Diabetes Mellitus Type 2
Diabetes Mellitus Type 2
Diabetes Mellitus Type 2
MELLITUS
TYPE II
INTRODUCTION
Diabetes, a life long disease which is caused by reduced production of
insulin, or by decreased ability to use insulin. Insulin, the hormone produced by the beta
cells in the pancreas, allows blood sugar (glucose) cells to be able to use blood sugar.
This hormone is necessary for glucose to go from the blood to the inside of the body
cells. With inadequate insulin, glucose builds up in the bloodstream instead of going into
the cells. The body is unable to use glucose for energy despite the high levels of glucose
in the bloodstream. This causes the excessive thirst, urination, and hunger, which are the
most common symptoms of diabetes. The excess sugar remains in the blood and is then
removed by the kidneys. This disease occurs in several forms, but the most common are
Type I Diabetes or Juvenile Onset Diabetes or Insulin-Dependent Diabetes Mellitus
(IDDM), Type II or Non Insulin-Dependent Diabetes Mellitus (NIDDM), and
Gestational.
In Type 1 diabetes, the classic symptoms are excessive secretion of urine
(polyuria), thirst (polydipsia), weight loss and tiredness. These symptoms may be less
marked in Type 2 diabetes. In this form, it can also happen that no early symptoms appear
and the disease is only diagnosed several years after its onset, when complications are
already present.
Prevalence. Recently compiled data show that approximately 150 million people
have diabetes mellitus worldwide, and that this number may well double by the year
2025. Much of this increase will occur in developing countries and will be due to
population growth, ageing, unhealthy diets, obesity and sedentary lifestyles. By 2025,
while most people with diabetes in developed countries will be aged 65 years or more, in
developing countries most will be in the 45-64 year age bracket and affected in their most
productive years.
Diagnosis. WHO has published recommendations on diagnostic values for blood
glucose concentration. The diagnostic level of fasting blood glucose concentration was
last modified in 1999.
Most complications are the result of problems with blood vessels. Glucose levels
that remain high over a long time cause both the small and large blood vessels to narrow.
The narrowing reduces blood flow to many parts of the body, leading to problems. There
are several causes of blood vessel narrowing. Complex sugar-based substances build up
in the walls of small blood vessels, causing them to thicken and leak. Poor control of
blood glucose levels also tends and decreased blood flow in the larger blood vessels.
Atherosclerosis leads to heart attacks and strokes. Atherosclerosis is between 2 and 6
times more common and tends to occur at a younger age in people with diabetes than in
people who do not have diabetes.
Over time, elevated levels of glucose in the blood and poor circulation can harm
the heart, brain, legs, eyes, kidneys, nerves, and skin, resulting in angina, heart failure,
strokes, leg cramps during walking (claudication), poor vision, kidney failure, damage to
nerves (neuropathy), and skin breakdown.
Poor circulation to the skin can lead to ulcers and infections and causes wounds to
heal slowly. People with diabetes are particularly likely to have ulcers and infections of
the feet and legs. Too often, these wounds heal slowly or not at all, and amputation of the
foot or part of the leg may be needed.
Prognosis. The prognosis in patients with diabetes mellitus is strongly influenced
by the degree of control of their disease. Chronic hyperglycemia is associated with an
increased risk of microvascular complications, as shown in the Diabetes Control and
Complications Trial (DCCT) in individuals with type 1 diabetes and the United Kingdom
Prospective Diabetes Study (UKPDS) in people with type 2 diabetes.
Epidemiology. A 2011 Centers for Disease Control and Prevention (CDC) report
estimated that nearly 26 million Americans have diabetes. Additionally, an estimated 79
million Americans have prediabetes.
Race-related demographics. The prevalence of type 2 diabetes mellitus varies
widely among various racial and ethnic groups. The image below shows data for various
populations. Type 2 diabetes mellitus is more prevalent among Hispanics, Native
Americans, African Americans, and Asians/Pacific Islanders than in non-Hispanic whites.
