Patients with diabetes need skilled care and nursing care. In the role of an assistant in the hospital and at home, a nurse can act, who goes through all the stages of examination, treatment, and rehabilitation with the patient of the clinic. We will talk more about the nursing process in diabetes care in our article.

What is the nursing process for diabetes mellitus

Priority Goal nursing process- ensuring health monitoring and assistance to patients with diabetes mellitus. Thanks to the care of the medical staff, a person feels comfortable and safe.

The nurse is assigned to a group of patients, thoroughly studies their characteristics, together with the attending doctor develops a diagnostic plan, studies the pathogenesis, possible problems etc. When working closely with patients, it is important to take into account their cultural and national habits, traditions, adaptation process, age.

Simultaneously with the provision medical services The nursing process provides scientific knowledge about diabetes mellitus. Clinical manifestations, etiology, anatomy and physiology of each patient are outlined separately. The collected data is used for scientific purposes, for the preparation of abstracts and lectures, in the process of writing dissertations, in the development of new drugs for diabetes. The information received is the main way to deeply study the disease from the inside, to learn how to care for diabetics quickly and efficiently.

Important! University students from the last courses are often used as medical staff of the nursing process. They are doing diploma and course practice. There is no need to be afraid of the inexperience of such brothers and sisters. Their actions, decisions are controlled by specialists with experience and education.

Features and stages of nursing care for diabetes

The main objectives of nursing care for patients with diabetes are:

1. Collect information about the patient, his family, lifestyle, habits, the initial process of the disease.
2. Make a clinical picture of the disease.
3. Outline a brief plan of action for nursing care of patients with diabetes mellitus.
4. Help a diabetic in the process of diagnosing, treating, and preventing diabetes.
5. Monitor compliance with doctor's orders.
6. Conduct a conversation with relatives about creating comfortable conditions for a patient with diabetes at home, after discharge from the hospital, and the specifics of nursing care.
7. Teach the patient to use a glucometer, make a diabetic menu, find out the GI, AI from the food table.
8. To convince a diabetic to control the disease, to undergo examinations from narrow specialists constantly. Set up to keep a food diary, draw up a disease passport, overcome difficulties in care on your own.

The algorithm of the nursing process consists of 5 main stages. Each sets a specific goal for the doctor and assumes the implementation of competent actions.

Stage	Target	Methods
Nursing examination	Collect patient information	Inquiry, conversation, study of the patient's card, examination
Nursing diagnostics	Get data on pressure, temperature, blood sugar level at the moment. Assess skin condition, body weight, pulse	Palpation, external examination, use of apparatus for measuring pulse pressure, temperature. Identification of potential problems and complications.
Drawing up a nursing process plan	Highlight the priority tasks of nursing care, designate the timing of assistance	Analysis of patient complaints, drawing up nursing care goals: long-term; short-term.
Implementation of the nursing plan	Implementation of the planned plan for nursing care for a patient with diabetes mellitus in a hospital	Choosing a diabetic care system: fully compensatory. Necessary for patients in a coma, unconscious, immobilized state. Partially compensatory. Responsibilities for nursing care are divided between the patient and the nurse, depending on the desire of the patient and his abilities. Supportive. A diabetic can take care of himself, he needs advice and a little help from a sister in care.
Assessing the effectiveness of the nursing care process	Analyze the work of medical personnel, evaluate the results obtained from the process, compare with the expected ones, draw a conclusion about the nursing process	a written analysis of the nursing process is drawn up; conclusion on the results of care; adjustments are made to the care action plan; the cause of defects is revealed if the patient's condition worsened.

Important! All data, the result of the inspection, survey, laboratory tests, tests, a list of procedures performed, appointments, the nurse enters into the medical history.

The nursing process for adults and elderly diabetics has its own characteristics. The list of nurses' worries includes the following daily duties:

• Glucose control.
• Measurement of pressure, pulse, temperature, output fluid.
• Creation of a rest mode.
• Medication control.
• Introduction of insulin.
• Inspection of the feet for cracks, non-healing wounds.
• Fulfillment of doctor's prescriptions for physical activity, even minimal.
• Creating a comfortable environment in the ward.
• Change of linen for bedridden patients.
• Control over nutrition, diet.
• Disinfection of the skin, in the presence of wounds on the body, legs, arms of the patient.
• cleaning oral cavity diabetic, prevention of stomatitis.
• Concern for the emotional well-being of the patient.

A presentation on the nursing process for people with diabetes can be viewed here:

Features of caring for patients with diabetes mellitus

When caring for children with diabetes, nurses must:

1. Closely monitor the child's diet.
2. Control the amount of urine and fluids you drink (especially in diabetes insipidus).
3. Examine the body for injuries, damage.
4. Monitor blood glucose levels.
5. Teach self-monitoring of the state, the introduction of insulin. You can watch the video instruction here How to inject insulin correctly

It is very difficult for children with diabetes to get used to the fact that they are different from their peers. The nursing process in caring for young diabetics should take this into account. It is recommended that medical staff talk about life with diabetes, explain that it is not worth getting hung up on the disease, and increase the self-esteem of a small patient.

What is School of Diabetes Care?

Every year, a large number of people in Russia and the world are diagnosed with diabetes. Their number is growing. For this reason, "Schools of Care for Diabetes Mellitus" are being opened at hospitals and medical centers. Classes are taught to diabetics and their relatives.

At lectures on diabetology, you can learn about the process of care:

• What is diabetes and how to live with it.
• What is the role of nutrition in diabetes.
• Features of physical activity in DM.
• How to develop a children's and adult diabetic menu.
• Learn to self-control sugar, pressure, pulse.
• Features of the hygiene process.
• Learn how to administer insulin, learn how to use it.
• What kind preventive measures can be accepted if there is a genetic predisposition to diabetes, the disease process is already visible.
• How to suppress the fear of illness, to carry out the process of calming.
• What are the types of diabetes, its complications.
• How is the process of pregnancy with diabetes.

Important! Classes to inform the population about the features of diabetes, care for diabetes are conducted by certified specialists, nurses with extensive work experience. Following their recommendations, you can get rid of many problems with diabetes, improve the quality of life, make the process of care simple.

Lectures for diabetics, their relatives on nursing care are free of charge at specialized medical centers, polyclinics. Classes are devoted to individual topics or have a general character, introductory. It is especially important to attend lectures for those who first encountered an endocrine disease and do not have practical experience in caring for sick relatives. After a conversation with the medical staff, handouts, books about diabetes, rules for caring for patients are distributed.

It is impossible to overestimate the importance and importance of the nursing process in diabetes mellitus. Health development, systems medical care in the 20-21st century, it made it possible to understand the causes of malfunctions in the thyroid gland, which greatly facilitated the fight against the complications of the disease, and reduced the mortality rate of patients. Seek qualified care in hospitals, learn how to take care of a sick relative or yourself at home, then diabetes will really become a way of life, not a sentence.

Type 2 diabetes mellitus is an endocrine disease in which there is an increase in blood glucose levels. The main cause of this pathology is a violation of the interaction of insulin produced by the pancreas and target cells. Interestingly, people of the Mongoloid race are more susceptible to this disease, as in Hong Kong, 12% of the population suffer from hyperglycemia.

Diabetes mellitus can be suspected in individuals with constant thirst and hunger, as well as frequent copious urination. The disease sometimes begins with itching, muscle weakness, visual impairment. It should be noted that diabetes itself is not so terrible as its complications, which are acute and chronic.

Acute complications of type 2 diabetes

Early signs of diabetes include:

Chronic complications of diabetes

Late manifestations are associated with vascular damage (micro- and macroangiopathies). Depending on the predominant violation of the function of a particular organ or system, there are:

• Nephropathy resulting from poor kidney function. At the same time, protein appears in the urine, edema increases, and hypertonic disease. As a terminal manifestation - chronic renal failure and anuria.
• Retinopathy is the most frequent illness eye, resulting from diabetic destruction of retinal vessels. It begins with a decrease in visual acuity and mosaic, and, ultimately, leads to blindness.
• Diabetic foot is a manifestation of microangiopathy of the vessels of the legs. With this complication in the area lower extremities purulent-necrotic manifestations develop, including gangrene.
• Angina pectoris and myocardial infarction with damage to the coronary arteries (heart vessels).
• Polyneuropathy, which occurs in half of all patients with diabetes mellitus. It is associated with disruption of the work of peripheral nerve fibers due to reduced blood supply. When the brain is affected, a stroke develops.

