A discussion on:

TYPE 1 AND TYPE 2

DIABETES MELLITUS

Student: Ma. Charis Anne M. Indanan

Section: BSN 3A
Clinical Instructor: Mr. Anthony Joseph C. Mercado
Subject Code: NUR 150
Date Submitted: May 27, 2021
Pathophysiology – Type 1 Diabetes Mellitus
Pathophysiology – Type 2 Diabetes Mellitus
 DRUG NAMES MECHANISM OF ACTION INDICATION/S SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Like other sulfonylureas, Indicated as an adjunct to Nausea, vomiting, loss of Assessment
chlorpropamide acts to diet and exercise to appetite, hunger, dizziness,
Chlorpropamide increase the secretion improve glycemic control headache, itching. 1. Monitor therapeutic
of insulin, so it is only effective in adults with type 2 effectiveness: Indicated by
Brand Name: HbA 1c levels >7%.
in patients who have diabetes mellitus. 
some pancreatic beta 2. Monitor blood and urine
Diabinese
cell function. It can cause glucose to determine
Classification: relatively long episodes effectiveness of glycemic
of hypoglycemia; this is one control.
Antidiabetic reason why shorter-acting 3. Lab tests: Periodic fasting
Sulfonylurea sulfonylureas such and postprandial blood
as gliclazide or tolbutamide are glucose; HbA1c every 3 mo;
Indication/Route/ baseline and periodic
used instead. The risk of
Dosage: hematologic and hepatic
hypoglycemia makes this drug
a poor choice for studies are advisable,
Antidiabetic
the elderly and patients with particularly in patients
Adult: PO Initial:
mild to receiving high doses. A CBC
100–250 mg/d with CONTRAINDICATION/S ADVERSE REACTIONS
moderate hepatic and renal im should be performed if
breakfast, adjust by
pairment. Chlorpropamide is symptoms of anemia
50–125 mg/d q3–5d Body as a Whole: Flushing,
also used in partial central appear.
until glycemic control photosensitivity, alcohol
diabetes insipidus 4. Report dizziness, shortness
is achieved, up to intolerance. of breath, malaise, fatigue.
750 mg/
5. Monitor for S&S of
GI: GI distress, anorexia, hypoglycemia (see
nausea, diarrhea, Appendix F).
constipation, cholestatic 6. Monitor I&O ratio and
jaundice. pattern: Infrequently,
chlorpropamide produces
Hematologic: Leukopenia, an antidiuretic effect, with
Thrombocytopenia, resulting severe
agranulocytosis. hyponatremia, edema, and
water intoxication. If fluid
Metabolic: Hypoglycemia, intake far exceeds output
Antidiuretic effect (SIADH), and edema develops
Dilutional hyponatremia, (weight gain), report to the
physician.
water intoxication.
Patient/family Education
CNS: Drowsiness, muscle 1. Report hypoglycemic
cramps, weakness, episodes to physician.
paresthesia. Because chlorpropamide
has a long half-life,
Skin: Rash, pruritus. hypoglycemia can be
severe, although onset is
not as fast or as dramatic
as with use of insulin.
2. Report any of the following
immediately to physician:
skin eruptions, malaise,
fever, or photosensitivity.
Immediately report these
symptoms to physician. A
change to another
hypoglycemic agent may be
indicated.
3. Do not self-dose with OTC
drugs unless approved or
prescribed by the physician.
4. Do not breast feed while
using this drug.
 DRUG NAMES MECHANISM OF ACTION INDICATION/S SIDE EFFECTS NURSING
RESPONSIBILITIES

