Diabetes mellitus disease is also called diabetes.
What is Diabetes Mellitus Disease
When you eat carbohydrates, after digesting it turns into sugar (glucose) which later starts flowing into our blood. Pancrease emits insulin hormone by which the glucose in the blood is absorbed by the cells, creating the energy required for our body.
If for some reason the pancreas stops making insulin, then this glucose will remain in the blood, due to which the blood sugar level will increase. Increasing the amount of sugar in the blood is called diabetes mellitus.
Types of Diabetes Mellitus Disease
There are mainly 3 types of diabetes, which include Type 1, Type 2, and Gestational diabetes.
1. Type 1 diabetes
- It is also called insulin-dependent diabetes.
- This type of diabetes is caused by an autoimmune defect. Immune cells of our body start destroying the beta-cells of our pancreas, which stops the production of insulin.
- This type of problem can be caused by a defect in our gene or due to some type of problem in the insulin-forming cells of the pancreas.
2. Type 2 diabetes
- It is called non-insulin-dependent and adult-onset diabetes, but yet unlike its name it can occur in young children and adolescent children.
- Also, this type of diabetes is more in people who are more obese.
- In this diabetes, the pancreas makes insulin but its quantity is very less.
- Type 2 diabetes occurs in about 90% of people.
3. Gestational diabetes
- There can be a decrease in the amount of insulin produced during pregnancy which can cause diabetes, this is called Gestational diabetes.
- The number of women who have this type of diabetes during pregnancy is about 2-10%.
- Women who develop symptoms of gestational diabetes also develop type-2 type diabetes after a week or year.
Pathophysiology of Diabetes Mellitus Disease
Each type of diabetes is caused by different reasons.
1. Type 1 Diabetes Mellitus
Defect in Gene
↓
Attacking beta cells by immune cells
↓
destruction of beta-cells
↓
No production of insulin
↓
Glucose remains in the blood, which then gradually increases the amount of glucose
↓
Type 1 diabetes mellitus
- When the amount of glucose in the blood is high, then glucose starts coming out of the body through urine. In this situation, more urine comes out to remove the excess glucose in the blood. This condition is called Polyuria.
- Glucose in the blood is not absorbed by cells due to insulin deficiency. In such a situation, fat is used as a source of energy to meet the lack of energy in the body.
- When fat is used by cells, the ketone body begins to form as a byproduct, which comes out with urine.
2. Type 2 Diabetes Mellitus
- In this, insulin is not or very less secreted by the beta cell of the pancreas.
- This allows very little insulin to bind to its receptors. (Due to which small amount of insulin goes inside the cell, which prevents fat breakdown and does not form ketone body)
- The amount of insulin in the blood starts to be higher than normal.
- Symptoms of diabetes are seen in the patient.
3. Gestational Diabetes Mellitus
- Some hormones secreted from the placenta during pregnancy (Cortisol, Human placental lactogen) produce insulin resistance.
- Due to which the level of glucose in the blood starts to increase.
Causes & Risk factors Diabetes Mellitus Disease
Type 1 Diabetes Mellitus
- Genetics - Genetics may be a risk factor for developing type 1 diabetes.
- Environmental factors - Beta cells can be destroyed by exposure to certain environmental factors such as viruses.
Type 2 Diabetes Mellitus
- Weight - Excess weight and obesity can lead to type diabetes as it can inhibit the formation of insulin.
- Sedentary life style - Due to a comfortable lifestyle and lack of exercise, insulin can be reduced in the body.
Gestational Diabetes Mellitus
- Weight - Women who are overweight before pregnancy and who have added extra weight, it becomes harder for the body to use insulin.
- Genetics - If a woman's parents and siblings have type-2 type diabetes, those women are most likely to develop GDM during pregnancy.
Sign & Symptoms of Diabetes Mellitus Disease
- Polyuria or Increased urination - The reason for excess urine is to remove more and more insulin present in the blood, due to which more urine comes than normal.
- Polydipsia or increased thirst - Due to excess outflow of urine, there is a lack of water in the body due to which there is more thirst.
- Polyphagia or increased appetite - Although the person eats more food due to more hunger, the produced glucose does not get into the cells.
- Fatigue and weakness - It's caused by the cells not getting glucose.
- Sudden vision changes - Due to polyuria, there is a lack of fluid in the blood, to compensate for this, the liquid present in the eyes is also pulled into the blood, which makes it difficult to see.
- Tingling or numbness in hands or feet - Due to glucose deficiency in cells.
- Dry skin - Due to polyuria, there is a lack of fluid in the body due to which the skin becomes dry.
- Skin lesions or wounds that are slow to heal - Glucose is unable to enter the cell due to which it remains in the blood. When an injury occurs, the WBCs do not accumulate at the injury site to heal as the glucose in their path causes blockage.
- Recurrent infections - Due to an excess of glucose in the blood, bacteria grow easily at the wound site.
Prevention of Diabetes Mellitus
Type 1 diabetes cannot be prevented because it is caused by immune system problems. But other types of diabetes can be prevented by avoiding or reducing their risk factors.
There are some measures that you can take to prevent type 2 diabetes:
- Do exercises that increase your heartbeat speed for at least 30 minutes daily. Such as brisk walking, cycling, swimming, etc.
- Do not use trans fat and saturated fat in your diet.
- Use fruits, vegetables, and whole grains in your diet.
