Diabetes Mellitus Type 2

1. Diabetes Mellitus Type 2Diabetes Mellitus Type 2
Submitted by:Submitted by:
Maribel Lacerna EspinosaMaribel Lacerna Espinosa
Aileen MacuroyAileen Macuroy
Dave Jay ManriquezDave Jay Manriquez
Submitted to:Submitted to:
Len GriffithLen Griffith

2. Video Presentation:
Diabetes Mellitus Type 2

3. Diabetes MellitusDiabetes Mellitus
A heterogeneous group of disordersA heterogeneous group of disorders
characterized by an elevation in thecharacterized by an elevation in the
level of glucose in the blood.level of glucose in the blood.
In Diabetes there may be a decrease inIn Diabetes there may be a decrease in
the body’s ability to respond to insulinthe body’s ability to respond to insulin
and/or a decrease or absence of insulinand/or a decrease or absence of insulin
produced by the pancreas.produced by the pancreas.

4. How will you know if youHow will you know if you
are a diabetic?are a diabetic?
 If you urinate frequently, experience excessiveIf you urinate frequently, experience excessive
thirst and unexplained weight loss.thirst and unexplained weight loss.
 If your casual blood sugar (plasma glucose)If your casual blood sugar (plasma glucose)
level is higher than 11 mmol/L.level is higher than 11 mmol/L.
 If you have fasting plasma glucose level of notIf you have fasting plasma glucose level of not
more than 7 mmol/L.more than 7 mmol/L.

5. Who are at risk of diabetes?Who are at risk of diabetes?
children of diabeticschildren of diabetics
obese peopleobese people
people with hypertensionpeople with hypertension
people with high cholesterol levelspeople with high cholesterol levels
people with sedentary lifestylespeople with sedentary lifestyles

6. Diabetes Mellitus Type 2Diabetes Mellitus Type 2
 Type 2: About 90% to 95% of people withType 2: About 90% to 95% of people with
Diabetes. Cause by a decrease in theDiabetes. Cause by a decrease in the
sensitivity of the cells to insulin and thesensitivity of the cells to insulin and the
decrease in the amount of insulin produced. Itdecrease in the amount of insulin produced. It
can be treated with diet, oral hypoglycemiccan be treated with diet, oral hypoglycemic
agents and insulin injections. It occurs mostagents and insulin injections. It occurs most
frequently in people who are over 30 years offrequently in people who are over 30 years of
age and obese.age and obese.

7. Pathophysiology
Pancrease
Indogenous Insulin
Obesity, Hereditary, Ethnic Group, History of Gestational Diabetes
Insulin
Resistance
Decrease in the
ability of pancreas
to produce insulin
Inappropriate
glucose
production by the
liver
Adipocytokines
(altercation in the
production of hormones
and cytokines by
adipose tissue
Hyperglycemia
Diabetes Mellitus Type 2

8. There are drug therapies using oral hypoglycemicThere are drug therapies using oral hypoglycemic
agents. Your doctor can prescribe one or two agent,agents. Your doctor can prescribe one or two agent,
depending on which is appropriate for you.depending on which is appropriate for you.
1. Sulfonylurea – Glibenclamide, Gliclazide,1. Sulfonylurea – Glibenclamide, Gliclazide,
Glipizide, Glimepiride, RepaglinideGlipizide, Glimepiride, Repaglinide
2. Biguanide – Metformin2. Biguanide – Metformin
3. Alpha-glucosidase Inhibitors – Acarbose3. Alpha-glucosidase Inhibitors – Acarbose
4. Thiazolidindione – Troglitazone, Rosiglitazone,4. Thiazolidindione – Troglitazone, Rosiglitazone,
Proglitazone.Proglitazone.

9. Insulin Therapy….Insulin Therapy….
ONSETONSET PEAKPEAK DURATIONDURATION CONSISTENCYCONSISTENCY
Short actingShort acting
insulininsulin
• RegularRegular
•SemilenteSemilente
½ to 1 hour½ to 1 hour
1 to 2 hours1 to 2 hours
2 to 4 hours2 to 4 hours
4 to 6 hours4 to 6 hours
6 to 8 hours6 to 8 hours
8 to 12 hours8 to 12 hours
ClearClear
ClearClear
IntermediateIntermediate
acting insulinacting insulin
• NPHNPH
• LenteLente
3 to 4 hours3 to 4 hours
SameSame
8 to 16 hours8 to 16 hours
SameSame
20 to 2420 to 24
hourshours
SameSame
CloudyCloudy
CloudyCloudy
Long actingLong acting
insulininsulin
• UltralenteUltralente 6 to 8 hours6 to 8 hours 14 to 2014 to 20
hourshours
30 to 3630 to 36
hours orhours or
greatergreater
CloudyCloudy