Indeed, the disease is becoming virtually pandemic in some groups of Native Americans
and Hispanic people. The risk of retinopathy and nephropathy appears to be greater in
blacks, Native Americans, and Hispanics.
PATIENTS PROFILE
Name:
CS
Age:
55 y/o
Birthday:
Gender:
Female
Civil Status:
Married
Address:
Educational Attainment:
College Graduate
Occupation:
Religion:
Roman Catholic
Chief Complaint:
Mode of Arrival:
Via wheelchair
Admitting Diagnosis:
Final Diagnosis:
Sources of Information:
LIFESTYLE
According to her, in the morning she does household chores, helps her children in
preparing for school and goes to work fro 8 hours. She eats 3 times a day. Her 24 hour
dietary intake includes: her breakfast consists of 2 cups of rice, instant noodles, egg and 1
glass of milk, her lunch is usually consist of 2 cups of rice, fried chicken, spaghetti and
coke that is usually served in her work place, her supper is 2-3 cups of rice, fried fish,
vegetables and a glass of water. She doesnt smoke and drinks alcohol. Her husband is the
one who purchases their meal and shes the one who prepares it. She considers her
activities of daily living as her exercise. She sleeps at night for about 6-8 hours without
any interruptions. According to her she is well rested. She finds herself good and
contented. There were no difficulties in performing her self-care activities prior to
hospitalization. She usually spends her free time caring and playing with her children and
sometimes talking to their neighbor. She has a good relationship with her husband,
children, relatives and neighbors.
SOCIAL BACKGROUND
CS is 55 years old. She is a mother of three. She and her husband finance the family. But
now that she is hospitalized her husband and her eldest child help in the finances. She
also stated that she has a good relationship with her family, neighbors and co-workers.
BEFORE HOSPITALIZATION:
According to the patient, Health is the state of having no signs and symptoms of illness
and also the state wherein she can do her work without easily getting tired. She stated
that she uses herbal medicines when she got wound such as Kutsay. She also stated
that, she uses over the counter drug such as Paracetamol, Neozep and Amoxicillin
whenever she experienced minor illness such as muscle pain, colds, cough, fever, and
head ache. And when those medicines didnt cure her illness and her condition worsens
that the time that she will seeks medical advice.
DURING HOSPITALIZATION:
The patients perception on health did not change. She states that general state of
her health is fine. She noticed slight changes to her body while she was at hospital. mas
tumaba pa nga ako ngayong naconfine ako as verbalized by the patient. However, she
displays signs of weakness on exertion and ability to conduct usual activities is impaired.
She manages her health by following doctors orders and responding to every nurses
interventions.
II.
BEFORE HOSPITALIZATION:
She eats 3 times a day. Her 24 hour dietary intake includes: her breakfast consists
of 2 cups of rice, instant noodles, egg and 1 glass of milk, her lunch is usually consist of 2
cups of rice, fried chicken, spaghetti and coke that is usually served in her work place,
her supper is 2-3 cups of rice, fried fish, vegetables and a glass of water. She doesnt
smoke and drinks alcohol. Her husband is the one who purchases their meal and shes the
one who prepares it.
DURING HOSPITALIZATION:
She eats three times a day that were served from dietary section which consists of
1 cup of rice, main dish and unsweetened dessert. She drinks 5-6 glasses of water a day.
She was hooked to Intravenous Fluid PNSS 1L x 12 hours.
III.
ELIMINATION PATTERN
BEFORE HOSPITALIZATION:
According to the patient, she voids 8-10 times a day without experiencing any
pain, approximately 1500-2000 ml per day as verbalized. She had a bowel elimination of
1-2 times a day without any difficulties and pain. Her stool is semi-formed and the color
is golden brown. She doesnt use enema or suppositories.
