Med-Surg Endocrine System part 18: Diabetes Mellitus

by Cathy Parkes September 22, 2020

In this video

Why it’s important to know diabetes inside and out

Definition of diabetes

Three types of diabetes

  • Type 1 diabetes
  • Type 2 diabetes
    • Risk factors of type 2 diabetes
  • Gestational Diabetes

Signs and symptoms of diabetes

  • The three P’s of diabetes
  • Easy way to remember skin changes

Diabetes diagnosis

  • Treatment for type 1 diabetes
  • Treatment for type 2 diabetes
    • Goal HgbA1C

Foot care

Illness care


Full transcript

Okay. In this video, we are going to talk about diabetes mellitus, and this is a super-important topic. If you're in nursing school, you will definitely be asked lots of questions about diabetes on your nursing exams. And then as a practicing nurse, you will be taking care of many patients with diabetes, in all likelihood. So diabetes has a lot of different comorbidities that it causes, so individuals with diabetes are hospitalized more than other people. So it's important to understand this disease inside and out so that you can properly care for your patients and educate them.

So in this video, we are going to talk about the pathophysiology of diabetes. We're going to talk about risk factors as well as signs and symptoms, labs, and diagnosis of diabetes, as well as foot care and illness care.

Diabetes causes chronic hyperglycemia, so increased blood glucose levels, due to insufficient insulin production by the pancreas and/or insulin resistance of the cells in the body. So insulin is kind of like an escort, and it helps to bring glucose from the bloodstream into the cells. So if there's not enough insulin, then glucose can't get it to the cells and it builds up in the bloodstream.

So there are three types of diabetes, type 1, type 2, and gestational diabetes.

With type 1, we have destruction of the beta cells in the pancreas due to an autoimmune dysfunction, and this leads to a lack of insulin secretion by the pancreas. So patients with type 1 diabetes, they are insulin dependent. They will require insulin for the rest of their lives in order for that glucose to get from the bloodstream into the cells.

Then we have type 2 diabetes. This is where we have progressive insulin resistance and decreased insulin production from the pancreas. And this typically occurs later in life, but not always. So we definitely are seeing increased incidences of juvenile diabetes.

Risk factors associated with type 2 diabetes includes obesity, inactivity, hypertension, hyperlipidemia, smoking, genetics, and race. So patients that are African American, Hispanic, or American Indian, they are definitely at higher risk for diabetes.

The third type of diabetes is gestational diabetes. So this is where the placental hormones counteract insulin, and this results in glucose intolerance during pregnancy.

Alright. Now, let's talk about the signs and symptoms of diabetes, which are basically the signs and symptoms of hyperglycemia. There's a lot to remember but they're all here on the back of card 44 [of the Endocrine system section in the Medical-Surgical Flashcard deck].

Let's first talk about the three P's, polydipsia, polyphagia, and polyuria. Poly means a lot or many. So with diabetes, we're going to have a lot of thirst, a lot of hunger, and a lot of urine.

Other symptoms include weight loss, warm and dry skin. So the way I remember the skin symptom is, "Warm and dry, sugar's high. Cold and clammy, needs some candy." So we'll talk about that cold and clammy skin when we cover hypoglycemia, but for hyperglycemia, the skin will be warm and dry.

Other symptoms include dehydration - which you may see weak pulses and decreased skin turgor in a patient with dehydration - fruity breath, Kussmaul respirations.

So with Kussmaul respirations, we have increased rate and depth of respirations. Other signs and symptoms include nausea and vomiting, weakness, and lethargy.

So in terms of diagnosis of diabetes, if the patient has two or more of the following labs on separate days, then that is indicative of diabetes. So these labs include a casual blood glucose over 200, a fasting blood glucose over 126, glucose over 200 with an oral glucose tolerance test or an Hgb A1c over 6.5%. So again, if they have two or more of those over separate days, then they would be diagnosed with diabetes.

In terms of treatment, insulin is definitely an important one to remember.

If your patient is type 1, that is all they're going to be getting, right? They're insulin dependent. Type 1 diabetic patients cannot take oral diabetic medications. They require insulin.

If your patient is type 2, they can take insulin, but they can also receive oral antidiabetic medications.

So when we are treating diabetes, our goal is to try to get the Hgb A1c under 7%. So that Hgb A1c result really tells us a lot about the patient's blood glucose levels over the past two, three months, as opposed to just doing a spot check on the blood glucose. It just tells you how that glucose is doing right then and there. That Hgb A1c is a more indicative result on how the patient has been managing their diabetes over the last several months. So that's going to be an important one to watch for, and our goal is to get that under 7%.

Alright. So finally, let's talk about foot care and illness care, which are some important teaching you'll need to provide your diabetic patient.

With foot care, as a wound nurse, I see lots and lots of diabetic foot ulcers that often lead to amputations. It's a huge complication of diabetes, so we need our diabetic patients to take care of their feet.

So some of the education you should provide your diabetic patients include that they need to inspect their feet daily. Using a mirror, they should always check their shoes for objects before putting their feet in there because that can cause damage.

They should apply moisturizer to their feet but not between the toes because putting it between the toes can result in athlete's foot, which is basically a fungal infection.

They should wear cotton socks, as opposed to synthetic socks, and they definitely need to wear closed-toe shoes. So they should not go barefoot or wear open-toed shoes, and their shoes need to be fitted properly. Ideally, they would go see their podiatrist and get some special properly-fitted shoes to help protect their feet.

They should cut their toe nails straight across. They shouldn't round them on the sides because that can cause hangnails, which can lead to really complicated infections.

They should also not use over-the-counter products for corn or callus removal.

And then finally, they should not use heating pads on their feet because diabetic patients have decreased sensation in their extremities. So if that heating pad is too hot, it can burn them and cause damage. And they won't even know because they can't really feel it.

In terms of illness care, this is definitely important. So I share an office with the diabetic educators at my hospital. And when patients get sick, they are much more likely to have life-threatening complications such as diabetic ketoacidosis, or DKA.

When your patient is sick, they need to monitor their blood glucose levels more frequently.

They should not skip insulin when they're sick.

And they also need to test their urine for ketones because if there is ketones in the urine, that could indicate that they have DKA.

Also, when the patient is sick, it's important to prevent dehydration. So they should drink about 3 liters of water per day to prevent that dehydration.

And then they should notify their provider if their illness lasts for more than one day, if they have a temperature over 38.6 degrees Celsius, if their blood glucose levels are over 250 or if their urine is positive for ketones.

Okay, so I know there's a lot of information in this video. I hope it's helpful. In my next video, we will go over complications and critical-care topics related to diabetes. Thank you so much for watching. If you have found value in these videos, be sure to like us, like the video, leave a comment. And be sure to subscribe as well to our channel. Thanks so much for watching!


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