Diabetes Mellitus Lecture NCLEX Review Notes

Below are review notes for Diabetes Mellitus to help you study for the NCLEX exam or your nursing
lecture exams.

As the nurse taking care of the diabetic patient, you must know how to properly care for them, especially
newly diagnosed diabetics. The nurses role include educating, assessing, planning, administering
medications, and evaluating treatment.

These NCLEX review notes will cover:

Key players in Diabetes Mellitus

Causes of Diabetes Mellitus

Complications of Diabetes Mellitus

Nursing Assessment

After reviewing these notes, don’t forget to take the Diabetes NCLEX quiz.

Lecture on Diabetes Mellitus

Diabetes Mellitus Lecture Notes for NCLEX Review

Key Players:

Glucose:

“Sugar” (body needs it to survive) fuels the cells of your body so they can work properly, BUT IT CAN
NOT ENTER THE CELL WITHOUT THE HELP OF INSULIN

It is stored mainly in the liver in the form of glycogen

Insulin:
“deals with high blood sugar levels”

A hormone that helps regulate the amount of glucose in the blood (too much glucose is very toxic to the
body).

It allows your body to use glucose by allowing it to enter the cells (without insulin glucose would just
float around in your body)

Secreted by the BETA cells of the pancreas from the islets of Langerhans

Glucagon:

“deals with low blood sugar levels”

A peptide hormone that causes the liver to turn glycogen into glucose…does the opposite as insulin.

Also secreted by the pancreas

Pancreas:

Releases insulin and glucagon

Liver:

Sensitive to insulin levels and stores and turns glycogen into glucose when the pancreas secretes
glucagon. Example: (if the body has increased blood glucose/increased insulin in the blood the liver with
absorb and store the extra glucose for later….if there is low blood sugar/low insulin levels the liver will
release glycogen which turns into glucose to help increase the blood sugar level)

Glucagon and Insulin Feedback Loop

Increased blood sugar -> pancreas releases insulin -> causes glucose to enter into the cells to be used or
be saved as glycogen for later (stored mainly in the liver)

Decrease blood sugar -> pancreas release glucagon -> causes the liver to release glycogen which turns
into glucose to increase the low blood sugar level

What happens in diabetes mellitus?

The body is unable to use glucose due to either the absence of insulin or the body’s resistance to use
insulin. Therefore, the patient becomes HYPERGLYCEMIA (the glucose just hangs out in the blood stream
which affects major organs of the body)
The body starts to metabolize FATS for energy (since it can’t get to the glucose…remember glucose can
NOT enter the cell without the help of INSULIN)….which happens in Type 1 diabetics OR there is a
moderate amount of insulin to deal with fats and proteins BUT carbs cannot be used (Type 2).

Causes of Diabetes Mellitus

Divided into types:

Type 1: the beta cells located in the islet of Langerhans don’t work (been destroyed) therefore the body
doesn’t release anymore insulin. For treatment, the patient MUST USE INSULIN.

Risk factors: Genetic, auto-immune (virus) NOT RELATED TO LIFESTYLE (like type 2)

What do patients look like clinically? Patients are young and thin….happens suddenly; ketones will be
present in the urine

Type 2: cells quit responding to insulin (won’t let insulin do its job by taking the glucose into the cell).
Therefore, the patient has INSULIN RESISTANCE. This leaves all the glucose floating around in the blood
and the pancreas senses there’s a lot of glucose present in the blood so it releases even more insulin.
Due to this the patient starts to experience hyperinsulinemia which caused metabolic syndrome

Treatment: diet and exercise (first line treatment)…when that doesn’t work oral medications are started
Note: The type 2 diabetic may NEED INSULIN DURING STRESS, SURGERY, OR INFECTION

Risk Factors: Lifestyle- being obese, sedentary, poor diet (sugary drinks), stress AND genetic
What do patients look like clinically? Patients are overweight, it happens overtime, rare to have ketones
(remember issues with carb metabolism) adult aged

Gestational: similar to type 2 diabetes where the cells are not receptive to insulin…typically goes away
after birth

Complications of Diabetes Mellitus

Hypoglycemia:

Blood glucose less than 60 mg/dL or drops rapidly from an elevated level.

Remember the mnemonic: “I’m sweaty, cold, and clammy….give me some candy”

Signs and Symptoms: Sweating, clammy, confusion, light headedness, double vision, tremors

Treatment: Need simple carbs if they can eat, or if unconscious IV D50

Simple carbs include: hard candies, fruit juice, graham crackers, honey

Organ Problems:

Hardens the vessel (atherosclerotic….makes vessels hard from all the glucose that sticks on the proteins
of the vessels and it forms plaques). So the patient can develop heart disease, strokes, hypertension,
neuropathy, poor wound healing (FROM DECREASE circulation), eye trouble, infection.