DURING HOSPITALIZATION:
She urinates 8-9 times a day, approximately 1800-2000 ml per day without any
difficulties and discomfort characterized as yellowish to clear urine and verbalized
mapanghi. She defecates 2-3 times a day with semi formed, brownish stool without any
discomfort.
IV.
BEFORE HOSPITALIZATION:
Her activities in a normal day were doing the household chores, helping her
children prepares for school and goes to work for 8 hours. After the work whenever she
had a free time, her leisure activities were watching T.V and sometimes having a
conversation with her neighbours. She is the one who prepares their food and wash their
dishes after eating. She considers her ADLs as her form of exercise and dont complaint
any difficulties of doing it.
DURING HOSPITALIZATION:
She can walk and has no activity restrictions. She does her ADLs independently
without any difficulties but her husband assists her when she goes to CR. She considers
walking around her room and doing her ADLs as her form of exercise.
V.
SLEEP-REST PATTERN
BEFORE HOSPITALIZATION:
She has no difficulty getting sleep. She sleeps 6 to 8 hours at night usually from 9
pm to 5 am, and it is sometimes interrupted because she has the urge to void but gets her
sleep back easily. According to her, even though her sleep pattern is sometimes
interrupted, she feels rested upon awakening the next day. She doesnt take any medicines
that aid her to sleep aside from taking a glass of milk every night before getting to bed.
DURING HOSPITALIZATION:
According to the patient, she sleeps about 8-10 hours at night and it is usually
interrupted due to the hospital routines like vital signs taking, and drug administration.
Parang kulang pa rin ang tulog ko pag gabi kasi paputol putol dahil sa pagvavital signs
at pagbibiga ng mga gamot. She does not take any sleeping aid or pills.
VI.
BEFORE HOSPITALIZATION:
The patient is College Graduate. She can understand English, Ilokano and
tagalong. She can understand instructions and can communicate well. She is able to
decide on her own, but sometimes, she seeks the opinion of her husband. According to
her, her five senses were functioning well. She did not have any problem in her vision,
hearing, ability to feel, taste and smell. She does not use any prosthesis to aid her senses.
DURING HOSPITALIZATION:
She is oriented to time, place and is able to communicate well and can understand
instructions. According to patient her, she does not have any problem in her vision,
hearing, ability to feel taste, and smell. . He responds to both verbal and non-verbal
stimuli.
VII.
BEFORE HOSPITALIZATION:
According to the patient, she is a jolly and a friendly person .She describes herself
as an individual who contributes to the happiness of the family. She considers herself as
being optimistic but sometimes pessimistic. She also mentioned that she is contented in
her life because of the love and support given by her family. She also said that shes
satisfied on the way she looks, and she has no plan of changing her physical appearance.
DURING HOSPITALIZATION:
She verbalized, Medyo mahina ako ngayon, pero kayang kaya ko pa namang
gawin yung
mga dati kong ginagawa bago ako maospital. She tries her best to
maintain her hygiene. Gagaling din ako, kailangan ko lang sundin ang mga sinasabi ng
doctor at mga nurse ko.
VIII. ROLE-RELATIONSHIP PATTERN
BEFORE HOSPITALIZATION:
The patient is the fourth child of her parent. She lives with her husband together
with her three children. According to her, she has a good relationship among the members
of the family. She also stated she does her best to be a good wife, and a mother to her
children.
During Hospitalization
According to her, she is thankful because she has a good family that are always
there to support her. She stated that when she will be discharge she will do her job being a
good mother, husband and member of the family. She still involves herself in decision
making. According to her, their relationship among the members of the family became
stronger when was hospitalized.
IX.
SEXUALITY-REPRODUCTIVE PATTERN
BEFORE HOSPITALIZATION:
She experienced her first menstruation at the age of 14 years old with a duration
of usually 3-4 days. She never had noticed any bleeding between her menstrual cycles.
She sometimes experience dysmenorrhea. Her coitarch was with her husband when she
was 23 years old. She uses Contraceptive pills as a form of their family planning.