10. Signs and Symptoms of Hyperglycemia
 Blood glucose level greater than 7 mmol/L
 Blurry vision
 Difficulty concentrating
 Frequent urination
 Headache
 High blood glucose
 High levels of sugar in the urine
 Increase fatigue

11. Health Teachings/ Nursing Interventions:
 Assessing learning needs
 Assessing physical, cognitive, and emotional
limitations
 Counseling
 Psychosocial preparation
 Home care management
 Health care resources
 Complementary and alternative therapies

12. Expected Outcomes
 Patient Verbalizes key elements of the
therapeutic regimen, including knowledge of
disease and treatment plan.
 Describes self-care measures that may
prevent or decrease progression of chronic
complications.
 Maintains a balance of nutrition activity,
and insulin availability that results in normal
blood glucose levels and optimum weight.

13. Complications of DiabetesComplications of Diabetes
 Macrovascular (large vessel) diseaseMacrovascular (large vessel) disease
 Cardiovascular diseaseCardiovascular disease
 Cerebrovascular diseaseCerebrovascular disease
 Microvascular (small vessel) diseaseMicrovascular (small vessel) disease
 Retinopathy (vision problems)Retinopathy (vision problems)
 Diabetic nephropathyDiabetic nephropathy
 Neuropathic diseasesNeuropathic diseases
 Diabetic neuropathyDiabetic neuropathy
 Impotence (Male erectile dysfunction)Impotence (Male erectile dysfunction)

14. Foot and Leg Problems in DiabetesFoot and Leg Problems in Diabetes
55% to 75% of lower extremity amputations are performed55% to 75% of lower extremity amputations are performed
on people with Diabetes. 50% of these amputations areon people with Diabetes. 50% of these amputations are
preventable, provided patients are taught preventivepreventable, provided patients are taught preventive
foot care measures and practice preventive foot care onfoot care measures and practice preventive foot care on
a daily basis.a daily basis.
Three diabetic complications contribute to the increasedThree diabetic complications contribute to the increased
risk of foot infections. They are:risk of foot infections. They are:
A. NeuropathyA. Neuropathy – Sensory neuropathy leads to loss of pain– Sensory neuropathy leads to loss of pain
and pressure sensation, and autonomic neuropathy leadsand pressure sensation, and autonomic neuropathy leads
to increased dryness and fissuring of the skin (secondaryto increased dryness and fissuring of the skin (secondary
to decreased sweating).to decreased sweating).

15. Foot and Leg Problems in DiabetesFoot and Leg Problems in Diabetes
B. Peripheral vascular diseaseB. Peripheral vascular disease – Poor circulation of the lower– Poor circulation of the lower
extremities contributes to poor wound healing and theextremities contributes to poor wound healing and the
development of gangrene.development of gangrene.
C. ImmunocompromiseC. Immunocompromise – Hyperglycemia impairs the ability of– Hyperglycemia impairs the ability of
specialized leukocytes to destroy bacteria. Thus, in poorlyspecialized leukocytes to destroy bacteria. Thus, in poorly
controlled diabetes there is a lowered resistance tocontrolled diabetes there is a lowered resistance to
certain infections.certain infections.
 Diabetic foot ulcer begins with a soft tissue injury of theDiabetic foot ulcer begins with a soft tissue injury of the
foot, the injury or fissure may go unnoticed until a seriousfoot, the injury or fissure may go unnoticed until a serious
infection has developed. Drainage, swelling, redness (frominfection has developed. Drainage, swelling, redness (from
cellulitis) of the leg, or gangrene may be the first sign ofcellulitis) of the leg, or gangrene may be the first sign of
foot problems that the patient noticesfoot problems that the patient notices

16. Foot and Leg Problems in DiabetesFoot and Leg Problems in Diabetes
 Treatment of foot ulcers involves bed rest, antibiotics, andTreatment of foot ulcers involves bed rest, antibiotics, and
debridement.debridement.
 Preventive foot care includes properly bathing, drying, and lubricatingPreventive foot care includes properly bathing, drying, and lubricating
feet (care must be taken not to allow moisture to accumulate fromfeet (care must be taken not to allow moisture to accumulate from
water or lotion between the toes.)water or lotion between the toes.)
 Feet must be inspected on a daily basis for any redness, blisters,Feet must be inspected on a daily basis for any redness, blisters,
fissures, calluses or ulcerations.fissures, calluses or ulcerations.
 Feet should be examined on a regular basis by a podiatrist, physician,Feet should be examined on a regular basis by a podiatrist, physician,
or nurse.or nurse.
 Patients should be taught to wear well-fitting, closed toe shoes.Patients should be taught to wear well-fitting, closed toe shoes.
 High risk behaviors should be avoided, such as walking barefoot, usingHigh risk behaviors should be avoided, such as walking barefoot, using
heating pads on the feet, wearing open toed shoes, and shavingheating pads on the feet, wearing open toed shoes, and shaving
calluses.calluses.