Generic Name: Promotes release of insulin Adjunct to diet, exercise in Rare (less than 3%): Altered Baseline assessment
from beta cells of pancreas, management of type 2 taste, dizziness, drowsiness,
Glipizide decreases glucose output diabetes mellitus. weight gain, constipation, 1. Check serum glucose
from liver, increases insulin diarrhea, heartburn, nausea, level.
Brand Name: 2. Discuss lifestyle to
sensitivity at peripheral vomiting, headache,
sites. photosensitivity, peeling of determine extent of
Glucotrol
skin, pruritus, rash. learning, emotional
Classification: Therapeutic Effect: lowers needs.
serum glucose 3. Ensure follow-up
Antidiabetic agent. instruction if pt or
family does not
Indication/Route/Dosage thoroughly
: understand diabetes
management or
Diabetes Mellitus PO:
serum glucose testing
ADULTS: (Immediate-
technique.
Release): Initially, 5
mg/day. Adjust dosage in CONTRAINDICATION/S ADVERSE REACTIONS Intervention/evaluation
2.5- to 5-mg increments at
intervals of several days. 1. Monitor serum glucose
Immediate-release: Hypersensitivity to glipizide, Overdose or insufficient food level, food intake.
Maximum once-daily sulfonamides. Diabetic intake may produce 2. Assess for
dose: 15 mg. Maximum ketoacidosis with or without hypoglycemia (esp. with hypoglycemia
dose/day: 40 mg. coma, type 1 diabetes increased glucose (cool/wet skin,
(Extended-Release): mellitus. demands). GI hemorrhage, tremors, dizziness,
Initially, 5 mg/day. May cholestatic hepatic jaundice, anxiety, headache,
increase dose no more leukopenia, tachycardia, perioral
frequently than q7days. thrombocytopenia, numbness, hunger,
Maximum dose: 20 pancytopenia, diplopia),
mg/day. ELDERLY: agranulocytosis, aplastic or hyperglycemia
(Immediate-Release): hemolytic anemia occur (polyuria, polyphagia,
Initially, 2.5–5 mg/day. May rarely. polydipsia, nausea,
increase by 2.5–5 mg/day vomiting, dim vision,
q1–2wks. (Extended- fatigue, deep or rapid
Release): Initially, 2.5 breathing).
mg/day. Dosing should be on
lower end of adult dosing. 3. Be alert to conditions
that alter glucose

requirements (fever,
increased activity or
stress, trauma,
surgical procedure).

Patient/ family teaching

1. Diet and exercise are
principal parts of
treatment; do not skip
or delay meals.
2. Avoid alcohol.
3. Carry candy, sugar
packets, other quick-
acting sugar
supplements for
immediate response
to hypoglycemia.
4. Wear medical alert
identification.
5. Check with physician
when glucose
demands are altered
(fever, infection,
trauma, stress, heavy
physical activity).
6. Avoid direct exposure
to sunlight.
 DRUG NAMES MECHANISM OF ACTION INDICATION/S SIDE EFFECTS NURSING
RESPONSIBILITIES