- Maintain a healthy body weight.
- Drink 7-8 liters of water a day.
- Avoid or reduce the use of refined carbohydrates and sugar from your diet.
Complications of Diabetes Mellitus Disease
If diabetes mellitus is not treated promptly, there may be the following risks:
- Hypoglycemia - Hypoglycemia occurs when the blood sugar levels decrease from 50 to 60 ml/dl due to too much insulin, too little food, or excessive physical activity.
- Diabetic Ketoacidosis - It occurs when your cells are unable to use the glucose in the blood. Therefore, the body has to make necessary energy by breaking down fat, but when fat is broken, the ketone body is also formed along with it. If these ketones start becoming more in the body, then they can also be fatal for the body.
- Neuropathy - If there is too much sugar in the blood, it can damage your nerves. This may cause tingling, numbness, pain, or burning sensation in the hands and feet.
- Diabetic kidney disease - Long-term high blood sugar levels can affect the ability of the kidneys to filter. If it is not treated at the right time, the patient may have to undergo dialysis.
- Hyperglycemic Hyperosmolar Nonketotic Syndrome - In this, the level of sugar in the body is greatly increased but no ketone body is formed or very little (as compared to diabetic ketoacidosis) in the body. This problem is mainly seen in patients with type 2 diabetes.
Assessment & Diagnosis of Diabetes Mellitus Disease
- HbA1C - This test measures how much glucose is bound to red blood cells (RBCs) in your body in the last two to three months.
Result: Less than 5.7% → Normal
Result: Between 5.7 and 6.4% → Prediabetic
Result: 6.5% or more → Diabetes
- Random blood sugar test - In this, blood sugar test can be done at any time, no matter when you last ate your food.
Result: 200 mg/dl or more → Diabetes
- Fasting blood sugar test - A blood sugar test is done after not eating for about 8-12 hours.
Result: Less than 100 mg/dl → Normal
Result: Between 100 and 125 mg/dl → Prediabetic
Result: 126 mg/dl or more → Diabetes
- Oral glucose tolerance test - In this, you are fed a sugary drink and after 2 hours sugar test is done.
Result: Less than 140 mg/dl → Normal
Result: Between 140 and 199 mg/dl → Prediabetic
Result: 200 mg/dl or more → Diabetes
- Serum acetone (ketones) test - In this ketone body is tested.
Diabetes Mellitus Treatment
Medical Management
Medical management for diabetes is as follows:
- Normalizing insulin activity is the most important goal for the treatment of diabetes.
- Injecting insulin to the patient 3-4 times a day, check insulin pump therapy and blood glucose level.
- Taking care of the nutrition of the patient, instruct for exercise, and giving health education to the patient.
Pharmacological Management
Treatment varies for all types of diabetes.
For Type 1 Diabetes Mellitus:
|
Insulin |
Action |
Examples |
|
Rapid-acting insulin |
Start work within 15 minutes and
its effects till 3 to 4 hours |
insulin aspart (NovoLog, FlexPen,
Fiasp) |
|
Short-acting insulin |
Start work within 30 minutes and
its effects till 6 to 8 hours |
Humulin and Novolin |
|
Intermediate-acting insulin |
Start work within 1 to 2 hours and
its effects till 12 to 18 hours |
insulin isophane (Humulin N,
Novolin N) |
|
Long-acting insulin |
Start work within few hours and
its effects till 24 hours to more |
insulin degludec (Tresiba) |
For Type 2 Diabetes Mellitus:
Diet and exercise can help some people in the treatment of type 2 diabetes. If lifestyle changes are not enough to reduce your blood glucose, then you may need to take medication for this.
|
Drugs
Type |
Action |
Examples |
|
Alpha-glucosidase inhibitors |
Slow the process of breakdown of
body suger & starchy food |
Acarbose and miglitol |
|
Glucagon-like peptides |
Encourages the release of insulin
from the pancreas |
Exenatide (Byetta, Bydureon),
Albiglutide (Tanzeum) |
|
Biguanides |
Reduce glucose amount |
Metformin |
|
DPP-4 inhibitors |
Destroys the hormone incretin.
Incretins help the body produce more insulin only when it is needed |
Linagliptin (Tradjenta),
saxagliptin (Onglyza), and sitagliptin (Januvia) |
|
Meglitinides |
Stimulating the release of insulin
in the presence |
Nateglinide (Starlix) and
repaglinide (Prandin) |
|
Sulfonylureas |
Stimulate pancrease for more
insulin |
Amaryl (Glimepiride), Daonil
(Gilbenclamide) |
According to the Mayo Clinic, approximately 10 to 20 percent of women suffering from diabetes during pregnancy need insulin to reduce their blood sugar. (Taking insulin in pregnancy is safe for the baby)
Nursing Management
A nurse should provide accurate information about the patient's condition so that the patient can be treated properly.
For this, the nurse should do the following:
Nursing Assessment
The nurse should assess the following for patients with diabetes:
- Assess the patient’s history - To detect diabetes in the patient, to find out the symptoms of the disease, to find out the amount of glucose in the blood, along with the lifestyle, economical factors of the patient, etc.
- Assess physical condition - Assessing blood pressure when the patient is up and sitting (also called orthostatic changes)
- Assessing the body-mass index.
- Getting a lab test done.
Click Here To See: Nursing Care Plans of Diabetes Mellitus
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