17. A Gangrene Foot….A Gangrene Foot….

18. Risk for injury related to sensory alterations
 Interventions and foot care practices:
 Cleanse and inspect the feet daily
 Wear properly fitting shoes
 Avoid walking barefoot
 Trim toenails properly
 Report non-healing breaks in the skin

19. What can you do to control your bloodWhat can you do to control your blood
sugar? Non-pharmacological Interventionssugar? Non-pharmacological Interventions
1.1.Diet TherapyDiet Therapy
2. Exercise2. Exercise
3. Control your weight3. Control your weight
4. Quit smoking.4. Quit smoking.
5. Maintain a normal blood5. Maintain a normal blood
pressurepressure
6. Keep cholesterol normal6. Keep cholesterol normal

20. Cultural Diversity and Traditional Healing Practices:
It is important that patients with diabetes consult with their
health care provider before using herbs or nutritional
supplements.
Hypoglycemic herbs and supplements: aloe, fish, oils, goldenseal,
bilberry eleuthero, ginseng, milk thistle, Chinese cinnamon, and
sage
Hyperglycemic herbs and supplements: St. John’s wort, celery
seeds, rosemary, and melatonin.

21. RememberRemember
If you have the classic symptoms of diabetes:If you have the classic symptoms of diabetes:
* See your doctor for blood sugar testing* See your doctor for blood sugar testing
* Start dieting* Start dieting
* Eat plenty of vegetables* Eat plenty of vegetables
* Avoid sweets such as chocolates and cakes* Avoid sweets such as chocolates and cakes
* Cut down on fatty foods* Cut down on fatty foods
* Exercise regularly* Exercise regularly
* If you are obese, try to lose some weight* If you are obese, try to lose some weight
* Avoid alcohol drinking and stop smoking* Avoid alcohol drinking and stop smoking
* If you are hypertensive, consult your doctor* If you are hypertensive, consult your doctor
for advice and managementfor advice and management

22. Review Questions
1.What are polydipsia and polyuria related to diabetes mellitus
primarily caused by?
a.The release of ketones from the cells during fat metabolism.
b.Fluid shifts resulting from the osmotic effect of hyperglycemia.
c.Damage to the kidneys from the exposure to high levels of glucose.
d.Changes in red blood cells resulting from attachment of excessive
glucose to hemoglobin.
Answer: Fluid shifts resulting from the osmotic effect of
hyperglycemia.

23. 2. The nurse is responsible for counselling the person with
diabetes regarding lifestyle changes. Which of the following
would be appropriate for the nurse to discuss?
a.The use of the same diabetes diet for all people with diabetes.
b.The importance of calorie restriction to control blood sugars.
c.The use of Canada’s Food Guide to support a well balanced
nutrition plan.
d.The importance of carbohydrate counting and insulin
adjustment for all people with diabetes.
Answer: The use of Canada’s Food Guide to support a well
balanced nutrition plan.

24. 3. Which of the following is an appropriate therapy for patients
with diabetes mellitus?
a.Use of diuretics to prevent and treat renal problems.
b.Use of angiotensin-converting enzyme inhibitors to prevent
and treat renal problems.
c.Use of commercial remedies or sharp blades to remove
calluses or corns.
d.Use of sugar-free drinks to treat hypoglycemia.
Answer: Use of angiotensin-converting enzyme inhibitors to
prevent and treat renal problems.

25. 4. What does effective collaborative management of diabetes
include?
a.Using insulin with all patients to achieve glycemic goals.
b.Relying on the health care provider as the central figure in the
program for good control.
c.Relying solely on nutritional therapy as the initial treatment
modality for all patients with diabetes.
d.Aiming for a balance of nutrition, activity, and medications together
with appropriate monitoring and patient and caregiver teaching.
Answer: Aiming for a balance of nutrition, activity, and
medications together with appropriate monitoring and patient and
caregiver teaching.

26. Bibliography
Psaltopoulou, T., Ilias, I., Alevizaki, M. (2010). The role of diet and lifestyle in primary,
secondary, and tertiary diabetes prevention: A review of meta-analysis. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923378/
Deng, F., Zhang, A., Chan, C. (2013). Acculturation, Dietary Acceptability, and Diabetes
Management among Chinese in North America. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753561/
Barry, M., Goldsworthy, S., Goodridge, D. (2014). Medical-Surgical Nursing in Canada:
Assessment and management of clinical problems. Third Canadian Edition. p. 1429-1432,
1448, 1453-1454.
Nanda Nursing Intervention. (2009). Nursing Intervention for Diabetes. Retrieved from
http://nanda-nursinginterventions.blogspot.ca/2011/05/nursing-intervention-for-
diabetes.html