Generic Name: Decreases hepatic Management of type 2 Occasional (greater than Baseline assessment
production of glucose. diabetes mellitus as 3%): GI disturbances
Metformin Decreases intestinal monotherapy or (diarrhea, nausea, vomiting, 1. Verify pt has not
absorption of glucose, concomitantly with oral abdominal bloating, received IV contrast
Brand Name: dye within last 48 hrs.
improves insulin sensitivity. sulfonylurea or insulin. flatulence, anorexia) that
are transient and resolve 2. Obtain CBC, renal
Glucophage
Therapeutic Effect: OFF-LABEL: Polycystic spontaneously during function test, fasting
Classification: Improves glycemic control, ovarian syndrome, therapy. serum glucose, Hgb
stabilizes/decreases body gestational diabetes A1c.
Antidiabetic agent weight, improves lipid mellitus. Prevention of type Rare (3%–1%):
profile. 2 diabetes. Unpleasant/metallic taste Intervention/evaluation
Indication/Route/Dosage that resolves spontaneously 1. Monitor fasting serum
: during therapy. glucose, Hgb A1c,
renal function, CBC.
Diabetes Mellitus PO
2. Monitor folic acid,
(Immediate-Release Tablets,
renal function tests
Solution): ADULTS,
for evidence of early
ELDERLY: Initially, 500 mg CONTRAINDICATION/S ADVERSE REACTIONS
lactic acidosis.
BID daily or 850 mg OD.
3. If pt is on concurrent
Hypersensitivity to Lactic acidosis occurs rarely oral sulfonylureas,
CHILDREN 10–16 YRS:
metformin. Renal but is a serious and often assess for
Initially, 500 mg BID daily.
disease/dysfunction; fatal complication. Lactic hypoglycemia
abnormal CrCl from any acidosis is characterized by (cool/wet skin,
cause including MI, increase in blood lactate tremors, dizziness,
septicemia, or shock; acute levels (greater than 5 anxiety, headache,
or chronic metabolic acidosis mmol/L), decrease in blood tachycardia,
(with or without coma). pH, electrolyte disturbances. numbness in mouth,
Symptoms include hunger, diplopia).
unexplained 4. Be alert to conditions
hyperventilation, myalgia, that alter glucose
malaise, drowsiness. May requirements: fever,
advance to cardiovascular increased activity,
collapse (shock), acute HF, stress, surgical
acute MI, prerenal azotemia. procedure
Patient/family teaching
1. Discontinue
metformin, report
immediately if
evidence of lactic
acidosis appears
(unexplained
hyperventilation,
muscle aches,
extreme fatigue,
unusual drowsiness).
2. Prescribed diet is
principal part of
treatment; do not
skip, delay meals.
3. Diabetes requires
lifelong control.
4. Avoid alcohol.
5. Report persistent
headache, nausea,
vomiting, diarrhea or
if skin rash, unusual
bruising/bleeding,
change in color of
urine or stool occurs.
6. Do not take dose for
at least 48 hrs after
receiving IV contrast
dye with radiologic
testing.
 DRUG NAMES MECHANISM OF ACTION INDICATION/S SIDE EFFECTS NURSING
RESPONSIBILITIES

Generic Name: Acts via specific receptor to Treatment of type 1 diabetes Occasional: Localized Baseline assessment
regulate metabolism of (insulin dependent) and type redness, swelling, itching,
Regular Insulin carbohydrates, protein, and 2 diabetes (non–insulin allergy to insulin cleansing 1. Obtain serum glucose
fats. Acts on liver, skeletal dependent) to improve solution. level, Hgb A1c.
Brand Name: Discuss lifestyle to
muscle, and adipose tissue. glycemic control.
Infrequent: Somogyi effect determine extent of
Humulin R
Liver: Stimulates hepatic OFF-LABEL: Insulin aspart, (rebound hyperglycemia) learning, emotional
Classification: glycogen synthesis, insulin lispro, insulin regular: with chronically excessive needs. If given IV,
synthesis of fatty acids. Gestational diabetes, mild to insulin dosages. Systemic obtain serum
Antidiabetic Agent moderate diabetic allergic reaction (rash, chemistries.
Muscle: Increases protein, ketoacidosis, mild to angioedema, anaphylaxis),
Indication/Route/Dosage: glycogen synthesis. moderate hyperosmolar lipodystrophy, Intervention/evaluation
hyperglycemic state. lipohypertrophy. 1. Assess for
Type 1 Diabetes: Multiple
hypoglycemia: cool,
daily injections, guided by Adipose tissue: Stimulates Rare: Insulin resistance. wet skin, tremors,
glucose monitoring or lipoproteins to provide free dizziness, headache,
continuous subcutaneous fatty acids, triglyceride anxiety, tachycardia,
insulin infusions, is standard synthesis. CONTRAINDICATION/S ADVERSE REACTIONS numbness in mouth,
of care. Usual initial dose:
hunger, diplopia.
0.2-0.6 unit/kg/day in Therapeutic Effect: controls 2. Assess sleeping pt for
divided doses. Usual serum glucose levels. Hypersensitivity to insulin, Severe hypoglycemia (due restlessness,
maintenance: 0.5–1.2 use during episodes of to hyperinsulinism) may diaphoresis.
units/kg/day in divided hypoglycemia. occur with insulin overdose, 3. Check for
doses. decrease/delay of food hyperglycemia:
intake, excessive exercise, polyuria, polyphagia,
Type 2 Diabetes: General pts with brittle diabetes. polydipsia,
goal is to achieve Hgb A1c Diabetic ketoacidosis may nausea/vomiting, dim
less than 7% using safe result from stress, illness, vision, fatigue, deep
medication titration. Dual omission of insulin dose, and rapid breathing.
therapy (metformin and a long-term poor insulin 4. Be alert to conditions
second antihyperglycemic control. altering glucose
agent) is recommended in
requirements: fever,
pts who fail to achieve
trauma, increased
glycemic goals after 3 mos
activity/stress,
with lifestyle interventions
surgical procedure.
and metformin monotherapy.

