Nursing Care Plan for Diabetes Mellitus

Pathophysiology

Diabetes Mellitus (DM) occurs when the body is unable to move glucose (sugar in the blood) into the cells to produce ATP (energy). Insulin is a hormone made by the pancreas that allows glucose to move across the cell wall. There are two types of diabetes mellitus, Type I and Type II.

Type I is an autoimmune disorder in which the immune system attacks the insulin-producing cells in the pancreas resulting in very little or no insulin being produced. This prevents the cells from receiving glucose and they begin to starve.

Type II is called insulin resistance diabetes because the cells no longer respond to insulin. Again, the glucose cannot enter the cells so it stays in the bloodstream and the cells starve.

Etiology

The cause of diabetes is not known, but it is believed to be genetic or triggered by a virus. Sugar intake does not cause diabetes, but many factors may increase the risk of developing the disease. Factors include autoimmune disease, high blood pressure, overweight and obesity, physical stress (such as injury or surgery), heavy alcohol use, smoking and a history of gestational diabetes.

Desired Outome

Maintain blood glucose levels within normal limits and prevent complications and progression of disease

Diabetes Mellitus Nursing Care Plan

Subjective Data:

  • Increased thirst
  • Increased hunger (especially after eating)
  • Dry mouth
  • Frequent urination
  • Fatigue, weakness
  • Unexplained weight loss
  • Numbness or tingling of hands and feet
  • Dry, itchy skin
  • Blurred vision
  • Confusion
  • Headaches
  • Nightmares

Objective Data:

  • Slow healing wounds
  • Hypoglycemia
  • Hyperglycemia
  • Sweaty
  • Tachycardia
  • Slurred speech

Nursing Interventions and Rationales:

  1. Blood sugar monitoring Normal range 70-180 mg/dL (Patients may have different target blood sugar levels): Fasting - upon waking up, Before each meal, At bedtime
    • The physician will determine the target blood glucose range for each patient.

      Teach patient how to use glucometer and when to test blood sugar level.

      Encourage patient to contact physician if blood glucose readings are higher than their target or if they have two readings >300 mg/dL
  2. Monitor feet and educate patient of importance for foot monitoring. Encourage proper foot care.
    • Decreased blood flow to the feet and neuropathy cause a reduction in sensation.

      Because of decreased sensation and slow wound healing, injuries to the feet, even as small as a blister, may progress rapidly and become serious wounds.

      Encourage daily foot care to include cleaning and inspecting the feet for injuries and trimming toenails straight across.

      Encourage patient to routinely visit a podiatrist.
      Monitor existing wounds and provide wound care as necessary.
  3. Monitor vitals / blood pressure
    • Diabetic patients are at higher risk of hypertension. Vascular strain can affect vision, kidney function or lead to stroke and heart attack.
  4. Administer Insulin: Rapid Acting Humalog Novalog, Fast/Short Acting Regular Insulin, Intermediate Acting NPH Insulin, Long Acting Lantus Levemir Educate patient on how to self-administer insulin at home
    • Administer insulin per facility and provider guidelines. Make yourself familiar with the types of insulin and how they work. You should know the onset, peak and duration of each insulin.

      Rapid Acting:
      Onset: 10 - 30 minutes
      Peak: 30 min - 3 hours
      Duration: 3 - 5 hours

      Fast/Short Acting:
      Onset: 30 min - 1 hour
      Peak: 2 - 5 hours
      Duration: Up to 12 hours

      Intermediate Acting:
      Onset: 1.5 - 4 hours
      Peak: 4- 12 hours
      Duration: Up to 24 hours

      Long Acting:
      Onset: 1 - 4 hours
      Peak: 4 - 12 hours
      Duration: Up to 24 hours

      Educate patient to self-administer, cleaning the site with alcohol prior to inserting needle, rotating injection sites and angle of injection.
  5. Encourage annual diabetic retina exams by opthamologist
    • Vascular changes can lead to deterioration of the retina. Encourage patient to have a dilated retinal exam at least once per year by an opthamologist.
  6. Educate patient on how to handle blood glucose fluctuations: Hyperglycemia (Hot and dry, sugar high), Hypoglycemia (Cold and clammy, give candy)
    • Hyperglycemia: If the glucose reading is higher than the target range, encourage patient to increase water intake

      Hypoglycemia: If the glucose reading is below the target range (<70 mg/dL) and the patient is awake and able to eat or drink, give orange juice, crackers and peanut butter to raise the glucose level.
  7. Nutrition and Lifestyle Education: Exercise - increase circulation, lose weight, Diet - make healthy diet choices, Avoid smoking Limit or avoid alcohol
    • Educate the patient on how to count carbs and what foods / beverages are to be avoided.

      Encourage patient to consult dietitian for counseling and meal preparation ideas

      Educate patient on the glycemic index of foods and how to read nutrition labels.

References

Date Published - Nov 1, 2018
Date Modified - Nov 1, 2018