Causes of Diabetes Mellitus (DM)

Diabetes Mellitus (DM) A chronic metabolic disorder marked by hyperglycemia. DM results either from a primary failure of the beta cells of the pancreas to produce enough insulin (type-1 DM) or from the development of insulin resistance in body cells, with initial increased insulin secretion to maintain metabolism, followed by eventual inability of the pancreas to secrete enough insulin to sustain normal metabolism (type-2 DM).

Type-1 Diabetes
(Previously called insulin-dependent diabetes mellitus [IDDM])

Incidence: Accounts for about 5% to 10% of diagnosed diabetes.

Onset: Develops most often in children and young adults, but the disorder can appear at any age.

Etiology: Develops when immune cells attack and destroy insulin-producing beta cells in the pancreas, resulting in loss of insulin production. Clinical Findings:Weight loss, muscle wasting, loss of subcutaneous fat, polyuria, polydipsia, polyphagia, ketoacidosis (see comparison of hyperglycemia and hypoglycemia in EMERG/TRAUMA).

Type-2 Diabetes
(Previously called adult-onset diabetes)

Incidence: Most common form of diabetes, accounting for 90% to 95% of diagnosed diabetes.

Onset: Gradual. Early on, the pancreas is usually producing enough insulin, but for unknown reasons, the body cells lose their ability to respond to the insulin effectively. Eventually, insulin production decreases or ceases altogether.

Etiology: Associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. About 80% of type-2 diabetics are overweight. Type 2 DM is increasingly being seen in children, adolescents, and young adults.

Clinical Findings: Polyuria, polydipsia, pruritus, peripheral neuropathy, frequent infections, and delayed healing of wounds or sores (see comparison table in EMERG/TRAUMA).

Gestational Diabetes
See OB/PEDS/GERI.

Nursing Focus
■ Routine assessment for hyperglycemia and hypoglycemia, and their associated s/s.
■ Monitor blood glucose level as ordered and document response to prescribed therapies.
■ Assess body systems for complications associated with the effects of diabetes.

Patient Teaching
■ Provide Pt with literature on managing diabetes.
■ Encourage necessary lifestyle changes including weight reduction if Pt is overweight, dietary modifications, and exercise.
■ Explain the purpose, dosage, route, and side effects of insulin and/or oral hypoglycemic agents.
■ If self-administered insulin is prescribed, ensure Pt’s ability to demonstrate appropriate preparation and administration.