Late complications of diabetes mellitus usually form several months or years after the diagnosis and are the first cause of the patient's disability.

Treatment of complications of diabetes

Treatment of acute complications must be carried out in the intensive care unit, because there is a real threat to the life of the patient. Do not forget about the rules of first aid for diabetics. For example, if a person with diabetes is acting strange and agitated, you can offer them candy or sugary juice. With hypoglycemia, the condition should improve, while with other causes it will not change. If the patient is in a medical facility, a 40% glucose solution must be administered.

In the hospital, patients with early complications associated with the development of acidosis are prescribed the administration of large volumes of saline and insulin under glycemic control.

Treatment of chronic complications of diabetes mellitus is carried out according to the affected organ:

• With nephropathy, correction of blood pressure and intrarenal hemodynamics is performed, with proteinuria, a protein-free diet is prescribed. With the development of chronic renal failure, the patient is transferred to insulin and hemodialysis or peritoneal dialysis is performed. In exceptional cases, kidney transplantation is indicated.
• In the treatment of diabetic retinopathy, the main goal is to prevent or delay the onset of blindness. This helps laser photocoagulation and removal of hemorrhages from the vitreous body.
• Treatment for diabetic foot can be conservative or surgical. In the first case, antibiotic therapy is used, unloading the affected area by wearing special shoes, and treating wounds with an antiseptic. If gangrene develops, then an early amputation within healthy tissues is necessary.
• Management of patients with cardiovascular complications is no different from generally accepted algorithms.
• There is no cure for diabetic polyneuropathy, but B vitamins, immunostimulants, and antioxidants can help relieve symptoms.

When, first of all, it is necessary to maintain blood glucose levels at an acceptable level. Even in the case of a severe course of the disease, patient awareness and well-chosen hypoglycemic therapy can prevent the development of acute complications and delay the onset of chronic ones.

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• List of abbreviations
• Introduction
• 1.3 Classification
• 1.4 Etiology of diabetes mellitusIItype
• 1.5 Pathogenesis
• 1.6 Cynic picture
• 1.8 Methods of treatment
• 1.9 Role nurse in the care and rehabilitation of DMIItype
• 1.10 Medical examination
• Chapter 2. Description of the material used and applied research methods
• 2.1 Scientific novelty of the research
• 2.2 Dark chocolate in the fight against insulin resistance
• 2.3 History of chocolate
• 2.4 Research part
• 2.5 Basic principles of the diet
• 2.6 Diagnostics
• Chapter 3. Results of the study and their discussion
• 3.1 Findings of the study
• Conclusion
• List of used literature
• Applications

List of abbreviations

DM - diabetes mellitus

BP - arterial pressure

NIDDM - non-insulin dependent diabetes mellitus

UAC - general analysis blood

OAM - general urinalysis

BMI - individual body weight

OT - waist circumference

DN - diabetic nephropathy

DNP - diabetic neuropathy

UVI - ultraviolet irradiation

coronary artery disease - ischemic disease hearts

SMT - sinusoidal modulated current

HBO - hyperbaric oxygen therapy

UHF - ultra high frequency therapy

CNS - central nervous system

WHO - World Health Organization

Introduction

"Diabetes mellitus is the most dramatic page in modern medicine, since this disease is characterized by high prevalence, early disability and high mortality" Ivan Dedov, Director of the Endocrinological Research Center, 2007.

Relevance. Diabetes mellitus is a common disease and is the third leading cause of death after heart disease. vascular diseases and cancer. Currently, according to WHO, there are already more than 175 million patients in the world, their number is growing steadily and by 2025 may reach 300 million. In Russia, only in the last 15 years, the total number of patients with diabetes mellitus has doubled. Over the past 30 years, there has been a sharp jump in the incidence of type 2 diabetes, especially in large industrial cities. developed countries, where its prevalence is 5-7%, primarily in the age groups of 45 years and older, as well as in developing countries, where the main age group is susceptible to this disease. The rise in the prevalence of type 2 diabetes is associated with lifestyle characteristics, ongoing socio-economic changes, population growth, urbanization and population aging. Calculations show that with an increase in the average life expectancy to 80 years, the number of patients with type 2 diabetes will exceed 17% of the population.

Diabetes mellitus is dangerous complications. This disease has been known since ancient times. Even before our era Ancient Egypt doctors described a disease resembling diabetes mellitus. The term "diabetes" (from the Greek. "I pass through") was first used by the ancient physician Areteus of Cappadocia. So he called abundant and frequent urination, when it is as if "all the liquid" taken orally passes quickly and everything passes through the body. "In 1674, for the first time, attention was paid to the sweet taste of urine in diabetes. The discovery of insulin in 1921 is associated with the names of Canadian scientists Frederick Banting and Charles Best The first treatment with insulin was developed by the English physician Lawrence, who himself suffered from diabetes.

In the 60-70s. last century, doctors had only to watch helplessly as their patients died from the complications of diabetes. However, already in the 70s. methods for the use of photocoagulation to prevent the development of blindness and methods for the treatment of chronic renal failure were developed, in the 80s. - clinics for the treatment of diabetic foot syndrome were created, which made it possible to halve the frequency of its amputations. A quarter of a century ago, it was difficult to even imagine how high the effectiveness of diabetes treatment can be achieved at the present time. Thanks to the introduction of non-invasive methods of outpatient determination of the level of glycemia into everyday practice, it was possible to achieve its thorough control. The development of pens (semi-automatic insulin injectors) and, later, "insulin pumps" (devices for continuous subcutaneous insulin administration) contributed to a significant improvement in the quality of life of patients.

The relevance of diabetes mellitus (DM) is determined solely by rapid growth morbidity. According to WHO in the world:

- 1 diabetic patient dies every 10 seconds;

- about 4 million patients die annually - this is the same as from HIV infection and viral hepatitis

- more than 1 million amputations of the lower extremities are performed every year in the world;

- more than 600 thousand patients completely lose their sight;

Approximately 500,000 patients have kidney failure, requiring costly hemodialysis treatment and an inevitable kidney transplant

diabetes diabetes nursing care

The prevalence of diabetes in Russian Federation is 3-6%. In our country, according to the 2001 referral data, more than 2 million patients were registered, of which about 13% were patients with type 1 diabetes mellitus and about 87% - type 2. However, the true incidence, as shown by the conducted epidemiological studies, is 8-10 million people, i.e. 4-4.5 times higher.

According to experts, the number of patients on our planet in 2000 amounted to 175.4 million, and in 2010 it increased to 240 million people.

It is quite obvious that the experts' forecast that the number of diabetic patients will double over the next 12-15 years is justified. Meanwhile, more accurate data of control and epidemiological studies conducted by the team of the Endocrinological Research Center in various regions of Russia over the past 5 years have shown that the true number of patients with diabetes in our country is 3-4 times higher than the officially registered and is about 8 million people (5.5% of the total population of Russia).

Chapter 1. The current state of the problem under study

1.1 Anatomical and physiological features of the pancreas

The pancreas is an unpaired organ located in abdominal cavity on the left, surrounded by a loop of the 12th intestine on the left, and the spleen. The mass of the gland in adults is 80 g, length is 14-22 cm, in newborns - 2.63 g and 5.8 cm, in children 10-12 years old - 30 cm and 14.2 cm. The pancreas performs 2 functions: exocrine ( enzymatic) and endocrine (hormonal).

exocrine function It consists in the production of enzymes involved in digestion, the processing of proteins, fats and carbohydrates. The pancreas synthesizes and releases about 25 digestive enzymes. They are involved in the breakdown of amylase, proteins, lipids, nucleic acids.

endocrine function perform special structures of the pancreas, the islets of Langerhans. Researchers are focusing on B-cells. It is they who produce insulin, a hormone that regulates blood glucose levels, and also affects fat metabolism,

e - cells that produce somatostatin, b-cells that produce glucagon, PP - cells that produce polypeptides.

1.2 The role of insulin in the body

I. Maintains blood sugar levels within 3.33-5.55 mmol/L.

II. Promotes the conversion of glucose to glycogen in the liver and muscles; glycogen is the "depot" of glucose.

III. Increases the permeability of the cell wall for glucose.

IV. It inhibits the breakdown of proteins and converts them into glucose.

V. Regulates protein metabolism, stimulating protein synthesis from amino acids and their transport into cells.

VI. Regulates fat metabolism, promoting the formation fatty acids.

Importance of other pancreatic hormones

I. Glucagon, like insulin, regulates carbohydrate metabolism, but the nature of the action is directly opposite to that of insulin. Under the influence of glucagon, glycogen is broken down into glucose in the liver, resulting in an increase in blood glucose levels.

