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
After reviewing these notes, don’t forget to take the Diabetes NCLEX quiz.
Lecture on Diabetes Mellitus
Diabetes Mellitus Lecture Notes for NCLEX Review
- “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
- “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
- “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
- Releases insulin and glucagon
- 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
- 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
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
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)