Chapter 53: Diabetes Nursing Management

The content differentiates between type 1 diabetes mellitus, characterized by autoimmune beta cell destruction resulting in absolute insulin deficiency, and type 2 diabetes mellitus, involving progressive insulin resistance and relative insulin insufficiency. The chapter examines additional variants including maturity onset diabetes of the young, gestational diabetes mellitus, and prediabetic states, while exploring the underlying mechanisms of glucose homeostasis, counterregulatory hormone function, and genetic predisposition factors. Clinical assessment focuses on recognizing the classic symptom triad of polyuria, polydipsia, and polyphagia, alongside secondary manifestations such as unexplained fatigue, recurrent infections, visual disturbances, and unintentional weight changes. Diagnostic evaluation encompasses hemoglobin A1C testing, fasting plasma glucose measurement, oral glucose tolerance testing, and random glucose assessment protocols. The interprofessional care approach emphasizes comprehensive patient education and self-management strategies guided by the diabetes care ABCs framework targeting hemoglobin A1C control, blood pressure management, and cholesterol optimization. Pharmacological interventions include various insulin formulations utilizing basal-bolus regimens, continuous subcutaneous insulin infusion systems, and inhaled insulin delivery methods, complemented by oral antidiabetic agents such as metformin, sulfonylureas, meglitinides, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, and sodium-glucose cotransporter-2 inhibitors. Non-insulin injectable therapies featuring glucagon-like peptide-1 receptor agonists and amylin analogs provide additional therapeutic options. The chapter emphasizes lifestyle modifications including medical nutrition therapy, carbohydrate counting techniques, structured exercise programs, and systematic blood glucose monitoring protocols, while addressing acute complications such as diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome, and chronic complications including diabetic nephropathy, peripheral neuropathy, and diabetic retinopathy.