DKA (Diabetic Ketoacidosis):

Happens in Type 1 diabetics (rare to happen in type 2)

There is no insulin in the body and the body starts to burn fats for energy since it can’t get to the glucose

Due to this the ketones, which are acids, start to enter into the body and this causes life-threatening
situation, such as acid/base imbalances

Signs and Symptoms of DKA: N&V, excessive thirst, hyperglycemia, Kussmaul breathing

HHNS Hyperglycemic hyperosmolar nonketotic syndrome:

Happens mainly in Type 2 diabetics

This presents with hyperglycemia without the breakdown of ketones…so there isn’t acidosis/ketosis
because there is just enough insulin present in the body to prevent the breakdown of fats

Signs and Symptoms of HHNS: very dehydrated, thirsty, hyperglycemic, mental status changes

Assessment Findings of DM

3 of Hyperglycemia P’s & SUGAR

Hyperglycemia: Three P’s

Polyuria: (frequent urination)

Why? elevated levels of glucose in the body causes the body to remove the water from inside the cell
(remember in the hypertonic, hypotonic video about OSMOSIS). The water will move to an area of
higher concentration which will be the blood stream and this causes more fluid to enter the blood
stream. The kidneys will secrete the extra water. HOWEVER, normally your kidneys could handle all of
the glucose by reabsorption but there is too much so it leaks into the urine…. GLYCOSURIA

Polydipsia: very thirsty

Why? the blood is trying to prevent the body from becoming dehydrated from the excessive urination so
it signals to the patient to drink more water…but it doesn’t work because the kidneys will remove the
excess water

Polyphagia: very hunger

Why? the body is burning FAT for energy since it doesn’t have any glucose to use so the body signals to
the person to keep eating so there will be food to use for energy. The patient will have WEIGHTLOSS!

*The 3 P’s present mainly in Type 1 Diabetics

Other Assessment findings of the Diabetic Patient

Remember “Sugar”

Slow wound healing

blUrry vision (damaged from glucose on eyes)

Glycosuria (kidneys can’t reabsorb all the extra glucose)

Acetone smell of breath (from burning ketones) *type 1

Rashes on skin DRY and itchy, repeated vaginal infections (yeast….loves glucose)

Diabetes Mellitus NCLEX Review Notes Medications & Nursing Management

Below are review notes for Diabetes Mellitus to help you study for the NCLEX exam or your nursing
lecture exams.

As the nurse taking care of the diabetic patient, you must know how to properly care for them, especially
newly diagnosed diabetics. The nurses role include educating, assessing, planning, administering
medications, and evaluating treatment.

These NCLEX review notes will cover:

Diet

Exercise

Oral Diabetic Medications

Insulin
Mnemonics

After reviewing these notes, don’t forget to take the Diabetes NCLEX quiz.

Lecture on Diabetes Mellitus for NCLEX Review

Diabetes Nursing Management

Nurse’s role: educating, monitoring, and administering (medications)

Teach patient to follow the Triangle of Diabetes Management

nclex diabetes review

nclex diabetes review**Diet, medications, and exercise all work together while monitoring blood glucose

Example: Patient wants to make sure their diet is balanced with their medication (insulin/oral meds) and
they use exercise to manage glucose levels (doing all this while monitoring blood glucose).

As the nurse you will be educating the diabetic…so for the NCLEX know education pieces like:

Diet, exercising, oral medications, giving insulin (peak times), drugs that increase blood glucose and
lower glucose etc.

Diabetic Diets

DIET: Diets are individualized due to physical activity and medication therapy (they always need
tweaking)…recommend following American Diabetic Association Diet (ADA)
Limitation of the following:

Carbs (45-60%) grains, vegetables with starches potatoes, corn, sweets…cookies, soda, dried beans, milk)

Fats (<20 %)….limit unhealthy fats saturated, trans fats, cholesterol: lard, gravies, whole milk, bologna,
hot dogs, sausage, processed foods hydrogenated oils…concentrate on mono & polyunsaturated
avocadoes, olives, peanuts, nuts

Proteins (15-20%) meats don’t increase the glycemic index: meats chicken, turkey, fish, plant based
beans, peas, low fat cheese, eggs whites

Exercising Management

Exercise: Aerobic the best (helps the body use insulin) ex: cardio running, walking, swimming etc.

Teach patient signs of hypoglycemia & hyperglycemia

Signs of Hypoglycemia:

“I’m sweaty, cold, and clammy….give me some candy”

“Sweating, clammy, confusion, light headedness, double vision, tremors”

Signs of Hyperglycemia: Three P’s

Polyphagia

I’m hot and dry…I must be on a sugar high!