II. Somastotin regulates insulin secretion (slows it down).

III. Polypeptides. Some affect the enzymatic function of the gland and the production of insulin, others stimulate appetite, and others prevent fatty degeneration of the liver.

1.3 Classification

Distinguish:

1. Insulin-dependent diabetes (type 1 diabetes), which develops mainly in children and young people;

2. Non-insulin-dependent diabetes (type 2 diabetes) - usually develops in overweight people over 40 years of age. This is the most common type of disease (occurs in 80-85% of cases);

3. Secondary (or symptomatic) diabetes mellitus;

4. Pregnancy diabetes.

5. Diabetes due to malnutrition.

1.4 Etiology of type II diabetes

The main factors provoking the development of type 2 diabetes mellitus are obesity and hereditary predisposition.

1. Obesity. In the presence of obesity I st. the risk of developing diabetes mellitus increases by 2 times, with II st. - 5 times, with III Art. - more than 10 times. With the development of the disease, the abdominal form of obesity is more associated - when fat is distributed in the abdomen.

2. Hereditary predisposition. In the presence of diabetes in parents or close relatives, the risk of developing the disease increases by 2-6 times.

1.5 Pathogenesis

Diabetes mellitus (lat. diabetesmellotus) is a group of endocrine diseases that develop as a result of a lack of the hormone insulin, resulting in hyperglycemia - a persistent increase in blood glucose. The disease is characterized by a chronic course and a violation of all types of metabolism: carbohydrate, fat, protein, mineral and water-salt.

United Nations symbol for diabetes mellitus

AT basis pathogenesis NIDSD lie three major mechanism:

Insulin secretion is impaired in the pancreas;

· Peripheral tissues (primarily muscles) become resistant to insulin, which leads to disruption of glucose transport and metabolism;

The production of glucose in the liver increases.

The main cause of all metabolic disorders and clinical manifestations of diabetes mellitus is insulin deficiency or its action.

Non-insulin-dependent diabetes mellitus (NIDDM, type II) is 85% of patients with diabetes mellitus. Previously, this type of diabetes was called adult diabetes, geriatric diabetes. In this variant of the disease, the pancreas is perfectly healthy and always secretes into the blood an amount of insulin that corresponds to the concentration of glucose in the blood. The "organizer" of the disease is the liver. The level of glucose in the blood in this variant of diabetes mellitus is increased only because of the inability of the liver to take excess glucose from the blood for temporary storage. In the blood, both glucose levels and insulin levels are simultaneously elevated. The pancreas is forced to replenish the blood with insulin all the time, to maintain it. elevated level. The level of insulin will constantly follow the level of glucose, rising or falling.

Acidosis, the appearance of the smell of acetone from the mouth, pre-coma, diabetic coma with NIDDM are fundamentally impossible, because. the level of insulin in the blood is always optimal. There is no insulin deficiency in NIDDM. Accordingly, NIDDM proceeds much more easily than IDDM.

1.6 Cynic picture

· Hyperglycemia;

· Obesity;

· Hyperinsulinemia (increase in the blood level of insulin);

Hypertension

Cardio - vascular diseases (CHD, myocardial infarction);

Diabetic retinopathy (decreased vision), neuropathy (decrease in sensitivity, dryness and peeling of the skin, pain and cramps in the limbs);

Nephropathy (protein excretion in the urine, increased blood pressure, impaired renal function).

1. At the first visit to the doctor, the patient usually has the classic symptoms of diabetes mellitus - polyuria, polydipsia, polyphagia, severe general and muscle weakness, dry mouth (due to dehydration and decreased function of the salivary glands), skin itching (in the genital area in women).

There is a decrease in visual acuity.

Patients notice that after the drops of urine have dried on the linen, white spots remain on the shoes.

2. Many patients go to the doctor for itching, boils, fungal infections, pain in the legs, impotence. Examination reveals non-insulin-dependent diabetes mellitus.

3. Sometimes there are no symptoms and the diagnosis is made by random examination of urine (glucosuria) or blood (fasting hyperglycemia).

4. Often, non-insulin-dependent diabetes mellitus is first detected in patients with myocardial infarction or stroke.

5. Hyperosmolar coma may be the first manifestation.

Symptoms from various organs and systems:

Leather and muscular system. Often there is dryness of the skin, a decrease in its turgor and elasticity, recurrent furunculosis, hydroadenitis, fungal skin lesions are often observed, nails are brittle, dull, striated and yellowish in color. Sometimes viteligo appears on the skin.

System bodies digestion. The most common changes are: progressive caries, periodontal disease, loosening and hair loss, gingivitis, stomatitis, chronic gastritis, diarrhea, rarely peptic ulcer stomach and duodenum 12.

Cordially - vascular system. Diabetes mellitus contributes to the early development of atherosclerosis, coronary artery disease. IHD in DM develops earlier, is more severe and more often gives complications. Myocardial infarction is the cause of death in almost 50% of patients.

Respiratory system. Patients are predisposed to pulmonary tuberculosis and frequent pneumonia. They suffer from acute bronchitis and are prone to its transition to a chronic form.

excretory system. Often there are cystitis, pyelonephritis, there may be carbuncle, kidney abscess.

NIDDM develops gradually, imperceptibly, and is often diagnosed incidentally during preventive examinations.

1.7 Complications of diabetes

Complications sugar diabetes share on the sharp and late.

To number acute include: ketoacidosis, ketoacidotic coma, hypoglycemic conditions, hypoglycemic coma, hyperosmolar coma.

Late complications: diabetic nephropathy, diabetic neuropathy, diabetic retinopathy, delayed physical and sexual development, infectious complications.

Acute complications diabetes mellitus.

Ketoacidosis and ketoacidotic coma.

The leading mechanism of the origin of the disease is absolute insulin deficiency, which leads to a decrease in glucose processing by insulin-dependent tissues, hyperglycemia and energy "hunger", a large physical load, a significant alcohol load.

Clinic: gradual onset, increasing dryness of the mucous membranes, skin, thirst, polyuria, weakness, headache, weight loss, the smell of acetone in the exhaled air, repeated vomiting, noisy breathing, muscle hypotension, tachycardia.

The final stage of CNS depression is coma. Treatment consists of combating dehydration and hypovolemia, eliminating intoxication by administering liquid (orally in the form of mineral and drinking water, intravenously in the form of saline, 5% glucose solution, rheopolyglucin).

Hypoglycemic states and hypoglycemic coma.

Hypoglycemia is a decrease in blood sugar levels. In 3-4% of cases, it is hypocoma that is the cause of the lethal outcome of the disease. The main reason leading to the development of hypoglycemia is the discrepancy between the amount of glucose in the blood and the amount of insulin in a specific period of time. Usually, such an imbalance occurs in connection with an overdose of insulin against the background of intense physical exertion, dietary disorders, liver pathology, and alcohol intake.

Hypoglycemic states develop suddenly: mental functions decrease, drowsiness appears, sometimes excitability, acute hunger, dizziness, headache, internal trembling, convulsions.

There are 3 degrees of hypoglycemia: mild, moderate and severe.

Mild hypoglycemia: sweating, a sharp increase in appetite, palpitations, numbness of the lips and the tip of the tongue, weakening of attention, memory, weakness in the legs.

In moderate forms of hypoglycemia, additional symptoms appear: trembling, visual impairment, thoughtless actions, loss of orientation.

Severe hypoglycemia is manifested by loss of consciousness and convulsions.

Characteristic signs of hypoglycemia are: sudden weakness, sweating, trembling, anxiety, hunger.

Consequences of hypoglycemic coma. The nearest (a few hours after the coma) - hemiparesis, hemiplegia, myocardial infarction, impaired cerebral circulation. Remote - develop in a few days, weeks. They are manifested by encephalopathy (headaches, memory loss, epilepsy, parkinsonism.

Treatment begins immediately upon diagnosis with intravenous jet injection of 20-80 ml of 40% r glucose until consciousness is restored. Intramuscular or subcutaneous administration of 1 ml of glucagon is recommended. Mild hypoglycemia is stopped by the usual intake of food and carbohydrates (3 pieces of sugar, or 1 tbsp of granulated sugar, or 1 glass of sweet tea or juice.)

