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Nursing for diabetes mellitus

Diabetes is a metabolic disorder that prevents the body from utilizing glucose completely or partially. There are basically two types of diabetes
Diabetes mellitus occurs when beta cells either are unable to produce insulin (Type I diabetes mellitus) or produce an insufficient amount of insulin (Type II diabetes mellitus). As a result, glucose does not enter cells but remains in the blood. Increased glucose levels in the blood signal to the patient to increase intake of fluid in an effort to flush glucose out of the body in urine. Patients then experience increased thirst and increased urination. Cells become starved for energy because of the lack of glucose and signal to the patient to eat, causing the patient to experience an increase in hunger. There are three types of diabetes mellitus. These are Type I, known as insulin-dependent , where beta cells are destroyed by an autoimmune process; Type II, known as non-insulin-dependent , where beta cells produce insufficient insulin, and gestational diabetes mellitus (DM that occurs during pregnancy)
Type 1 diabetes usually occurs in childhood or adolescence but can develop at any age. These patients need insulin everyday.
Type 2 diabetes is common among adults, especially those who are overweight and over age 40. These people are able to control their blood sugar levels through weight control, regular exercise and a well-balanced diet.
Medications
Pharmacologic treatment of diabetes includes a spectrum of different insulin preparations and oral agents. Insulin therapy usually involves a combination of short acting and intermediate or long-acting preparations. When the blood glucose level is not stabilized, a sliding scale may be used to cover glucose levels that are out of established goals for glucose control. Oral agents may be used alone or may be combined with other oral agents or combined with insulin.
Nutrition
Nutritional guidelines for diabetes care have become liberalized in recent years. Ideally, the diet is tailored to be healthy and to reflect personal preferences. The specific diabetes treatment is then adjusted accordingly.
The old diabetic diet is no longer a recommended approach in the care of individuals with diabetes, although it may be used when it meets the individual’s needs effectively.
There are several guiding principles behind nutritional choices for individuals with diabetes including: 1) maintenance of an ideal body weight, 2) limitation of fat and cholesterol, 3) establishment of goals for glucose levels and on-going monitoring especially if food intake is variable or changing and 4) medication adjustment when glucose levels are outside of target ranges for the individual or if diet changes for any reason (choice, acute illness, treatment of other conditions.) Individuals also are free to exercise personal choice with respect to food selection.
Some people with diabetes will make choices based on personal preference that are not necessarily consistent with medical recommendations. It is advisable to provide education and nutritional counseling, but ultimately, the individual may make choices as they wish. In this situation glucose target levels may be higher than optimal.
Exercise
Exercise continues to be an important component of diabetes care. As with medications and nutrition, it must be tailored to the individual’s preferences, abilities and overall medical condition. When an exercise program is initiated, monitoring for the exercise effect on the blood glucose level may reassure the resident and caregivers that the activity can be undertaken safely. Continued monitoring of the glucose level with exercise will usually not be necessary unless the individual experiences marked variations in glucose levels or the amount of exertion changes. It is also important for staff to monitor for signs of hypoglycemia keeping in mind that some individuals who have longstanding diabetes may develop hypoglycemic unawareness.
If hypoglycemia occurs with exercise or activities, the physician should be notified for recommendations (adjusting medications, testing glucose before exercise, pre-treating with a snack, timing of exercise) to minimize problems related to glucose control during exercise. It is usually not necessary to discontinue an exercise program simply because of an episode of hypoglycemia.
Blood glucose monitoring
Monitoring regimens for diabetes vary depending on the type of diabetes, the type of treatment and the goals for glucose control. Individuals with diet-controlled diabetes may have the blood glucose tested infrequently (weekly or monthly) with periodic addition of a hemoglobin A1c measurement. Individuals with Type 2 diabetes treated with oral agents may have testing several times/week at varying times with periodic addition of a hemoglobin A1c measurement. Individuals treated with insulin, whether Type 1 or Type 2, will have testing based on goals for treatment and stability of disease. Testing may range from 2 to 4 times/day typically with additional testing when acute illness or when other factors affect the level of glucose control and with periodic addition of a hemoglobin A1c measurement. Attending physicians will set the glucose-monitoring schedule according to the specific needs of the individual. In general, the testing frequency increases with attempts at tighter glucose control or when control becomes out of target ranges. People with terminal illness and diabetes may choose to minimize glucose and other types of testing.
Common symptoms of diabetes mellitus
Following are the major diabetes symptoms:
1. Increased thirst
2. Frequent urination
3. Increase in appetite
4. Weight loss in type 1 diabetes
5. Obesity in type 2 diabetes
6. Skin irritation or infection
7. Decreased healing capacity
8. Weakness or loss of strength
9. Erection problems
Causes of diabetes mellitus
Following are the major diabetes causes:
1.    Hereditary factors
2.     Excess intake of carbohydrate foods like chocolates, rice etc
3.     Insulin deficiency
4.     Insulin resistance
5.     High blood pressure
6.     High cholesterol
7.     Stressful and over burdened life
8.     Lack of exercise or physical activities
9.     Excess eating habits
Diabetes complications
1.     Hardening of the arteries (atherosclerosis)
2.     Heart problems
3.     Eye problems
4.     Blindness
5.     Kidney problems
6.     Nerve problems
Diabetes advice
1.     Treatment plans vary for individuals with diabetes depending on type of diabetes, concurrent disease and individual needs.
2.     Blood Glucose target ranges should be defined and should be realistic for individual residents.
3.     Do regular exercises
4.     Lose weight
5.     Eat fiber rich foods
6.     Drink eight to ten glasses of water daily
7.     Do not take alcohol, soft drinks, and sugary desserts
8.     Avoid bare foot walking
9.     Test urine regularly etc.
10.     Acute changes in clinical condition may present as blood glucose level deviations suggesting the need for further assessment of the underlying cause.
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