Polydipsia

Polyuria

Always check blood sugar prior to exercising: if lower than 100 eat a small carb snack and carry SIMPLE
carbs with you while exercising in case of hypoglycemic attack

Example of simple carbs: hard candy, honey, crackers/graham crackers, fruit juice
****If patient plans on exercising for an extended period of time, check glucose prior, during, and after.

****If blood glucose is higher than 250 with ketones present in urine prior to exercise avoid exercise
until glucose and ketones stabilize.

Diabetic Medications

NCLEX specific:

Oral medications (for patients with Type 2 diabetes when exercise and diet doesn’t work to control blood
glucose):

Sulfonylureas: ides zides, mides, rides” (most common) stimulate beta cells in pancreas to make insulin
(Glyburide, Glipizide, Diabinese, Amaryl) AVOID ETOH….extreme hypoglycemia

Meglitinides: “glinide” Ex: repaglinide “Prandin” stimulate beta cells in pancreas to make insulin…instruct
pts to take first bite with meal

Biguanides: Metformin (Glucophage)….causes the liver to decrease its stores of glucose. Watch out if
patient is scheduled for surgery/procedure (heart cath)…stop for 48 hours and watch renal function…
diarrhea

Alpha-glucoside inhibitors: Precose, Glyset lower blood sugar by slowly down the breakdown of starchy
foods in the GI system which helps slowly rise the blood sugar… instruct pts to take first bite with meal

Thiazolidinedione: “glitazone” reduce glucose production in the liver: Actos/Avandia watch liver function
and heart function increase risk of MIs

Medications that cause hypoglycemia

Remember from the hypertension lecture that Beta Blockers (mask symptoms of hypoglycemia)

Other medication that cause it: ETOH, ASA, Sulfonylureas (medications used to treat type 2: Glyburide,
Glipizide, Diabinese), and MAO inhibitors (meds for depression) , Bactrim (common antibiotic)

Medications that cause hypergycemia

Thiazide diuretics (HCTZ), Glucocorticoids (Prednisone, Hydrocortisone), estrogen therapy

Insulin

It is used for Type 1 regularly, and sometimes for Type 2 diabetics if the patient is experiencing stress on
the body like surgery or illness.

Know the categories of insulin. Example: whether they are rapid, short, intermediate, long acting and the
onset, peak, and duration.

Note: Peak is the most susceptible time for hypoglycemia

Insulin Mnemonics

Note that if you use the word insulin you can divide the word and separate it into specific categories of
insulin types. Watch the lecture above for a full in-depth explanation about this mnemonic.

insulin mnemonic nclex, nursing school insulin

Rapid-Acting Insulin:

“15 minutes feels like an hour during 3 rapid responses.”

Onset: 15 minutes

Peak: 1 hour

Duration: 3

Short-Acting Insulin:
“Short-staffed nurses went from 30 patient to (2) 8 patients.”

Onset: 30 minutes

Peak: 2 hours

Duration: 8 hours

Intermediate-Acting Insulin:

“Nurses Play Hero to (2) eight 16 year olds.”

Onset: 2 hours

Peak: 8 hours

Duration: 16 hours

Long-Acting Insulin:

“The two long nursing shifts never peaked but lasted 24 hours.”

Onset: 2 hours

Peak: NONE

Duration: 24 hours

Key Points to Remember about Administering Insulin

Rotate sites: do not use the same site more than once in a 2-3 week period this PREVENTS
LIPODYSTROPHY (pitting of subq fat)

Sites include: abdomen, arms, and thighs

When mixing insulin (clear to cloudy) clean=regular, cloudy=NPH

Don’t massage site after administration increase hypoglycemia due to absorption

Dawn Phenomenon:

Watch for Dawn phenomenon (hence the name dawn…crack of dawn means the waking hours) this is a
time when the body will increase the blood sugar in preparation for waking. However, when you have
insulin problems (not enough of it) the increased blood sugar causes HYPERGLYCEMIA

Typical time: 5am to 8 am

Treatment: may need a night time dose of NPH to counteract.

Somogyi Effect:

Somogyi effect (remember S in Somogyi for sleeping hours): This is a drop in blood sugar at the hours of
2 to 3 am. This happens when the body releases hormones such as coristol, catecholamines, growth
hormones to increase the blood sugar. However, in diabetics the body can’t cope with the increased
blood sugar and the sugar will be elevated.

Treatment: Eat a bedtime snack….a dose of bedtime insulin will prevent it from dropping so low or
decreasing insulin amounts at night