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1、1,Diabetes Mellitus,2,Teaching objectives,grasp the definition and types of diabetes mellitus realize etiology and pathogenesis realize diagnosis and classification grasp the clinical manifestation for the patient with diabetes mellitus be aware of the main lab examination realize the treatment for

2、the patient with diabetes mellitus,3,Introduction,There are more and more people suffer from diabetes with the development of society, population aging and changes of life style.,4,Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia which results from the defec

3、ts of insulin secretion or function, or both.,5,Long-standing diabetes may lead to multisystem damage such as eye, kidney, nerve, heart, blood vessels and so on.,6,Etiology,Etiology and pathology are complex, and still unknown. But it is a syndrome results from compound etiological factor and has re

4、lation to inheritance, autoimmune and environment.,7,Factors associated with diabetes include obesity, aging, and ethnic group.,8,Classification,Type 1 diabetes Stage 1: genetics emotivity Stage 2: start autoimmune Stage 3: immunology abnormality,9,Stage 4: progressive dysfunction of beta cells Stag

5、e 5: clinical diabetes Stage 6: beta cells of the clients who have longtime diabetes are damaged thoroughly, blood insulin level is very low,10,Type 2 diabetes genetics emotivity hyperinsulinism and (or) insulin resistance impaired glucose tolerance (IGT) clinical diabetes,11,Other types include bet

6、a cell genetic defects, endocrinopathies, and drug or chemical-induced diabetes gestational diabetes mellitus,12,Clinical manifestation,Metabolic disorders syndrome: polyuria, polydipsia, polyphagia and weight loss,13,Acute complications of diabetes: DKA, hyperosmolar nonketotic diabetic coma, infec

7、tion,14,DKA,evocation factors surgery, stress, infection, deficiency of insulin dosage, pregnancy, delivery, anesthesia, or illness may trigger DKA,15,Clinical features Classic symptoms of hyperglycemia (polyuria, polyphagia, polydipsia) precede DKA. Other symptoms: nausea, vomiting, abdominal pain,

8、 headache, weakness, fatigue, hyperpnea,16,Lab test Laboratory values will reveal blood glucose from 300 to 600 mg/dl(16.7-33.3mmol/l), and metabolic acidosis. Urine will be positive for glucose and ketones.,17,hyperosmolar nonketotic diabetic coma,evocation factors include illness or other stressor

9、 such as infection, cerebrovascular events, or some drugs.,18,Clinical features lethargy, illusion, disorientation, seizure and coma.,19,Lab test blood glucose is higher than 33.3 mmol/l, usually 33.3-66.6 mmol/l and serum osmolality 350 mmol/l,20,infection,Skin infection, septicaemia, pulmonary tub

10、erculosis,infection of urinary system,21,Chronic complications of diabetes: cardiovascular diseases, nephropathy, diabetic neuropathy, retinopathy, diabetic foot infection,22,Cardiovascular diseases,pain, paresthesia of lower extremeties and intermittent claudication heart failure, arrhythmia, cardi

11、ogenic shock,and sudden death,23,Nephropathy,nephrosclerosis edema, proteinuria, hypertension,24,diabetic neuropathy,numbness, pain and paresthesia of extremeties, muscular atrophy,25,retinopathy : microangiopathy diabetic foot infection: gangrenous,26,27,28,Lab test,urine glucose blood glucose IGT,

12、29,Treatment,Diet maintain as near-normal blood glucose level as possible, achieve optimal serum lipid levels, provide adequate energy.,30,Activity: aerobic exercise Oral glucose-lowering agents: sulfonylurea, biguanides, glucosidase Insulin therapy,31,Insulin Therapy,notice administer insulin as or

13、dered, inject insulin on time with correct type and precise dosage time, position and method of injection side effects of insulin therapy: hypoglycemia, insulin allergy, subcutaneous fat atrophy or proliferation,32,Transplantation of pancreas and islet Treatment for gestational diabetes Treatment fo

14、r DKA : intravenous infusion, insulin therapy, keep balance of electrolyte and acid-base, prevent and manage complications Hyperosmolar nonketotic diabetic coma,33,Nursing process,Assessment Subjective data Objective data,34,Nursing diagnosis 1: Deficient Knowledge: Diabetes, medical regimen, diet, exercise, self-care management skills (insulin injection, SMBG) related to new diagnosis or changes in treatment Nursing diagnosis 2: Imbalanced Nutrition: Less than body requirements related to imbalance between insulin, diet, and activi