Hyperosmolar coma. The reasons for its development is the increased content of sodium, chlorine, sugar, urea in the blood. It proceeds without ketoacidosis, develops within 5-14 days. The clinic is dominated by neurological symptoms: impaired consciousness, muscle hypertonicity, nystagmus, paresis. Dehydration, oliguria, tachycardia are sharply expressed. emergency care should begin with the introduction of a hypotonic (0.45%) solution of sodium chloride and 0.1 U / kg of insulin.

Late complications of diabetes

diabetic nephropathy (DN) - specific damage to the vessels of the kidneys is the main cause of premature death of patients with diabetes mellitus from uremia and cardiovascular diseases. Leads to the development of chronic renal failure.

diabetic retinopathy - damage to the retina in the form of microaneurysms, pinpoint and spotted hemorrhages, solid exudates, edema, and the formation of new vessels. Ends with hemorrhages in the fundus, can lead to retinal detachment. The initial stages of retinopathy are determined in 25% of patients with newly diagnosed type 2 diabetes mellitus. The incidence of retinopathy increases by 8% per year, so that after 8 years from the onset of the disease, retinopathy is already detected in 50% of all patients, and after 20 years in approximately 100% of patients.

Diabetic neuropathy (DPN) - frequent complication SD. The clinic consists of the following symptoms: night cramps, weakness, muscle atrophy, tingling, tension, goosebumps, pain, numbness, decreased tactile, pain sensitivity.

According to the medical statistics of polyclinic No. 13, I identified complications and mortality in patients with diabetes, indicating the immediate cause of death in 2014

1.8 Methods of treatment

Treatment with oral antidiabetic drugs (PSP)

Classification:

I. Alpha-glucosidase inhibitors that slow down the absorption of carbohydrates in small intestine(glucobay).

II. Sulfonylureas (stimulate the release of insulin from B-cells, enhance its action). These are Chlorpropamide (Diabetoral), Tolbutamide (Orabet, Orinase, Butamid), Gliclazide (Diabeton), Glibenclamide (Maninil, Gdyukobene).

III. Biguanides (utilize glucose, reduce the production of glucose by the liver and its absorption in the gastrointestinal tract, enhance the action of insulin: Phenformin (Dibotin), Metformin, Buformin.

IV. Derivatives of thiazolidinediones - Diaglitazone (change the metabolism of glucose and fats, improve the penetration of glucose into tissues).

V. Insulin therapy

VI. Combination therapy (insulin + oral hypoglycemic drugs - PSP).

IV. Crestor (Reduces elevated cholesterol concentrations. Primary prevention of major cardio - vascular complications.)

VII. Atacand (Used for arterial hypertension.)

Diet therapy in patients with type II diabetes

Diet therapy for type II diabetes differs little from dietary approaches for type I diabetes. If possible, you should reduce the calorie content of the diet. It is recommended to prescribe a diet with a calorie content of 20-25 kcal per kg of actual body weight.

Using the table, you can determine the type of physique and daily energy requirement.

In the presence of obesity, calorie content decreases according to the percentage of excess body weight to 15-17 kcal per kg (1100-1200 kcal per day). Daily calories: carbohydrates-50%, proteins - 15-20%, fats - 30-35%.

Dietary fat distribution: 1/3 saturated fat, 1/3 simple unsaturated fatty acids, 1/3 polyunsaturated fatty acids (vegetable oils, fish)

It is necessary to determine the "hidden fats" in the products. They can be found in frozen and canned foods. Avoid products containing 3 g or more of fat per 100 g of product.

	main sources
Reduced fat intake	butter, sour cream, milk, hard and soft cheeses
Reduced intake of saturated fatty acids	pork, duck meat, cream, coconuts
3. Increased intake of foods high in protein and low in saturated fatty acids	fish, chicken, turkey meat, game.
4. Increase intake of complex carbohydrates, fiber	all kinds of fresh and frozen vegetables and fruits, all kinds of cereals, rice
5. slight increase in the content of simple unsaturated and polyunsaturated fatty acids	sunflower, soybean, olive oil
Reduced cholesterol intake	brain, kidneys, tongue, liver

1. Fractional nutrition

2. Limiting Saturated Fat Intake

3. Exclusion from the diet of mono - and polysaccharides

4. Reduce cholesterol intake

5. The use of foods high in dietary fiber. Dietary fiber improves the processing of carbohydrates by tissues, reduces the absorption of glucose in the intestine, which helps to reduce glycemia and glucosuria.

6. Reduce alcohol intake

Individual weight body determined on formula:

With the help of BMI, one can assess the degree of risk of developing type II diabetes, as well as atherosclerosis, arterial hypertension.

BMI and associated health risk

		health risk	Events
underweight		missing
		missing
overweight		elevated	weight loss
obesity		very tall
pronounced obesity		extremely high	immediate weight loss

Waist circumference (WC) is a simple indicator by which you can judge how susceptible you are to the above diseases. OT for women should be at least 88 cm, and for men - less than 102 cm.

Physical activity and calorie consumption

In patients with DM various types physical activity consumes a certain amount of calories, which must be immediately replenished. When resting in a sitting position, 100 kcal is consumed per hour, the same number of calories is contained in 1 apple or 20 g of peanuts. Walking for an hour at a speed of 3-4 km / h burns 200 kcal, this is the number of calories contained in 100 g of ice cream. Riding a bicycle at a speed of 9 km / h consumes 250 kcal / h, the same kcal contains 1 meat pie.

Reducing body weight to an optimal level is beneficial for everyone fat people but especially in patients with type II diabetes. Exercise plays a huge role in weight loss and health improvement. Exercise has been shown to reduce insulin resistance (in other words, increase sensitivity) to insulin, which can improve glycemic control even without regard to the degree of weight loss. In addition, the influence of risk factors for the development of cardiovascular diseases decreases (for example, high blood pressure decreases). In type II diabetes, moderate-intensity exercise is recommended ( walking tour, aerobic, resistance exercise) for 30 minutes daily. However, they must be systematic and strictly individual, since in response to physical activity Several types of reactions are possible: hypoglycemic conditions, hyperglycemic conditions (in no case should you start physical education with blood sugar more than mol / l), metabolic changes up to ketoacidosis, fiber detachment.

Surgical methods for the treatment of diabetes mellitus

This year marks 120 years since the first attempt to transplant a pancreas to a diabetic patient. But until now, transplantation has not been widely introduced into the clinic due to the high cost and frequent rejection. Currently, attempts are being made to transplant the pancreas and β-cells. In most cases, rejection and death of the graft occurs, which complicates and limits the use of this method of treatment.

Insulin dispensers

Insulin dispensers - "insulin pump" - small devices with a reservoir for insulin, fixed on the belt. They are designed so that they inject insulin subcutaneously through a tube, at the end of which there is a needle, continuously for 24 hours a day.

Positive aspects: they allow to achieve good compensation for diabetes, the moment of using syringes, repeated injections is excluded.

Negative sides: dependence on the device, high cost.

Physiotherapeutic prophylactic agents

Physiotherapy indicated for non-severe diabetes, the presence of angiopathy, neuropathy. Contraindicated in severe diabetes, ketoacidosis. Physical factors in patients are applied to the area of ​​the pancreas to stimulate it for a general effect on the body and the prevention of complications. SMT (sinusoidal modulated currents) help lower blood sugar levels, normalize fat metabolism. Course 12-15 procedures. SMT electrophoresis with medicinal substance. for example with adebit, manilin. use nicotinic acid, magnesium preparations (lower blood pressure), potassium preparations (needed to prevent seizures)

Ultrasound prevents the occurrence of lipodystrophy. Course 10 procedures.

UHF- procedures improve the function of the pancreas and liver. Course 12-15 procedures.

UFO stimulates general metabolism, increases the barrier properties of the skin.

HBO ( hyperbaric oxygenation) - treatment and prevention of oxygen under high blood pressure. This type of exposure is necessary with DM, as they have oxygen deficiency.

Balneo - and resort therapeutic prophylactic means

Balneotherapy is the use of mineral waters for therapeutic and prophylactic purposes. With diabetes, it is recommended to use mineral waters, which have a beneficial effect on blood sugar levels, and the removal of acetone from the body.

Useful carbonic, oxygen, radon baths. Temperature 35-38 C, 12-15 minutes, course 12-15 baths.

Resorts with drinking water mineral waters: Essentuki, Borjomi, Mirgorod, Tatarstan, Zvenigorod

Phytotherapy for diabetes

Aronia (Rowan) chokeberry reduces the permeability and fragility of blood vessels, use drinks from berries.