According to her, she is contented to her husband thats why she does not engage to any
sexual relationship outside marriage.
DURING HOSPITALIZATION:
She shows affection to her husband by hugging and kissing. Her condition doesnt
seem affected on how they show love and care to each other. Moreover, this binds them
more as family.
X.
BEFORE HOSPITALIZATION:
She stated that when she has a problem she usually keep silent and usually think
that everything will be alright instead of doing things or wasting her time for nonsense
thing which can not help in solving the problem. But when she cant tolerate it anymore
thats the time that she will cry and ask for help. She stated that she asked help first to
God, then to her husband and family. She solves the problem without giving up
.During Hospitalization
She considers her condition right now as the most stressful event happened in her
life. She uses the same coping mechanism.
XI.
VALUE-BELIEF PATTERN
BEFORE HOSPITALIZATION:
The patients religious affiliation is Roman Catholic. She is attending mass with
her family often. She recognized God as source of strength and her also expresses her
faith and concerns to deceased person through atangs. She also believes in the power of
albularyos thats why she seeks some alternative medicines for sometimes. Her family
is the most important person in her life.
DURING HOSPITALIZATION:
According to the patient she shows communication to God through his prayers
and asks for recovery. She always prays before she sleeps. She still recognized God as
her source of strength.
NORMAL
RESULT
FINDING
110-170 g/L
NORMAL
concentration (Hgb)
Erythrocyte Volume 0.472
0.37-0.480
NORMAL
Fraction (hct)
Erythrocyte number 4.82
3.5-5.0 x 109/L
NORMAL
Hemoglobin
ACTUAL
FINDING
Mass 155
ANALYSIS
concentration
(RBC)
THROMBOCYTE
180
150-450 x 109/L
NORMAL
(Platelet)
LEUKOCYTE
11
4.0 x 109/L
INCREASED
(WBC
Due to injury to
the
endothelial
wall caused by
increased
pressure in the
wall
to
secondary
sluggish
circulation.
ACTUAL
NORMAL
RESULT
ANALYSIS
FINDING
110-170 g/L
NORMAL
concentration (Hgb)
Erythrocyte Volume 0.465
0.37-0.480
NORMAL
Fraction (hct)
Erythrocyte number 4.85
3.5-5.0 x 109/L
NORMAL
Hemoglobin
FINDING
Mass 150
concentration
(RBC)
THROMBOCYTE
186
150-450 x 109/L
NORMAL
(Platelet)
LEUKOCYTE
7.8
4.0 x 109/L
NORMAL
(WBC
BLOOD CHEMISTRY
August 20, 2015
PARAMETER
ACTUAL
NORMAL
RESULT
ANALYSIS
Sodium
Potassium
FINDING
140.5
2.8
FINDING
135-148mEq/L
3.5-5.30mEq/L
NORMAL
DECREASED
Due to frequent
urination,
potassium loss
occurs
Creatinine
0.70
0.50-0.90
mg/dl
URINALYSIS
NORMAL
RADIOGRAPHIC STUDIES
Chest X-RAY AP
August 20, 2015
PHYSICAL ASSESSMENT
DATE OF ASSESSMENT: AUGUST 22, 2015
MENTAL STATUS
LEVEL OF CONCIOUSNESS: The patient is fully awake, alert, conscious, and coherent
and responds to question spontaneously.
ORIENTATION: The patient is oriented to person, time and place as she recognized other
persons and herself and is aware of when and where she presently is.
APPEARANCE AND BEHAVIOR: The patient is well- dressed and properly groomed.
She is cooperative and can follow instruction appropriately.
SPEECH: The patient can speak and express herself clearly.