Patient/family teaching
1. Instruct on proper
technique for drug
administration, testing
of glucose,
signs/symptoms of
hypoglycemia and
hyperglycemia.
2. Diet and exercise are
essential parts of
treatment; do not
skip/delay meals.
3. Carry candy, sugar
packets, other sugar
supplements for
immediate response
to hypoglycemia.
4. Check with physician
when insulin demands
are altered (e.g.,
fever, infection,
trauma, stress, heavy
physical activity).
5. Do not take other
medication without
consulting physician.
6. Weight control,
exercise, hygiene
(including foot care),
not smoking are
integral parts of
therapy.
7. Protect skin, limit sun
exposure.
MIXING INSULIN MEDICATIONS Two types of ordered insulin

PURPOSE: Insulin syringes (0.3, 0.5, 1- or 2-mL capacity) with 24–31-gauge needle, 5/16
(five-sixteenths) to 1/2 (one-half) inch long or needleless adaptors
To prepare a mixed dose of short acting and intermediate/long-acting insulin.
Alcohol wipe
CONSIDERATIONS:
PROCEDURE:
1. When combining insulins in a syringe, make sure they are compatible. The
following insulins may be combined: 1. Adhere to Standard Precautions.
a. Novolog (Lispro) and Humalog (Aspart), Rapid acting insulin, can be
mixed with NPH if provided by the same manufacturer and are
administered within 15 minutes after mixing.
b. Regular (short acting insulin) and NPH can be mixed.
c. Glargine (Lantus): Cannot be mixed with another insulin. 2. Check physician's order for both types of insulin dosages, frequency, and route
of administration. Check the insulin vials for the type, strength, and expiration
2. Rapid acting or Regular insulin is drawn up first, followed by date. Mix the insulins by rolling the vials between your palms approximately 20
intermediate/long-acting insulin; use within 15 minutes. times. DO NOT shake the vials.
3. Mixing insulin for future use (pre-drawing insulin): 3. Use an alcohol swab to cleanse the rubber stopper on top of both vials. Allow
to air dry.
a. Novolog, Humalog, and Lantus are not recommended for pre-drawn use,
b. Novolin NPH and Regular insulin may be stored for 30 days, if 4. Draw air into the syringe in an amount equal to the prescribed dose of longer
refrigerated. acting insulin or NPH insulin. Inject all the air into the NPH vial. Remove the
c. Humulin NPH and Regular insulin may be stored for 21 days, if syringe from the vial.
refrigerated.
d. Pre-drawn syringes should be stored with the needle pointing up so 5. Draw air into the syringe in an amount equal to the prescribed dose of rapid
particles do not clog the needle. acting insulin or regular insulin. Inject air into the regular insulin vial. Invert the
vial and withdraw the prescribed dose of regular insulin.
4. All pre-drawn syringes should be gently rolled between the hands before use
to mix. 6. Before removing syringe from regular insulin vial, check for air bubbles in the
syringe barrel. If present, lightly tap the syringe with your finger. Push up slightly
5. Insulin administration is an appropriate procedure to teach to patients and on the plunger to force the air back into the vial. Make sure the syringe still
caregivers. contains the prescribed dose of insulin. If not, draw up the amount needed.
Withdraw needle and syringe.
6. Vials of insulin not in use should be refrigerated. Extreme temperatures (< 36
degrees or > 86 degrees Fahrenheit, 30 degrees Celsius) and excess agitation 7. Insert needle into longer acting insulin or NPH vial and invert vial. Withdraw
should be avoided to prevent loss of potency, clumping, frosting, or precipitation. the correct amount of NPH insulin, being sure not to push any regular insulin into
Insulin in use may be kept at room temperature for 28 to 30 days after opening. the vial. If regular insulin is discharged into the NPH insulin vial, the vial will have
to be discarded.
7. An opened vial of insulin refrigerated or stored at room temperature should be
discarded 30 days after opened. 8. Follow insulin administration procedure and inject insulin into subcutaneous
tissue. Aspiration is not necessary.
EQUIPMENT:
AFTER CARE: you to stop taking a particular medication or to change the dosage before
your test temporarily.
1. Document in patient's record:

a. Medication, type and amount prepared. Medications that can affect your blood glucose levels include:
b. Date and time administered.  corticosteroids
c. Patient’s response.
d. Instructions given to patient/caregiver.  diuretics

 birth control pills

 hormone therapy

 aspirin (Bufferin)

 antipsychotics

 lithium

 epinephrine (Adrenalin)

 tricyclic antidepressants

 monoamine oxidase inhibitors (MAOIs)

 ·phenytoin

 sulfonylurea medications

Severe stress can also cause a temporary increase in your blood glucose
Fasting Blood Sugar Test and is usually due to one or more of these factors:
Blood glucose tests are either random or fasting tests.  surgery
For a fasting blood glucose test, you can’t eat or drink anything but water  trauma
for eight hours before your test. You may want to schedule a fasting
 stroke
glucose test first thing in the morning so you don’t have to fast during the
day. You may eat and drink before a random glucose test.  heart attack
Fasting tests are more common because they provide more accurate
results and are easier to interpret.
A blood sample will be taken after an overnight fast. For most tests, you
Before your test, tell your doctor about the medications you’re taking, will be told not to consume anything but water for eight
including prescriptions, over-the-counter drugs, and herbal supplements.
Certain medications can affect blood glucose levels. Your doctor may ask
hours leading up to the test. For a few tests, a 12-hour fast may be
needed. You'll fast overnight before the test and have your blood drawn to
determine your fasting blood sugar level. Then you'll drink the liquid and
have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours
afterward.

Results
o A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal.
o A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is
considered prediabetes.
o If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have
diabetes.

Type 1 Diabetes Mellitus Diet

Choose healthful protein foods

Including protein in every meal can help balance blood sugar. People should
choose healthful protein foods and vary their choices. Examples of these foods
include:

lean meat and poultry, fish, eggs, beans and lentils, tofu, nuts and seeds, low
fat dairy foods

Eat plenty of non-starchy vegetables

People should include plenty of non-starchy vegetables in the diet. According to

the ADA, diets that consist of mainly plant-based foods — such
as Mediterranean, vegan, and vegetarian diets — show benefits for diabetes,
weight loss, and blood pressure.

Non-starchy vegetables are fiber-rich and have less effect on blood sugar than
starchy vegetables. Non-starchy vegetables include:

greens, such as lettuce, kale, cabbage, pak choi, spinach, rocket, and
watercress, bell peppers, zucchini and eggplant, green beans, mushrooms,
broccoli and cauliflower
Include nuts, seeds, beans, and legumes Foods with a low glycemic load (index) only cause a modest rise in blood
sugar and are better choices for people with diabetes. Good glycemic control can
Nuts, seeds, beans, and legumes are good sources of fiber, which can slow down
help in preventing long-term complications of type 2 diabetes.
the release of sugar into the blood. They are also a source of protein.
Fats don't have much of a direct effect on blood sugar but they can be useful in
Choose whole grains
slowing the absorption of carbohydrates.
People should choose whole grains in preference to refined grains. Whole grains
Protein provides steady energy with little effect on blood sugar. It keeps blood
are a source of carbohydrates, but their fiber content means that they have
sugar stable, and can help with sugar cravings and feeling full after eating.
a better effect on blood sugar than refined grains.
Protein-packed foods to eat include beans, legumes, eggs, seafood, dairy, peas,
Opt for healthful fats tofu, and lean meats and poultry.