Hawthorn improves metabolism

Cowberry - has a tonic, tonic, uroseptic effect

Cranberry- quenches thirst, improves well-being.

Tea mushroom- with hypertension and nephropathy

1.9 The role of the nurse in the care and rehabilitation of type II diabetes

Nursing care for diabetes

AT Everyday life under the care of the sick (compare - care, take care) usually understand the provision of assistance to the patient in meeting his various needs. These include eating, drinking, washing, moving, bowel movements, and Bladder. Care also implies the creation of optimal conditions for the patient to stay in a hospital or at home - peace and quiet, a comfortable and clean bed, fresh underwear and bed linen, etc. The importance of patient care cannot be overestimated. Often the success of treatment and the prognosis of the disease are entirely determined by the quality of care. So, you can flawlessly perform a complex operation, but then lose the patient due to the progression of congestive inflammatory phenomena of the pancreas resulting from his prolonged forced immobility in bed. It is possible to achieve significant recovery of damaged motor functions limbs after suffering a cerebrovascular accident or complete fusion of bone fragments after a severe fracture, but the patient will die due to pressure sores formed during this time due to poor care.

So nursing is a must integral part the whole process of treatment, affecting to a large extent on its effectiveness.

Caring for patients with organ diseases endocrine system usually includes a number of general activities carried out in many diseases of other organs and systems of the body. So, with diabetes, it is necessary to strictly adhere to all the rules and requirements for caring for patients experiencing weakness (regular measurement of blood glucose levels and keeping records on the sick leave, monitoring the state of the cardiovascular and central nervous systems, oral care, supply of the vessel and urinal, timely change of underwear, etc.) With a long stay of the patient in bed, special attention is paid to careful care of the skin and prevention of bedsores. At the same time, caring for patients with diseases of the endocrine system also involves the implementation of a number of additional measures associated with increased thirst and appetite, skin itching, frequent urination and other symptoms.

1. The patient should be positioned with maximum comfort, since any inconvenience and anxiety increase the body's need for oxygen. The patient should lie on the bed with an elevated head end. It is often necessary to change the position of the patient in bed. Clothing should be loose, comfortable, not restricting breathing and movement. In the room where the patient is located, regular ventilation (4-5 times a day), wet cleaning are necessary. The air temperature should be maintained at 18-20°C. Outdoor sleeping is recommended.

2. It is necessary to monitor the cleanliness of the patient's skin: regularly wipe the body with a warm, damp towel (water temperature - 37-38 ° C), then with a dry towel. Particular attention should be paid to natural folds. First, wipe the back, chest, stomach, arms, then dress and wrap the patient, then wipe and wrap the legs.

3. Nutrition should be complete, properly selected, specialized. Food should be liquid or semi-liquid. It is recommended to feed the patient in small portions, often, easily absorbed carbohydrates (sugar, jam, honey, etc.) are excluded from the diet. After eating and drinking, be sure to rinse your mouth.

4. Monitor the mucous membranes of the oral cavity for the timely detection of stomatitis.

5. It is necessary to observe the physiological functions, the correspondence of the diuresis of the drunk liquid. Avoid constipation and flatulence.

6. Regularly follow the doctor's prescriptions, trying to ensure that all procedures and manipulations do not bring significant anxiety to the patient.

7. In case of a severe attack, it is necessary to raise the head of the bed, provide access to fresh air, warm the patient's legs with warm heating pads (50-60 ° C), give hypoglycemic and insulin preparations. When the attack disappears, they begin to give nutrition in combination with sweeteners. From the 3rd-4th days of illness, at normal body temperature, distraction and unloading procedures should be carried out: a series of light exercises. On the 2nd week, you should start doing exercise therapy exercises, massage chest and limbs (light rubbing, in which only the massaged part of the body is opened).

8. When high temperature the patient's body should be opened, with a chill, rub the skin of the trunk and limbs with light movements with a 40% solution of ethyl alcohol using a non-rough towel; if the patient has a fever, the same procedure is carried out using a solution of table vinegar in water (vinegar and water in a ratio of 1: 10). Apply an ice pack or a cold compress to the patient's head for 10-20 minutes, the procedure must be repeated after 30 minutes. Cold compresses can be applied to the large vessels of the neck, in the armpit, on the elbow and popliteal fossae. Make a cleansing enema with cool water (14-18 ° C), then a therapeutic enema with a 50% solution of dipyrone (1 ml of the solution mixed with 2-3 tsp of water) or insert a suppository with dipyrone.

9. Carefully monitor the patient, regularly measure body temperature, blood glucose, pulse, respiratory rate, blood pressure.

10. Throughout his life, the patient is under dispensary observation (examinations once a year).

Nursing examination of patients

The nurse establishes a trusting relationship with the patient and finds out complaints: increased thirst, frequent urination. The circumstances of the onset of the disease are clarified (heredity, aggravated by diabetes, viral infections causing damage to the islets of Langerhans of the pancreas), which day of illness, what level of glucose in the blood at the moment, what medications were used. On examination, the nurse pays attention to appearance patient (the skin has a pink tint due to the expansion of the peripheral vascular network, often boils and other pustular skin diseases appear on the skin). Measures body temperature (increased or normal), determines palpation of respiratory rate (25-35 per minute), pulse (frequent, weak filling), measures blood pressure.

Definition problems patient

Possible nursing diagnoses:

Violation of the need to walk and move in space - chilliness, weakness in the legs, pain at rest, ulcers of the legs and feet, dry and wet gangrene;

back pain in the supine position - the cause may be the occurrence of nephroangiosclerosis and chronic renal failure;

Seizures and loss of consciousness are intermittent;

increased thirst - the result of an increase in glucose levels;

Frequent urination - a means of removing excess glucose from the body.

Nursing Intervention Plan

Patient problems:

A. Existing (real):

- thirst;

- polyuria;

drynessskin;

- cutaneousitching;

- elevatedappetite;

increasedweightbody,obesity;

- weakness,fatigue;

decreased visual acuity;

- heartache;

pain in the lower extremities;

- the need to constantly follow a diet;

- the need for constant administration of insulin or taking antidiabetic drugs (maninil, diabeton, amaryl, etc.);

Lack of knowledge about:

- nature of the disease and its causes;

- diet therapy;

- self-help for hypoglycemia;

- foot care;

- calculation of bread units and menu preparation;

- using a glucometer;

- complications of diabetes mellitus (coma and diabetic angiopathy) and self-help in coma.

B. Potential:

- precomatous and coma states:

- gangrene of the lower extremities;

- ischemic heart disease, angina pectoris, acute myocardial infarction;

- chronic renal failure;

- cataract, diabetic retinopathy;

pustular skin diseases;

- secondary infections;

- complications due to insulin therapy;

- slow healing of wounds, including postoperative ones.

Short-term goals: reducing the intensity of the listed complaints of the patient.

Long-term goals: achieve diabetes compensation.

Nurse independent action

Actions	Motivation
Measure temperature, blood pressure, blood glucose;	Collection of nursing information;
Define qualities pulse rate, NPV, blood glucose level;	Monitoring the patient's condition;
Provide clean, dry, warm bed	Create favorable conditions for improving the patient's condition,
ventilate the ward, but do not supercool the patient;	oxygenation with fresh air;
Wet cleaning of the ward with disinfectant solutions chamber quartzing;	Prevention of nosocomial infections;
Washing with antiseptic solutions;	skin hygiene;
Ensure turning and sitting down in bed;	Avoidance of violation of the integrity of the skin - the appearance of bedsores; Prevention of congestion in the lungs - prevention of congestive pneumonia
Have conversations with the patient about chronic pancreatitis, diabetes mellitus;	Convince the patient that chronic pancreatitis, diabetes mellitus are chronic diseases, but permanent treatment it is possible for the patient to improve his condition;
Provide popular science literature on diabetes mellitus.	Expand information about the disease sick.