VITAL SIGNS:
BP: 150/90 mmHg
RR: 21cpm
PR: 99bpm
Temperature: 37.8
AREA
TECHNIQUE
NORMAL
ACTUAL
ANALYSIS
ASSESSED
Head
USED
Inspection,
FINDING
Normocephalic,
FINDINGS
Normocephalic,
Normal
Palpation
symmetrical,
symmetrical, absence
dandruff, dandruff,
inflammation,
eruption
swelling.
inflammation,
and eruption
swelling.
and
Hair
Inspection
distributed, Normal
finely
distributed,
distributed, finely
straight
and
Inspection
sores.
Symmetrical,
sores.
no Symmetrical,
no Normal
lesions
no lesions
no
and
edema.
and
edema.
Eyes
Eyebrows
Inspection
Hair
evenly Hair
evenly Normal
Conjunctiva
Cornea/Sclera
movement.
Skin intact,
Palpation
Inspection
Inspection
movement.
w/o Skin intact,
w/o Normal
redness
and nodules.
nodules.
Pinkish
Pinkish
Normal
Whitish, cornea is Whitish, cornea is Normal
and
shiny transparent,
smooth
positive
Inspection
equal
transparent,
Pupils
and
Inspection,
swelling,
equally
smooth
blinking positive
reflex.
Black
in
equal
in
reactive
and and
to
shiny
and
blinking
reflex.
color, Black in color, equal Normal
size, in size, reactive to
light, light, visual acuity is
visual
acuity
is normal,
can
see
in
the
normal,
can
see objects
objects
in
w/o
w/o congestion,
edema,
Inspection
or growth.
and No
edema
Ears
palpation
Inspection
tearing
and Color same as the Color same as the Normal
Palpation
or No edema or tearing
facial skin
Both
facial skin
ears
are Both
symmetrical,
Auricle
with
Normal
ears
are
symmetrical,
lesions, tenderness,
redness,
Nose
Inspection
palpation
scaling
clean.Has
the
ability to hear.
and No
discharges, No
ulceration, growth, ulceration,
discharges, Normal
growth,
nasal
polyps, nasal
polyps,
mucous
and obstruction
and
to
smell. ability
Sinuses
Inspection
smell.
no Sinuses
tenderness
Lips
to
no
tenderness
No nasal flaring
No nasal flaring
Uniform, pink in Uniform, pink
in Normal
and Inspection
and smooth
smooth
Tongue at midline Tongue at midline Normal
tongue
Teeth
tenderness.
Complete,
Inspection
tenderness
white,
Complete,
white, Normal
Inspection
palpation
free of debris
free of debris
and Negative neck vein Negative neck vein Normal
distention
distention
No masses
No masses
No tenderness
No tenderness
to flex
and
extend
the
neck extend
without
RESPIRATORY
Chest and lungs
Inspection
the
any without
neck
any
discomfort
discomfort
Symmetric
chest Symmetric
chest Normal
expansion,
quiet, expansion,
quiet,
rhythmic
and rhythmic
and
effortless
effortless respiration
respiration
RR=12-20 cpm
RR=12-20 cpm.
Palpation
Auscultation
(-)
masses
adventitious (-)
breath sounds
adventitious Normal
breath sounds
Cardiovascular
Auscultation
regular sounds,
regular
Inspection
ECG
100bpm
rhythm.
abnormal
Abdomen
No and
heart
rate
rhythm.
No
ECG abnormal
Inspection
reading
Unblemished
Auscultation
reading
skin Unblemished
Palpation
sound
No
skin NORMAL
sounds
of
bruit
sound
tenderness, No tenderness, relax Normal
relax abdomen
INTEGUMENTS
ECG
abdomen
Skin color
Inspection
Normal
dark brown
Skin
color Inspection
uniformity
General
except
uniform General
on
areas except
exposed to sun
Skin Turgor
Palpation
When
uniform Normal
on
areas
exposed to sun
back
to
previous state
previous state
Inspection
Convex
Convex
Normal
Inspection
Normal
Nails
Fingers and toes
Nail bed color
pinkish
Texture
Extremeties
Palpation
Inspection
palpation
Smooth to touch
Smooth to touch
Normal
and No lesions, edema, Noted with wounds Due to
slug
circulation, oxy
supply
move
can
freely
and
ambulate
independently.
