such as
glucose tablets or juice.
- Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS): Recognize and
respond promptly to these life-threatening conditions by monitoring for dehydration, confusion, and
high glucose levels.
- Long-term Complications: Monitor for complications like cardiovascular disease, nephropathy,
neuropathy, and retinopathy.
7. Follow-up Care:
- Schedule regular follow-up visits to assess progress, adjust care plans, and provide ongoing
education.
 PREVENTION MANAGEMENT :
Prevention Management for Diabetes Mellitus:
1. Healthy Diet:
- Focus on whole grains, lean proteins, healthy fats, and fruits/vegetables.
- Limit sugary drinks and refined carbohydrates.
- Practice portion control and mindful eating.
2. Regular Physical Activity:
- Aim for at least 150 minutes of moderate-intensity exercise weekly.
- Include strength training to enhance insulin sensitivity.
- Maintain consistent activity levels.
3. Weight Management:
- Achieve and maintain a healthy weight; modest weight loss can reduce diabetes risk.
- Monitor body mass index (BMI).
 PREVENTION MANAGEMENT :

4. Regular Health Screenings:

- Conduct routine blood sugar tests, especially for at-risk individuals.
- Detect prediabetes early to implement lifestyle changes.
- Monitor blood pressure and cholesterol levels.
5. Smoking Cessation:
- Quit smoking to lower the risk of insulin resistance.
- Seek support through groups or counseling.
6. Stress Management:
- Reduce stress through mindfulness, meditation, or yoga.
- Recognize the link between stress and unhealthy habits.
 PREVENTION MANAGEMENT :

7. Alcohol Consumption:
- Limit alcohol intake to moderate levels (1 drink/day for women, 2 for men).
8. Education and Awareness:
- Increase public awareness about diabetes risks and lifestyle changes.
- Educate individuals on personal risk factors
9. Family and Community Support:
- Encourage family participation in healthy behaviors.
- Engage in local diabetes prevention programs.
 HEALTH TEACHING :

Health Teaching Management for Diabetes Mellitus:

1. Understanding Diabetes Mellitus:
- Chronic condition due to insufficient or ineffective insulin.
- Includes Type 1, Type 2, and Gestational Diabetes.
2. Monitoring Blood Glucose:
- Regular monitoring helps adjust lifestyle and treatment.
- Use of glucometers and continuous glucose monitors (CGMs).
- Educate on target blood sugar ranges.
3. Dietary Management:
- Focus on high-fiber, lean protein, and healthy fats.
- Teach carbohydrate counting and portion control.
- Limit refined carbs and sugars.
 HEALTH TEACHING :

4. Physical Activity:
- Exercise enhances insulin sensitivity and lowers blood glucose.
- Encourage aerobic and strength training.
- Aim for 150 minutes of exercise per week.
5. Medication Management:
- Proper insulin administration and medication adherence.
- Teach timing and purpose of medications.
6. Preventing Complications:
- Recognize and treat hypoglycemia and hyperglycemia.
- Educate on long-term risks like heart disease, nephropathy, and neuropathy.
- Encourage regular check-ups.
 HEALTH TEACHING :

7. Self-Care and Support:

- Promote self-monitoring and emotional support.
- Importance of regular follow-ups with healthcare providers.
8. Education and Empowerment:
- Continuous education on diabetes management.
- Set realistic, achievable health goals.
 RESOURCES :

• https://www.medicalnewstoday.com/articles/323627
• https://diabetesjournals.org/clinical/article/26/2/77/1823/Microvascular-and-
Macrovascular-Complications-of
• https://link.springer.com/chapter/10.1007/978-981-16-5123-6_3
• https://doi.org/10.2337/diaclin.26.2.77
• http://www.chatgpt.com/
• http://www.diabetes.org/
• http://www.cdc.gov/
• http://www.who.int/