Dependent actions of a nurse

Rep: Sol. Glucosi 5% - 200 ml D.S. For intravenous drip infusion.	Artificial nutrition during hypoglycemic coma;
Rp: Insulini 5ml (1ml-40 ED) D. S. for subcutaneous administration, 15 IU 3 times a day 15-20 minutes before meals.	Replacement therapy
Rp: Tab. Glucobai0 .0 5 D. S. insideafterfood	Enhances the hypoglycemic effect, slows down the absorption of carbohydrates in the small intestine;
Rep: Tab. Maninili 0.005 № 50 D. S By mouth, morning and evening, before meals, without chewing	Hypoglycemic drug, Reduces the risk of developing all complications of non-insulin-dependent diabetes mellitus;
Rep: Tab. Metformini 0.5 № 10 D.S After meals	Utilize glucose, reduce the production of glucose by the liver and its absorption in the gastrointestinal tract;
Rep: Tab. Diaglitazoni 0.045 №30 D.S after meals	Reduces the release of glucose from the liver, changes the metabolism of glucose and fats, improves the penetration of glucose into tissues;
Rep: Tab. Crestory 0.01 No. 28 D.S after meals	Reduces high levels of cholesterol. primary prevention of major cardiovascular complications;
Rep: Tab. Atacandi 0.016 No. 28 D.S after meals	With arterial hypertension.

Interdependent actions of the nurse:

Ensure strict adherence to diet number 9;	Moderate restriction of fats and carbohydrates;
	Improvement of blood circulation and trophism of the lower extremities;
Physiotherapy: Electrophoresis: a nicotinic acid magnesium preparations potassium preparations copper preparations Ultrasound	Helps lower blood sugar levels, normalizes fat metabolism; Improves the function of the pancreas, dilates blood vessels; reduce blood pressure; seizure prevention; prevention of seizures, lowering blood sugar levels; preventing the progression of retinopathy; Improves the function of the pancreas and liver; Prevents the occurrence of lipodystrophy; Stimulates general metabolism, calcium and phosphorus metabolism; prevention of diabetic neuropathy, development of foot lesions and gangrene;

Efficacy evaluation: the patient's appetite decreased, body weight decreased, thirst decreased, pollakiuria disappeared, the amount of urine decreased, dryness of the skin decreased, itching disappeared, but general weakness remained during normal physical activity.

Emergency conditions with diabetes:

A. Hypoglycemic state. Hypoglycemic coma.

Overdose of insulin or antidiabetic tablets.

Lack of carbohydrates in the diet.

Insufficient food intake or skipping meals after insulin administration.

Hypoglycemic states are manifested by a feeling of severe hunger, sweating, trembling of the limbs, severe weakness. If this condition is not stopped, then the symptoms of hypoglycemia will increase: trembling will increase, confusion in thoughts, headache, dizziness, double vision, general anxiety, fear, aggressive behavior and the patient will fall into a coma with loss of consciousness and convulsions.

Symptoms of hypoglycemic coma: the patient is unconscious, pale, there is no smell of acetone from the mouth. moist skin, profuse cold sweat, increased muscle tone, free breathing. Arterial pressure and pulse are not changed, the tone of the eyeballs is not changed. In the blood test, the sugar level is below 3.3 mmol / l. there is no sugar in the urine.

Self-help for hypoglycemic condition:

It is recommended at the very first symptoms of hypoglycemia to eat 4-5 pieces of sugar, or drink warm sweet tea, or take 10 glucose tablets of 0.1 g, or drink from 2-3 ampoules of 40% glucose, or eat a few sweets (preferably caramel ).

First aid for hypoglycemic condition:

Call a doctor.

Call a laboratory assistant.

Place the patient in a stable lateral position.

Place 2 sugar cubes on the cheek where the patient is lying.

Prepare medicines:

40 and 5% glucose solution. 0.9% sodium chloride solution, prednisolone (amp.), hydrocortisone (amp.), glucagon (amp.).

B. Hyperglycemic (diabetic, ketoacidotic) coma.

Insufficient dose of insulin.

Violation of the diet (high content of carbohydrates in food).

Infectious diseases.

Stress.

Pregnancy.

Operational intervention.

Harbingers: increased thirst, polyuria, possible vomiting, loss of appetite, blurred vision, unusually severe drowsiness, irritability.

Symptoms of a coma: consciousness is absent, the smell of acetone from the mouth, hyperemia and dryness of the skin, noisy deep breathing, decreased muscle tone - "soft" eyeballs. Pulse - thready, arterial pressure is lowered. In the analysis of blood - hyperglycemia, in the analysis of urine - glucosuria, ketone bodies and acetone.

With the appearance of harbingers of coma, urgently contact an endocrinologist or call him at home. With signs of hyperglycemic coma, urgent emergency call.

First aid:

Call a doctor.

Give the patient a stable lateral position (prevention of retraction of the tongue, aspiration, asphyxia).

Take urine with a catheter for express diagnostics of sugar and acetone.

Provide intravenous access.

Prepare medicines:

Short-acting insulin - actropid (fl.);

0.9% sodium chloride solution (vial); 5% glucose solution (vial);

Cardiac glycosides, vascular agents.

1.10 Medical examination

Patients are under the supervision of an endocrinologist for life, the level of glucose is determined in the laboratory every month. At the diabetic school, they learn self-monitoring and insulin dose adjustment.

Dispensary observation endocrinological patients of health care facilities, MBUZ No. 13, outpatient department No. 2

The nurse teaches patients to keep a diary on self-monitoring of the condition, response to insulin administration. Self-control is the key to diabetes management. Each of the patients should be able to live with their illness and, knowing the symptoms of complications, insulin overdoses, at the right time to cope with this or that condition. Self-control allows you to lead a long and active life.

The nurse teaches the patient to independently measure the level of sugar in the blood using test strips for visual determination; use a device to determine the level of sugar in the blood, as well as use test strips for the visual determination of sugar in the urine.

Under the supervision of a nurse, patients learn how to inject themselves with insulin with a syringe - pens or insulin syringes.

Where need keep insulin ?

Open vials (or filled syringe - pens) can be stored at room temperature, but not in the light at t ° not higher than 25 ° C. The supply of insulin should be stored in the refrigerator (but not in the freezer compartment).

Places introductions insulin

Thighs - outer third of the thigh

Abdomen - anterior abdominal wall

Buttocks - upper outer square

How right conduct injections

To ensure complete absorption of insulin, injections must be made into the subcutaneous fat, and not into the skin or muscle. If insulin is administered intramuscularly, then the process of insulin absorption is accelerated, which provokes the development of hypoglycemia. At intradermal administration insulin is poorly absorbed

"Schools of Diabetes", in which all these knowledge and skills are taught, are organized at endocrinological departments and polyclinics.

Historical development of diabetes. The main causes of diabetes mellitus, its clinical features. Diabetes mellitus in old age. Diet in type II diabetes mellitus, pharmacotherapy. Nursing process in diabetes mellitus in the elderly.

term paper, added 12/17/2014

The influence of the pancreas on the physiological processes in the body. Clinical manifestations and types of diabetes mellitus. Symptoms of diabetic autonomic neuropathy. Methods of perioperative insulin therapy in concomitant diabetes mellitus.

abstract, added 01/03/2010

The risk of developing diabetes mellitus, signs of the disease. Predisposing factors for diabetes mellitus in children. Principles for providing primary nursing care with hyperglycemic and hypoglycemic coma. Organization of therapeutic nutrition in diabetes mellitus.

term paper, added 05/11/2014

Types of diabetes. Development of primary and secondary disorders. Deviations in diabetes mellitus. Frequent symptoms hyperglycemia. Acute complications of the disease. Causes of ketoacidosis. The level of insulin in the blood. secretion by beta cells of the islets of Langerhans.

abstract, added 11/25/2013

The severity of diabetes. Organization of the nursing process in the care of patients. Reception medicines. The use of insulin to lower blood glucose levels. Monitoring compliance with the medical and protective regime.

presentation, added 04/28/2014

Typical complaints in diabetes mellitus. Features of the manifestation of diabetic microangiopathy and diabetic angiopathy of the lower extremities. Dietary advice for diabetes. Patient examination plan. Features of the treatment of diabetes mellitus.

medical history, added 03/11/2014

The concept of diabetes mellitus as a disease, which is based on a lack of the hormone insulin. Death rates from diabetes. Diabetes mellitus I and II types. Acute and chronic complications in type I diabetes. Emergency conditions in type II diabetes.

abstract, added 12/25/2013

The concept of diabetes. The role of physical therapy in diabetes mellitus. The use of physical exercises in order to restore normal motor-visceral reflexes that regulate metabolism. Features of therapeutic exercises.

abstract, added 07.10.2009

The concept of diabetes mellitus as an endocrine disease associated with relative or absolute insufficiency of insulin. Types of diabetes mellitus, its main clinical symptoms. Possible complications of the disease, complex treatment of patients.

presentation, added 01/20/2016

Epidemiology of diabetes mellitus, glucose metabolism in the human body. Etiology and pathogenesis, pancreatic and extrapancreatic insufficiency, pathogenesis of complications. Clinical signs diabetes mellitus, its diagnosis, complications and treatment.