(+) weakness
to
lo
extremities
decreases
cau
increase more. People older than 65 years tend to have slightly higher levels, especially
after eating.
If the body does not produce enough insulin to move the glucose into the cells, or if the
cells stop responding normally to insulin, the resulting high levels of glucose in the blood
and the inadequate amount of glucose in the cells together produce the symptoms and
complications of diabetes.
PATHOPHYSIOLOGY
OF
DIABETES MELLITUS
TYPE II
ETIOLOGY: UNKNOWN
PRECIPITATING FACTOR
-Obesity
-Genetics
-Hypertension
-Diet
-Occupation
-Gender
-Sedentary Lifestyle
-Stress, Trauma, Surgery
OSMOTIC DIURESIS
POLYDIPS
THIRST
IA
POLYPHAG
Potassium Loss
LIPOLYSIS
wt.
GLUCOSURI
LOSS
CELLULAR DHN
CELLULAR STARVATION
POLYPHAGIA
LIPOLYSIS (FATS)
DIABETIC KETOACIDOSIS
KIDNEY
ACTIVATION OF RAAS
ACETONE BREATH
KETONURIA
KUSSMAULS RESPIRATIONS
MACROVASCULAR
BLOOD VESSEL WALLA THICKEN SCLEROSE AND
OCCLUDED BY PLAQUE
Coronary Artery Disease
Cerebrovascular Disease
Peripheral Vascular Disease
>Diminished Peripheral Pulses
>Intermittent Claudication
MICROVASCULAR
EYES- Blurring of Vision->Blindness (DIABETIC
RETINOPATHY)
KIDNEY- Decrease Kidney Function
-Microalbuminuria
-Anemia, thirst, Fatigue, Frequent UTI
-(DIABETIC NEPHROPATHY)
NERVES- Paresthesia, Absent Reflexes, pain, weakness,
numbness and loss of sensation (DIABETIC NEUROPATHY)
Temperature: 37.8
DIAGNOSIS
PLANNING
Altered body
temperature:
hyperthermia related to
temperature will
INTERVENTION
Encouraged light dressing
EVALUATION
Goal met. Patients
body temp decreased
degree celcius
body
degree celcius.
room
Tepid sponge bath rendered.
Subjective:
maiinit ang
Paracetamol given as
ordered.
pakiramdam ng paa
ko
celcius to 37 degree
celcius.
ASSESSMENT
Weakness, easy
DIAGNOSIS
Activity intolerance
PLANNING
After 1 day of
fatigability, ,
related to sluggish
nursing
dizziness
circulation of the
intervention, the
BP=150/80 mmHg
blood resulting to
increase oxygen
to report
demand.
measurable increase
Subjective:
Nanghihina ako
in a activity
tolerance as
evidence by
patients
verbalization OK
na ako,hindi na ako
mahina, kaya ko ng
INTERVENTION
Assessed the baseline tolerance for
activity, ability to adapt to
patient demonstrated
active participation.
lifestyle
Instructed patient to avoid extending
activities beyond tolerances to
conserve energy and oxygen
demand.
Assessed for presence of factors
contributing to fatigue such as
presence of acute or chronic illness.
Promoted comfort measures by
assisting during ROM and provide
for relief of pain as prescribed to
EVALUATION
Goal met; the
ASSESSMENT
OBJECTIVE:
PLANNING
After 1 hour of nursing
INTERVENTION
Observed localize signs of
EVALUATION
Goal met; the
Presence of unhealed
infection particularly at
patient identified
interventions to
extremities for 2
interventions to prevent
causative factors.
Stressed proper hand hygiene
prevent or reduced
weeks.
DIAGNOSIS
Risk for infection
or reduce risk of
infection.
SUBJECTIVE:
Parang mainit ang
pakiramdam ng
akong paa. Medyo
Makati din.
cross contamination.
