DIABETES MELLITUS

MANAGEMENT

The therapeutic goal for diabetes management is to achieve normal blood glucose levels
(euglycemia) without hypoglycemia while maintaining a high quality of life.

5 COMPONENTS
1.) Nutritional therapy
Nutritional management of diabetes mellitus include the following goals
• providing all the essential food constituents(eg. Vitamins,minerals)necessary
for optimal nutrition.
• Meeting energy needs
• Preventing wide daily fluctuations in blood glucose levels, with blood
glucose levels as close to normal as is safe and practical to prevent or reduce
the risk for complications
• Decreasing serum lipid levels,if elevated, to reduce the risk for macro
vascular disease.
Changes in diet to be 30% fat (mostly monounsaturated fat and polyunsaturated
fat), 40-55% carbohydrates (high fiber, low glycemic index) and 15% protein.
The distribution of carbohydrates and calories throughout the day are important,
as well as limiting total calories to achieve a near ideal body weight. These
changes will lower blood glucose and lipid levels.
2.) Exercise
Ideally, a person with diabetes should exercise at the same time(preferably when
their blood glucose levels are at their peak) and in the same amount each day
3.) Monitoring
Blood glucose monitoring is a cornerstone of diabetes mellitus. Using frequent self-
monitoring of blood glucose (SMBG) levels and learning how to respond to the
results enable people with DM to adjust their treatment regimen to obtain optimal
blood glucose control
For most patients who require insulin, SMBG is recommended two –four times
daily(usually before meals and at bedtime).patients not receiving insulin may be
instructed to assess their blood glucose levels at least two- three times per week.

4.) Pharmacologic therapy

Types of Type 2 Diabetes Medications
1. Sulfonylureas: Stimulate the beta cells in the pancreas to produce more insulin.
There needs to be some functioning beta cells present.
2. Meglitinides: Stimulate beta cells in the pancreas, are fast acting and can lower
blood glucose in a few hours.
3. Biguanides (Metformin): This medication works mainly on the liver to decrease
the amount of glucose it releases. It also decreases insulin resistance in muscle and
fat cells.
4. Thiazolidinediones: Increases muscle cells sensitivity to insulin and decreases
liver glucose production.
 5. DPP-4 Inhibitors: Place of action is the intestine. The inhibition of this enzyme
slows the rise in your blood sugar after eating.
6. Alpha-Glucosidase Inhibitors: Place of action is the intestine. This medication
inhibits the enzyme that breaks down carbohydrates, so the carbohydrate absorption
is delayed and slowed.

Injectable Medications for Type 2 Diabetes

- Exenatide (brand name Byetta): Taken by injection, this medication helps your
body make more insulin.
- Pramlintide (brand name Symlin): A synthetic form of the hormone amylin
produced by the beta cells of the pancreas that regulates the release of glucose into
the bloodstream by slowing gastric emptying.
5.) Education

NURSING MANAGEMENT

Patient education
Patient must become knowledgeable about nutrition, medication effects and side
effects, exercise, disease progression, prevention strategies, blood glucose monitoring
techniques, and medication adjustment.

7 tips for managing DM

1. healthy eating
2. being active
3. monitoring
4. taking medicines
5. problem solving
6. reducing risks
7. healthy coping

Observe systemic rotation of injection sites within anatomic area to prevent localize
changes in fatty tissue (lipodystrophy).

DISCHARGE PLANNING

Educate patient of the importance of self-monitoring of blood glucose level and

instruct patient how to use glucose meters.

Instruct patient how to do Self-injection of insulin

 1. with one hand,stabilize the skin by spreading it or pinching up a large
area.
2. pick up syringe with the other hand and hold it as you would hold a pencil.
Insert needle straight into te skin
3. to inject the insulin, push the plunger all the way in.
4. pull needle straight out of skin. Press cotton ball over the injection site for
several seconds
5. using disosabe syringe only once and discard into hard plastic
container(with tight fitting top) such as an empty bleach or detergent
container.

Selecting and rotating injection site

The 4 main areas for injection are the abdomen, upper arms (posterior surface),
thighs(anterior surface) and hips
The patient should not try to use the same site more than once in 2-3 weeks.
If the patient is planning to exercise, insulin should not be injected to the limb
that will be exercise because this will cause the drug to be absorbed faster, which
may result to hypoglycemia

Incorporation of insulin injections into daily schedule

1. Instruct patient to use mnemonic device such as the word “TIE” , which help
the patient remember the orderof activities(“T”=test{blood
gkucose },”I”=insulin injection, “E”=eat).
2. Give information regarding hypoglycemia
Symptoms: shakiness, sweating, nervousness, hunger, weakness
Treatment: 15 g concentrated carbohydrate such as 3 glucose tablets, .5 cup
juice.
After initial treatment,follow with snack including starch and protein, such as
cheese and crackers, milk and crackers, half sandwich.

3. Instruct patient to maintain regular follow-up