Diabetes is a chronic disease, which occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. This leads to an increased concentration of glucose in the blood (hyperglycaemia).
- Type 1 diabetes (previously known as insulin-dependent or childhood-onset diabetes) is characterized by a lack of insulin production.
- Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes) is caused by the body’s ineffective use of insulin. It often results from excess body weight and physical inactivity.
- Gestational diabetes is hyperglycaemia that is first recognized during pregnancy.
Diagnostic Studies – Diabetes Mellitus Nursing Care Plans
- Serum glucose: Increased 200–1000 mg/dL or more.
- Serum acetone (ketones): Strongly positive.
- Fatty acids: Lipids, triglycerides, and cholesterol level elevated.
- Serum osmolality: Elevated but usually less than 330 mOsm/L.
- Glucagon: Elevated level is associated with conditions that produce (1) actual hypoglycemia, (2) relative lack of glucose (e.g., trauma, infection), or (3) lack of insulin. Therefore, glucagon may be elevated with severe DKA despite hyperglycemia.
- Glycosylated hemoglobin (HbA1C): Evaluates glucose control during past 8–12 wk with the previous 2 wk most heavily weighted. Useful in differentiating inadequate control versus incident-related DKA (e.g., current upper respiratory infection [URI]). A result greater than 8% represents an average blood glucose of 200 mg/dL and signals a need for changes in treatment.
- Serum insulin: May be decreased/absent (type 1) or normal to high (type 2), indicating insulin insufficiency/improper utilization (endogenous/exogenous). Insulin resistance may develop secondary to formation of antibodies.
- Sodium: May be normal, elevated, or decreased.
- Potassium: Normal or falsely elevated (cellular shifts), then markedly decreased.
- Phosphorus: Frequently decreased.
- Arterial blood gases (ABGs): Usually reflects low pH and decreased HCO3 (metabolic acidosis) with compensatory respiratory alkalosis.
- CBC: Hct may be elevated (dehydration); leukocytosis suggest hemoconcentration, response to stress or infection.
- BUN: May be normal or elevated (dehydration/decreased renal perfusion).
- Serum amylase: May be elevated, indicating acute pancreatitis as cause of DKA.
- Thyroid function tests: Increased thyroid activity can increase blood glucose and insulin needs.
- Urine: Positive for glucose and ketones; specific gravity and osmolality may be elevated.
- Cultures and sensitivities: Possible UTI, respiratory or wound infections.
Nursing Priorities – Diabetes Mellitus Nursing Care Plans
- Restore fluid/electrolyte and acid-base balance.
- Correct/reverse metabolic abnormalities.
- Identify/assist with management of underlying cause/disease process.
- Prevent complications.
- Provide information about disease process/prognosis, self-care, and treatment needs.
Discharge Goals – Diabetes Mellitus Nursing Care Plans
- Homeostasis achieved.
- Causative/precipitating factors corrected/controlled.
- Complications prevented/minimized.
- Disease process/prognosis, self-care needs, and therapeutic regimen understood.
- Plan in place to meet needs after discharge.
6 Diabetes Mellitus Nursing Care Plans
- Risk for Infection — Diabetes Mellitus
- Risk for Disturbed Sensory Perception — Diabetes Mellitus
- Powerlessness — Diabetes Mellitus
- Imbalanced Nutrition Less Than Body Requirements — Diabetes Mellitus
- Deficient Fluid Volume — Diabetes Mellitus
- Fatigue — Diabetes Mellitus