Stressed proper foot care for
easy and fast healing and
prevent infection.
Administered Cefazolin 1
gram/ IV, an antibiotic, as
ordered
DRUG STUDY
CEFAZOLIN
Classification: Anti- Infective
Therapeutic actions:
Interferes with bacterial cell wall synthesis, causing cell to rupture and die.
Indications:
To treat bacterial infections of the skin.
Contraindications:
Contraindicated to patient with hypersensitivity to cephalosporin or penicillin.
Nursing interventions:
Administer drug slowly, to promote comfort measures.
Provide thorough patient teaching, including measures to avoid adverse effects
and warning signs of problems.
Instruct patient to report reduce urinary output, bruising and bleeding.
Administer drug exactly as prescribed.
Review all other significant and life threatening adverse reactions, especially
those related to the drugs.
KETOROLAC
Classification: Analgesic, antipyretic, anti inflammatory, NSAIDs
Therapeutic Actions:
Interferes with prostaglandin synthesis by inhibiting cyclooxygenase pathway of
arachidonic acid metabolism.
Indications: Moderate to severe pain
Contraindications. Contraindicated in patients with hypersensitivity to drug or other
NSAIDs.
Advance renal impairment, risk for renal failure.
Nursing interventions:
Inform patient drug is meant only for short term pain management.
Instruct patient to report bleeding and adverse CNS reaction
Provide thorough patient teaching, including measures to avoid adverse effects and
warning signs of problems.
PARACETAMOL
Classification: Analgesic, Antipyretic
Therapeutic Actions:
Pain relief may result from inhibition of prostagaldin synthesis in CNS, with subsequent
blockage of pain impulses
Fever reduction may result from vasodilation and increase peripheral blood flow in
hypothhhalamus, which dissipates heat and lowers body temperature.
Indications: Mild pain or Fever
Contraindications: Contraindicated in patients with hypersensitivity to drug
Nursing interventions:
Assess type of pain and assess fever.
Assess hepatic, hematologic and renal function.
Provide thorough patient teaching, including measures to avoid adverse effects
and
METFORMIN
Classification: Nonsulfonylureas
Therapeutic Actions: May increase the peripheral use of glucose, increase production of
insulin, decrease hepatic glucose production, and alter intestinal absorption of glucose
Indications: Adjunct to diet and exercise for the treatment of type II DM.
Contraindications: Contraindicated in patients with hypersensitivity to drug.
Nursing interventions:
Administer the drug as prescribed in the appropriate relationship to meals to
ensure therapeutic effectiveness.
Monitor nutritional status to provide nutritional consultation as needed.
Monitor response carefully, blood glucose monitoring is the most effective way to
evaluate dosage.
Monitor patients response to the drug (stabilization of blood glucose levels)
Monitor for adverse effects (Hypoglycemia, GI upsets)
Monitor the effectiveness of comfort measures and compliance to the regimen.
INSULIN
Classification: Replacement Insulin
Therapeutic Actions: Promotes the storage of bodys fuels, facilitates the transport of
various metabolites and ions across cell membranes, and stimulates the synthesis of
glycogen from glucose, of fats from lipids, and of proteins from amino acids.
Indications: Use to treat Type I DM, Type II DM in patients whose diabetes can not be
controlled by diet or other agents.
Contraindications: NO Contraindications because insulin is used as hormonal
replacement.
Nursing interventions:
Gently rotate vial and avoid vigorous shaking to ensure uniform suspension of
insulin.
Give insulin thru SQ and rotate injection sites regularly to avoid lipodystrophy.
Administer the drug as prescribed in the appropriate relationship to meals to
ensure therapeutic effectiveness.
Monitor nutritional status to provide nutritional consultation as needed.
Monitor response carefully, blood glucose monitoring is the most effective way to
evaluate dosage.
Monitor patients response to the drug (stabilization of blood glucose levels)