Diabetes mellitus (D.M) Nursing Lecture

Diabetes mellitus (D.M)
It is a chronic metabolic condition in which the body is unable to utilize carbohydrate properly owing to deficiency of insulin.
-The body is also unable to store and utilize fat properly with decrease protein
Most cases of diabetes mellitus are believed to be genetically determined, however the exact means of genetic transmission is still uncertain. Most theories favor multifactorial inheritance .
-Viral infection e.g: mumps, congenital rubella,coxsackie virus may play a role.
-The sexual incidence of D.M is equal.
1) Polydipsia
2) Polyphagia
3) Polyuria
4) Loss of weight
5) Skin boils may develop
6) Enuresis may be the presenting symptom in previously toilet trained child.
7) Diabetic coma is common presentation in children characterized by increasing drowsiness and dehydration with breath smell of acetone, abdominal pain and vomiting also occur.
1- clinical feature.
2- G.U.E→glucosuria,ketonuria in case of coma.
3- blood sugar↑
The aims of treatment are:
1- To allow the child live normal life with controlled blood glucose level during
day and night.
2- Ensure normal growth and development.
3- Avoid D.M complication.

1- Insulin : is specific drug for D.M,the dose of insulin is measured in units and
special syringes are used for subcutaneous injection, a child can be taught to
give his own injection after the age of 7years.
-The site of injection is rotated to prevent poor absorption and fibrosis of the
-Insulin should be refrigerated.
Types of insulin :
1- rapid acting e.g regular insulin(purified).
2- intermediate acting e.g monotard and lentard.
3- long acting e.g ultralente.
– each package contains 100 unit/ml.
– frequently the doctor will order a combination of short acting insulin and
intermediate one.
– long acting insulin are seldom given to children because of the danger of
hypoglycemia during sleep.
2- Exercise : is important for the patient with diabetes mellitus because it lead
the body to use sugar and promotes good circulation, it lowers the blood
sugar and in this respect acts like more insulin. The diabetic patient who has
planned vigorous exercise should carry extra sugar with him to avoid insulin
3- Diet : an exact intake is not prescribed but regularity and consistency of
meals are stressed, excessive carbohydrate intake and between meals snack
are discourraged.Assure that the essential amount of callor,protien,minerals
, vitamin are obtained.
– Prognosis:
– Providing the children receive close supervision out look is good.
– Normal growth is an indication of good control.
Nursing care:
1) Educate the family about the disease and it’s complication, insulin
administration and they should know symptom of hypoglycemia and
2) Skin care: bathe daily ,dry well. Cleansing of the inguinal region,axilla, perinium is especially important as yeast
and fungal infections tend to occurs there.
– Inspect skin for cuts, rashes,abrasions,bruises,cysts or boils and treat it
3) Foot care:
– Proper habits of foot hygiene need to be established. Instruct the patient to
wash and dry his feet each day.
– Inspect for interdigital cracking and check for the character of toe nails. Change
socks daily, avoid socks that punch up or fit too tightly, replace shoes often as
child grows, instruct the patient not to walk bare foot.
4) Infections:
– Immunize against communicable diseases.
– Cystitis, subcutaneous nodules and monilial vulvitis occur with greater frequency in diabetic patients.
– During late adolescence females should see a gynecologist yearly.
5) Emotional Upsets:
These can be disturbing to the patient and may require food and or insulin adjustment.
– Family therapy and other forms of psychotherapy may be required.
6) Urine test :
– Stress the importance of urine test.
7) Travel :
– Parents need to be aware of the diet requirement.
– Bring additional supply of insulin.
– Carry urine testing equipment.
– Keep a supply of sugar on hand.
8) Follow up care:
– See physician regularly.
– Visit dentist regularly for professional cleaning of teeth and gums(brush daily).
– Have eyes examined regularly.
9) Surgery:
– The diabetic usually tolerates surgery well.
– Insulin may be given before or after operation.

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