In everyday life, nursing is usually understood as helping the patient to meet his various needs. These include eating, drinking, washing, moving, emptying the bowels and bladder. Care also implies the creation of optimal conditions for the patient to stay in a hospital or at home - peace and quiet, a comfortable and clean bed, fresh underwear and bed linen, etc. The importance of patient care cannot be overestimated. Often the success of treatment and the prognosis of the disease are entirely determined by the quality of care. So, you can flawlessly perform a complex operation, but then lose the patient due to the progression of congestive inflammatory phenomena of the pancreas resulting from his prolonged forced immobility in bed. It is possible to achieve a significant recovery of damaged motor functions of the limbs after suffering a cerebrovascular accident or complete fusion of bone fragments after a severe fracture, but the patient will die due to pressure sores formed during this time due to poor care.

Thus, patient care is an essential part of the entire treatment process, which to a large extent affects its effectiveness.

Care of patients with diseases of the organs of the endocrine system usually includes a number of general activities carried out in many diseases of other organs and systems of the body. So, with diabetes, it is necessary to strictly adhere to all the rules and requirements for caring for patients experiencing weakness (regular measurement of blood glucose levels and keeping records on the sick leave, monitoring the state of the cardiovascular and central nervous systems, caring for the oral cavity, filing a vessel and urinal, timely change of underwear, etc.) With a long stay of the patient in bed, special attention is paid to careful care of the skin and prevention of bedsores. At the same time, caring for patients with diseases of the endocrine system also involves the implementation of a number of additional measures associated with increased thirst and appetite, skin itching, frequent urination and other symptoms.

1. The patient should be positioned with maximum comfort, since any inconvenience and anxiety increase the body's need for oxygen. The patient should lie on the bed with an elevated head end. It is often necessary to change the position of the patient in bed. Clothing should be loose, comfortable, not restricting breathing and movement. In the room where the patient is located, regular ventilation (4-5 times a day), wet cleaning are necessary. The air temperature should be maintained at 18-20°C. Outdoor sleeping is recommended.

2. It is necessary to monitor the cleanliness of the patient's skin: regularly wipe the body with a warm, damp towel (water temperature - 37-38 ° C), then with a dry towel. Particular attention should be paid to natural folds. First, wipe the back, chest, stomach, arms, then dress and wrap the patient, then wipe and wrap the legs.

3. Nutrition should be complete, properly selected, specialized. Food should be liquid or semi-liquid. It is recommended to feed the patient in small portions, often, easily absorbed carbohydrates (sugar, jam, honey, etc.) are excluded from the diet. After eating and drinking, be sure to rinse your mouth.

4. Monitor the mucous membranes of the oral cavity for the timely detection of stomatitis.

5. It is necessary to observe the physiological functions, the correspondence of the diuresis of the drunk liquid. Avoid constipation and flatulence.

6. Regularly follow the doctor's prescriptions, trying to ensure that all procedures and manipulations do not bring significant anxiety to the patient.

7. In case of a severe attack, it is necessary to raise the head of the bed, provide access to fresh air, warm the patient's legs with warm heating pads (50-60 ° C), give hypoglycemic and insulin preparations. When the attack disappears, they begin to give nutrition in combination with sweeteners. From the 3rd-4th days of illness, at normal body temperature, distraction and unloading procedures should be carried out: a series of light exercises. On the 2nd week, you should start performing exercise therapy exercises, massage of the chest and limbs (light rubbing, in which only the massaged part of the body is opened).

8. At a high body temperature, it is necessary to open the patient, rub the skin of the trunk and limbs with light movements with a 40% solution of ethyl alcohol using a non-rough towel during chills; if the patient has a fever, the same procedure is carried out using a solution of table vinegar in water (vinegar and water in a ratio of 1: 10). Apply an ice pack or a cold compress to the patient's head for 10-20 minutes, the procedure must be repeated after 30 minutes. Cold compresses can be applied to the large vessels of the neck, in the armpit, on the elbow and popliteal fossae. Make a cleansing enema with cool water (14-18 ° C), then a therapeutic enema with a 50% solution of dipyrone (1 ml of the solution mixed with 2-3 tsp of water) or insert a suppository with dipyrone.

9. Carefully monitor the patient, regularly measure body temperature, blood glucose, pulse, respiratory rate, blood pressure.

10. Throughout his life, the patient is under dispensary observation (examinations once a year).

Nursing examination of patients The nurse establishes a trusting relationship with the patient and finds out complaints: increased thirst, frequent urination. The circumstances of the onset of the disease are clarified (heredity, aggravated by diabetes, viral infections causing damage to the islets of Langerhans of the pancreas), which day of illness, what level of glucose in the blood at the moment, what medications were used. On examination, the nurse pays attention to the appearance of the patient (the skin has a pink tint due to the expansion of the peripheral vascular network, often boils and other pustular skin diseases appear on the skin). Measures body temperature (increased or normal), determines palpation of respiratory rate (25-35 per minute), pulse (frequent, weak filling), measures blood pressure.

Clinical examination

Patients are under the supervision of an endocrinologist for life, the level of glucose is determined in the laboratory every month. At the diabetic school, they learn self-monitoring and insulin dose adjustment.

Table 1. Dispensary observation of endocrinological patients in the city of Orel for 2013-2015

The nurse teaches patients to keep a diary on self-monitoring of the condition, response to insulin administration. Self-control is the key to diabetes management. Each of the patients should be able to live with their illness and, knowing the symptoms of complications, insulin overdoses, at the right time to cope with this or that condition. Self-control allows you to lead a long and active life.

The nurse teaches the patient to independently measure the level of sugar in the blood using test strips for visual determination; use a device to determine the level of sugar in the blood, as well as use test strips for the visual determination of sugar in the urine.

Under the supervision of a nurse, patients learn how to inject themselves with insulin with a syringe - pens or insulin syringes.

Where should insulin be stored?

Open vials (or filled syringe - pens) can be stored at room temperature, but not in the light at t ° not higher than 25 ° C. The supply of insulin should be stored in the refrigerator (but not in the freezer compartment).

Insulin injection sites

Thighs - outer third of the thigh

Abdomen - anterior abdominal wall

Buttocks - upper outer square

How to properly inject

To ensure complete absorption of insulin, injections must be made into the subcutaneous fat, and not into the skin or muscle. If insulin is administered intramuscularly, then the process of insulin absorption is accelerated, which provokes the development of hypoglycemia. When administered intradermally, insulin is poorly absorbed.

"Schools of Diabetes", in which all these knowledge and skills are taught, are organized at endocrinological departments and polyclinics.

Chapter 2

Diagnostics

The concentration of sugar (glucose) in capillary blood on an empty stomach exceeds 6.1 mmol / l, and 2 hours after eating it exceeds 11.1 mmol / l;

as a result of a glucose tolerance test (in doubtful cases), the blood sugar level exceeds 11.1 mmol / l;

the level of glycosylated hemoglobin exceeds 5.9%;

there is sugar in the urine;

Measurement of sugar. Measuring sugar levels is necessary for healthy people as part of medical examinations and for diabetics. For the purposes of clinical examination, the measurement is carried out in the laboratory on an empty stomach once every one to three years. This is usually enough to diagnose a disease related to sugar levels. Sometimes, if there are risk factors for diabetes or suspected early development of diabetes, the doctor may recommend more frequent tests. Healthy people do not need constant monitoring of sugar levels and the presence of a glucometer. Sometimes, during the annual medical examination, a person suddenly learns about elevated blood sugar levels. This fact serves as a signal for regular monitoring of their health. For daily monitoring, you need to purchase a special device for measuring blood sugar. This device is called a glucometer.

Glucometer and its choice. This device is specially designed to measure blood glucose levels. If you use your meter regularly, keep a lancing device, sterile lancets, and blood-reactive test strips handy. Lancets differ in length, so they are selected taking into account the age of the user of the device.

Depending on the principle of operation, glucometers are divided into two main groups - these are photometric and electrochemical devices. The principle of operation of a photometric type device is as follows: immediately after glucose enters the reagent, which is located on the surface of the test strip used, it immediately turns blue. Its intensity varies depending on the concentration of glucose in the patient's blood - the brighter the color, the higher the sugar level. Such color changes can be noticed only with the help of a special optical device, which is very fragile and needs special care, which is the main disadvantage of photometric devices.

