Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body.
The two types of diabetes are referred to as type 1 and type 2. Former names for these conditions were insulin-dependent and non-insulin-dependent diabetes, or juvenile onset and adult onset diabetes.
Type 1 Diabetes Mellitus
- Associated with HLA DR3 and DR4 and islet cell antibodies around the time of diagnosis. Patients always need insulin treatment and are prone to ketoacidosis.
- The term ‘type 1a diabetes’ is applied to the development of type 1 diabetes resulting from an autoimmune T cell-mediated islet cell destruction.
- Risks of developing type 1 diabetes are broadly similar in all ethnic groups; however, there is increasing evidence that certain infectious agents or certain components of diet in early childhood trigger the development of autoimmunity to the pancreatic beta cells in genetically susceptible individuals.
- Concordance is >30% in identical twins; four genes are thought to be important. One (6q) determines islet sensitivity to damage – eg, from viruses or cross-reactivity from cow’s milk-induced antibodies.
- Approximately 15% of those with diabetes – usually juvenile-onset, but may occur at any age. It may be associated with other autoimmune diseases. It is characterised by insulin deficiency.
Type 2 diabetes Mellitus
- Type 2 diabetes is associated with excess body weight and physical inactivity.
- Type 2 diabetics may eventually need insulin treatment.
- Caused by impaired insulin secretion and insulin resistance and has a gradual onset.
- All racial groups are affected but increased prevalence in people of South Asian, African, African-Caribbean, Polynesian, Middle-Eastern and American-Indian ancestry.
- Approximately 85% of those with diabetes; they are usually older at presentation (usually >30 years of age) but it is increasingly diagnosed in children and adolescents.
Symptoms of diabetes can develop suddenly (over days or weeks) in previously healthy children or adolescents, or can develop gradually (over several years) in overweight adults over the age of 40. The classic symptoms include feeling tired and sick, frequent urination, excessive thirst, excessive hunger, and weight loss.
Ketoacidosis, a condition due to starvation or uncontrolled diabetes, is common in Type I diabetes. Ketones are acid compounds that form in the blood when the body breaks down fats and proteins. Symptoms include abdominal pain, vomiting, rapid breathing, extreme lethargy, and drowsiness. Patients with ketoacidosis will also have a sweet breath odor. Left untreated, this condition can lead to coma and death.
With Type II diabetes, the condition may not become evident until the patient presents for medical treatment for some other condition. A patient may have heart disease, chronic infections of the gums and urinary tract, blurred vision, numbness in the feet and legs, or slow-healing wounds. Women may experience genital itching.
Nursing Diagnosis related to Diabetes Mellitus
1. Risk for Infection
high glucose levels
reduction in leukocyte function.
2. Imbalanced Nutrition, Less Than Body Requirements
poor nutrition intake.
3. Fluid Volume Deficit
osmotic diuresis (hyperglycemia).
4. Activity Intolerance
5. Knowledge Deficit: about the disease process
related tyo: lack of information.
6. Risk for Impaired Skin Integrity