Diabetes mellitus is an endocrine disorder of the pancreas gland in which beta cells of the pancreas do not produce enough insulin.

The main feature of diabetes mellitus is hyperglycemia (High blood glucose level) to affects of insulin production and action.

Definition of Diabetes mellitus

• Diabetes mellitus is a chronic metabolic endocrine disorder in which impaired carbohydrate, lipid, and protein metabolism due to insufficient secretion of insulin.
• Obesity is the most common risk factor of diabetes mellitus.

Types of Diabetes mellitus (DM) 

1. Types-1 Diabetes mellitus
2. Type -2 Diabetes mellitus
3. Gestational Diabetes mellitus
4. Secondary Diabetes mellitus
5. Impaired glucose tolerance.

1. Types-1 Diabetes mellitus

Other name of type -1 DM  are –

1. Insulin-dependent diabetes mellitus ( IDDM )
2. Juvenile diabetes mellitus.

Types-1 DM, in which the absence of insulin produced due to destruction of B-cells of pancreas.

Mostly Types-1 DM occur in young peoples, under 30 year ( juvenile DM )

Types-1 DM required daily insulin administration (Hence it is called insulin dependent DM).

Types-1 DM is less prevalent (10% case of DM).

2. Types-2 Diabetes mellitus

• Type-2 DM also called non-insulin-dependent Diabetes mellitus.
• Types-2 DM is more common, classical and ideal DM.
• Types-2 DM is a more prevalent DM (90% case).
• Types-2 DM is also called ” maturity onset DM (because commonly occurs in elder peoples).
• Types-2 DM occurs due to the effect of insulin production, caution and secretion.

3. Gestational Diabetes mellitus  

Generally gestational DM is diagnosed during pregnancy after 24 week of gestational.

4. Secondary Diabetes mellitus – 

Secondary DM is a hyperglycemic condition due to any disease and pathology.

Cause of Diabetes mellitus

• Idiopathic (Unknown)
• Genetic makeup
• Immunological reaction – Types-4 hyper – sensitivity.
• Environmental exposure.

Risk Factors of Diabetes mellitus

• Obesity
• Hypertension
• Cardiovascular disease
• Age
• Physical in activity
• Family history
• Race
• Polycystic ovary disease
• Diet (excessively sweet)
• Sedentary lifestyle.

Clinical Manifestation of Diabetes mellitus

Sign and Symptom in Diabetes mellitus.

• Hyperglycemia
• Polyuria
• Polydipsia
• Polyphagia
• Glycosuria
• Dehydration
• Nausea and vomiting
• Weight loss
• Weakness, fatigue, Restlessness
• Lethargy
• Hypertension
• Delay wound healing.
• Ketoacidosis
• Hyperosmolar hyperglycemic non ketonic syndrome.

Pathophysiology of Diabetes mellitus

Risk factor / cause

↓

Antibody formation

↓

Antigen and antibody reaction

↓

Affect / destroy the beta cell of pancreas

↓

Absence / insufficient production of insulin

↓

Hyperglycemia

↓

Diabetes mellitus

↓

Polyuria, glycosuria, polydipsia, polyphagia.

Diabetes mellitus Diagnosis Examination  

• History collection and physical examination.
• Random blood sugar assesses (if more than 126 mg/dl, DM is positive).
• Urine test – for sugar and ketone bodies.
• Glucose tolerance test ( intake 75 gm. sugar orally )
• Lipid profiles.
• Postprandial blood sugar ( 2 hrs. after meal )
• Glycosylated haemoglobin (HbA1C) – Assess 120 day’s sugar level.

Management of Diabetes mellitus

• Management of diabetes mellitus depends upon type, severity, Etiology and complication.
• Lifestyle modification – Diet modified
•  Regular exercise
• Treat Hypertension.
• Medication – Insulin
• Oral hypoglycaemic agent.
• Health education.

Diet Modification in Diabetes mellitus

• Diet modification is the basic part of DM management.
• Diet manages weight control and sugar control.
• In fat, olive oil polyunsaturated fatty acid (PUFA) is used.
• Use polysaccharide carbohydrates.
• Small frequent diet should be intake.
• Brown Rice and brown braids.
• Low sugar intake.

Exercise in Diabetes mellitus

• Monitor blood glucose level before and after exercise.
• Exercise help to – Reduce body weight
• Decrease cholesterol level
• Improve circulation
• Modify the complication
• Increase insulin production.
• General exercise are – walk
• Physical activity
• Yoga
• Meditation
• Running.

Medication in Diabetes mellitus

• Oral hypoglycaemic agent – decrease blood glucose level.
• Oral hypoglycaemic agent used only type 2 Diabetes mellitus.
• Insulin – Regular (short-acting) insulin
• Long acting insulin
• Intermittent insulin
• Rapid acting insulin.
• Insulin is generally used to treat type 1 DM but sometimes administered in sever Types-2 DM.

Side-effect of insulin

1. Skin allergic reaction
2. Insulin site fat mobilization ( insulin lipodystrophy )
3. Somogyi phenomenon
4. Insulin resistance.

Complication of Diabetes mellitus 

• Hypoglycaemia – Due to excessive insulin production.
• Diabetic ketoacidosis – Due to Types-1 DM.
• Hyperglycaemic hyperosmolar nonketotic syndrome (HHNKS) – generally occurs in Types-2 DM.

Nursing Management of Diabetes Mellitus

• Nurses assess the patient’s general condition and past medical history of the patient.
• Assess type of DM and type of insulin is suitable for the patient.
• Monitor vital signs and blood glucose level.
• Nurses educate patients to decrease body weight.
• Nurses instruct patients for modified lifestyles and change dietary patterns.
• Provide health education and help to maintain a healthy lifestyle.
• Other function of nurse in DM patient –
  • Regular exercise
  • Nutritional modification
  • Help in weight reduction
  • Investigation of blood glucose
  • Provide drugs therapy
  • Health education.
• Instruct patients to avoid any activity that causes any injury and accident.

Diabetes Mellitus Key Points

1. Metabolic disorder of beta cell of the pancreas – Diabetes Mellitus.
2. Complete destruction of insulin production causes the – Types-1 DM.
3. Affect the insulin production cause the – Types-2 DM.
4. Diabetes mellitus during pregnancy – Gestational DM.
5. Most common risk factor of DM – Obesity.
6. Most common clinical DM is – Types-2 DM.
7. Less prevalent and less common DM – Types-1 DM.
8. Which Diabetes mellitus occurs in young people – Types-1 DM.
9. Non-insulin-dependent Diabetes mellitus – Types-2 DM
10. Common complication of Types-1 DM is – Ketotic Acidosis.
11. Common symptoms of diabetes mellitus are – Polyuria, Polydipsia, and Polyphagia.
12. Maturity onset Diabetes mellitus is – Type-2 DM.
13. Sugar provides a glucose tolerance test – 75 gm. orally.
14. Random blood sugar is positive, if blood sugar level – More than 200 mg/dl.
15. Which diagnostic test helps to investigate 120 days sugar history – HbA1C.
16. Which insulin administrator IV – regular insulin.
17. Types-1 DM manage by – Administer of insulin.
18. Which insulin is humulin N – Intermediate acting insulin.
19. Common route of insulin administration – Subcutaneous.
20. Insulin storage in the – Refrigerator.