单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Diabetes Mellitus,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 the patient with diabetes mellitus,Introduction,There are more and more people suffer from diabetes with the development of society,population aging and changes of life style,.,Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia which results from the defects of insulin secretion or function,or both.,Long-standing diabetes may lead to multisystem damage such as eye,kidney,nerve,heart,blood vessels and so on.,Etiology,Etiology and pathology are complex,and still unknown.But it is a syndrome results from compound etiological factor and has relation to inheritance,autoimmune and environment.,Factors associated with diabetes include obesity,aging,and ethnic group.,Classification,Type 1 diabetes,Stage 1:genetics emotivity,Stage 2:start autoimmune,Stage 3:immunology abnormality,Stage 4:progressive dysfunction of beta cells,Stage 5:clinical diabetes,Stage 6:beta cells of the clients who have longtime diabetes are damaged thoroughly,blood insulin level is very low,Type 2 diabetes,genetics emotivity,hyperinsulinism and(or)insulin resistance,impaired glucose tolerance(IGT),clinical diabetes,Other types,include beta cell genetic defects,endocrinopathies,and drug or chemical-induced diabetes,gestational diabetes mellitus,Clinical manifestation,Metabolic disorders syndrome:,polyuria,polydipsia,polyphagia and weight loss,Acute complications of diabetes,:,DKA,hyperosmolar nonketotic diabetic coma,infection,DKA,evocation factors,surgery,stress,infection,deficiency of insulin dosage,pregnancy,delivery,anesthesia,or illness may trigger DKA,Clinical features,Classic symptoms of hyperglycemia(polyuria,polyphagia,polydipsia)precede DKA.,Other symptoms:nausea,vomiting,abdominal pain,headache,weakness,fatigue,hyperpnea,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.,hyperosmolar,nonketotic diabetic coma,evocation factors,include illness or other stressor such as infection,cerebrovascular events,or some drugs.,Clinical features,lethargy,illusion,disorientation,seizure,and coma.,Lab test,blood glucose is higher than 33.3 mmol/l,usually 33.3-66.6 mmol/l and serum osmolality 350 mmol/l,infection,Skin infection,septicaemia,pulmonary tuberculosis,infection of urinary system,Chronic complications of diabetes,:,cardiovascular diseases,nephropathy,diabetic neuropathy,retinopathy,diabetic foot infection,Cardiovascular diseases,pain,paresthesia of lower extremeties and intermittent claudication,heart failure,arrhythmia,cardiogenic shock,and sudden death,Nephropathy,nephrosclerosis,edema,proteinuria,hypertension,diabetic neuropathy,numbness,pain and paresthesia of extremeties,muscular atrophy,retinopathy:,microangiopathy,diabetic foot infection:,gangrenous,Lab test,urine glucose,blood glucose,IGT,Treatment,Diet,maintain as near-normal blood glucose level as possible,achieve optimal serum lipid levels,provide adequate energy.,Activity:,aerobic exercise,Oral glucose-lowering agents:,sulfonylurea,biguanides,glucosidase,Insulin therapy,Insulin,Therapy,notice,administer insulin as ordered,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,Transplantation of pancreas and islet,Treatment for gestational diabetes,Treatment for DKA:,intravenous infusion,insulin therapy,keep balance of electrolyte and acid-base,prevent and manage complications,Hyperosmolar nonketotic diabetic coma,Nursing process,Assessment,Subjective data,Objective data,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 activity,Nursing diagnosis 3:,risk for infection related to hyperglycemia,fat metabolism disorder,Nursing diagnosis 4:,potential complications,hypoglycemia,Nursing diagnosis 5:,potential complications DKA,hyperosmolar coma,THANKS!,