Including healthful fats in meals can help someone feel fuller and avoid eating too Five diabetes "superfoods" to eat include chia seeds, wild salmon, white
many carbohydrates. Healthful fats include: balsamic vinegar, cinnamon, and lentils.

Avocados, olives and olive oil, nuts and seeds, oily fish, such as salmon, tuna, Healthy diabetes meal plans include plenty of vegetables, and limited
and mackerel processed sugars and red meat.

Stay hydrated Diet recommendations for people with type 2 diabetes  include

a vegetarian or vegan diet, the American Diabetes Association diet (which also
Less water in the body means a higher Trusted Source blood sugar concentration, emphasizes exercise), the Paleo Diet, and the Mediterranean diet.
so it is crucial for someone with type 1 diabetes to stay hydrated.
Guidelines on what to eat for people with type 2 diabetes include eating
Foods to avoid  low glycemic load carbohydrates, primarily from vegetables, and
consuming fats and proteins mostly from plant sources.
Foods to avoid or limit include:
What to not to eat if you have type 2 diabetes: sodas (regular and diet),
added sugars, refined grains, such as white bread, pasta, and rice, processed
refined sugars, processed carbohydrates, trans fats, high-fat animal products,
foods, sugary breakfast cereals, sweet treats, soda and other sugary drinks
high-fat dairy products, high fructose corn syrup, artificial sweeteners, and
fried foods, alcoholic beverages
any highly processed foods.

Type 2 Diabetes Mellitus Diet

Foods to eat for a type 2 diabetic diet meal plan include complex

carbohydrates such as brown rice, whole wheat, quinoa, oatmeal, fruits,
vegetables, beans, and lentils. Foods to avoid include simple carbohydrates,
which are processed, such as sugar, pasta, white bread, flour, and cookies,
pastries.
 DEFINING NURSING SCIENTIFIC PLANNING INTERVENTION RATIONALE EVALUATION
CHARACTERSTIC DIAGNOSIS ANALYSIS

Subjective: Risk for Type 2 diabetes After 8 hours of Independent 1. Patient may be After 8 hours of
infection mellitus occurs nursing admitted with nursing
“Hindi gumagaling related to high when the pancreas interventions, 1. Observe for signs of interventions,
ang sugat ko” (My infection and infection, which
produces the patient will the patient was
wounds are not glucose levels, inflammation. could have
insufficient identify able to identify
healing) as decreased amounts of the interventions to 2. Maintain aseptic precipitated the interventions to
verbalized by the leukocyte hormone insulin prevent or technique for IV ketoacidosis state, prevent or
patient. function. and/or the body's reduce risk of insertion procedure, or may develop a reduce risk of
infection. administration of nosocomial infection.
Objective: tissues become medications, and
infection.
resistant to normal providing
 Flushed 2. High glucose in
or even high levels maintenance and
appearance. of insulin. This site care. Rotate IV the blood creates
 Wound causes high blood sites as indicated. an excellent
drainage. glucose (sugar) 3. Provide catheter or medium for
 V/S taken levels, which can perineal care. Teach bacterial growth.
as follows: lead to a number of the female 3. Minimizes the risk
complications if patient to clean for infection.
T:37.4 untreated. from front to back 4. Peripheral
after elimination. circulation may be
P:87 4. Provide impaired, placing
conscientious skin
R:19 patient at
care, gently
increased risk for
massage bony
BP: 120/90 skin irritation or
areas. Keep the skin
dry, linens dry and breakdown and
wrinkle free. infection.
5. Place in semi – 5. Facilitates lung
fowler’s position. expansion and
6. Encourage adequate reduces risk of
dietary and fluid aspiration.
intake of 3000 6. Decrease
ml/day. susceptibility to
infection.
Collaborative
1. Identifies organisms
1. Obtain specimen for so that most
culture and appropriate drug
sensitivities as therapy can be
indicated. instituted.