The principle of operation of electrochemical devices for measuring blood sugar is based on the detection of weak electric currents emanating from the test strips after the interaction of the test strip reagent with blood glucose. When measuring sugar levels on electrochemical glucometers, the results are the most accurate, so they are much more popular.

When choosing a glucometer, you should always focus on the state of health and price category. It is better for older people to give their preference to glucometers with an affordable price, with a large display, with indications in Russian. For young people, a compact glucometer that can fit in your pocket is more suitable.

Four easy steps to take the test:

1) It is necessary to open the fuse;

2) Get a drop of blood;

3) Apply a drop of blood;

4) Get the result and close the fuse.

Glucose tolerance test - curve with sugar load. It is carried out if the level of glucose in the blood is normal, and there are risk factors (see table).

Examination of the fundus - signs of diabetic retinopathy. Ultrasound of the pancreas - the presence of pancreatitis.

Prevention

· Balanced diet;

· Physical activity;

Obesity prevention or treatment;

Exclude from the diet foods containing easily digestible carbohydrates and foods rich in animal fats;

Compliance with a rational mode of work and life

Timely and adequate use of medicines. Forecast

Currently, diabetes is incurable. The duration of life and working capacity of the patient largely depends on the timeliness of the detection of the disease, its severity, the age of the patient and the correct treatment. The earlier diabetes occurs, the more it shortens the life of patients. The prognosis for diabetes mellitus is mainly determined by the degree of damage to the cardiovascular system. Patients with diabetes mild form able-bodied. In moderate and severe diabetes mellitus, work capacity is assessed individually, depending on the course of the disease and concomitant diseases.

2.2. Self-control and education of patients with diabetes mellitus.

Practice has shown that the most important condition effective treatment patients with diabetes mellitus is to teach them almost everything that the doctor knows, that is, the basics of diet therapy of the diet, the rules for selecting insulin therapy and treatment with tablets, the regimen of physical activity and rest, family planning, etc. It is very important that the patient consciously participate in the treatment process , understood its meaning and goals, knew how important self-control and prevention of late complications are. Thus, effective therapy diabetes should be comprehensive and include several components: application medicines- insulin or oral hypoglycemic drugs, diet, dosed physical activity, prevention and treatment of late complications, teaching the patient self-control skills. Ignoring at least one of the components can lead to irreversible consequences. The modern concept of managing patients with diabetes treats this disease as associated with a certain lifestyle. This approach puts in the first place a system of highly effective outpatient monitoring of patients, and not an expansion of the base for their inpatient treatment. In this regard, the leading role of the primary link of specialized diabetic care, which is represented in our country by endocrinologists and nurses of district polyclinics and endocrinological dispensaries, is obvious. More than 2 million patients with DM have been registered in the Russian Federation.

The goals of effective diabetes care include

Complete or almost complete normalization of metabolic processes in order to eliminate acute chronic complications of diabetes

Improving the quality of life of the patient: the disease should be as little as possible on the way of life, so that the patient does not depend on others as much as possible, actively and competently participates in the treatment of his disease.

Solving these problems requires great efforts from health workers and, in particular, in the development of patient education systems. In view of the shortage of endocrinologists-diabetologists and taking into account international experience, we have developed a patient education program with the participation of nursing staff. This made it possible for doctors to engage exclusively in the healing process.

Basic principles of the diet.

Exclude easily digestible carbohydrates (sweets, sweet fruits, bakery products).

Divide your meal into four to six small meals throughout the day.

50% of fats should be of vegetable origin.

The diet should satisfy the body's need for nutrients.

You must follow a strict diet.

Vegetables should be consumed daily.

Bread - up to 200 grams per day, mostly rye.

Lean meat.

Vegetables and greens. Potatoes, carrots - no more than 200 g per day. But other vegetables (cabbage, cucumbers, tomatoes, etc.) can be consumed with virtually no restrictions.

Fruits and berries of sour and sweet and sour varieties - up to 300g per day.

Beverages. Green or black tea is allowed, it is possible with milk, weak coffee, tomato juice, juices from berries and sour fruits.

Techniques that will help reduce the calorie content of food and get rid of excessive body weight

Divide the amount of food planned for the day into four to six small portions. Avoid long periods of time between meals.

If you feel hungry between meals, eat vegetables.

Drink water or soft drinks without sugar. Do not quench your thirst with milk, as it contains both fats that obese people need to consider and carbohydrates that affect blood sugar levels.

Do not keep a large amount of food at home, otherwise you will definitely run into a situation where something needs to be eaten, otherwise it will spoil.

Ask for support from your family, friends, switch to a "healthy" way of eating together.

The most high-calorie foods are those that contain a lot of fat. Remember the high calorie content of seeds and nuts.

You can't lose weight quickly. The best option is 1-2 kg per month, but constantly.

Standard Diet #9

Usually medical nutrition with diabetes, start with a standard diet. The daily meal is divided into 4-5 times. The total calorie content is 2300 kcal per day. Fluid intake per day - about 1.5 liters. Such a power supply is shown in the table below.

Table 2. The ratio of dairy products in grams and bread units

(1 XE \u003d 10-12 g of carbohydrates. 1 XE increases blood sugar by 1.5-2 mmol / l.)

Table 3. The ratio of bakery products in grams and bread units.

1 st. a spoonful of raw cereals. Boiled 1 XE \u003d 2 tbsp. spoons of the product (30 g).

Table 5. The ratio of vegetables and fruits in grams and bread units.

Vegetables, berries, fruits
Boiled potatoes	1 piece the size of a large chicken egg 65g
Mashed potatoes	2 tablespoons 30g
Fried potatoes	2 tablespoons 30g
Dry potatoes (chips)	2 tablespoons 30g
apricots	2-3 pcs. 110gr
Quince	1 piece, large 140g
A pineapple	1 piece (cross section) 140 gr
Watermelon	1 piece 270gr
Orange	1 piece, medium 150gr
Banana	1/2 pieces, medium 70g
Cowberry	7 tablespoons 140g
Grape	12 pieces, small 70g
Cherry	15 pieces 90g
Pomegranate	1 piece, medium 170gr
Grapefruit	1/2 pieces, large 170g
Pear	1 piece, small 100g
Melon	1 piece 100gr

6-8 art. tablespoons of berries such as raspberries, currants, etc. equals about 1 cup (1 tea cup) of these berries. About 100 ml of juice (no added sugar, 100% natural juice) contains about 10 g of carbohydrates.

Table 5. The ratio of legumes in grams and bread units.

PULSES, NUTS	1 XE = amount of product in grams
beans	1 st. spoon, dry
Peas	7 art. spoons, fresh
Carrot	3 pieces, medium
nuts
Beet	1 piece, medium
Beans	3 art. spoons, boiled
Table 6. The ratio of different products in grams and bread units.
Other products	1 XE = amount of product in grams
Carbonated water with sugar	1/2 cup
Kvass	1 glass
Honey	12gr
Ice cream	65gr
Lump sugar	2 pieces
Sugar	2 teaspoons
Chocolate	20gr

The total number of calories in the diet from the table is 2165.8 kcal.

If with such a standard diet there is a slight decrease in blood and urine sugar levels (or even sugar disappears completely in the urine), then after a couple of weeks the diet can be expanded, but only with the permission of a doctor! The doctor will check the level of sugar in the blood, which should not be higher than 8.9 mmol / l. If everything is in order, your doctor may allow you to add some foods filled with carbohydrates to your diet. For example, 1-2 times a week will allow you to eat 50 g of potatoes or 20 g of porridge (except semolina and rice). But such an increase in the diet of products must be constantly strictly controlled due to changes in blood and urine sugar levels.

Diet menu number 9 for diabetes

Here best option diet menu for diabetes for one day:

Breakfast - buckwheat porridge (buckwheat - 40 g, butter - 10 g), meat (you can fish) pate (meat - 60 g, butter - 5 g), tea or weak coffee with milk (milk - 40 ml).

· 11:00-11:30 - drink a glass of kefir.

· Dinner: vegetable soup(vegetable oil - 5 g, soaked potatoes - 50 g, cabbage - 100 g, carrots - 20 g, sour cream - 5 g, tomato - 20 g), boiled meat - 100 g, potatoes - 140 g, butter - 5 g, apple - 150-200 g.

· 17:00 - drink a yeast drink, such as kvass.

Dinner: carrot zrazy with cottage cheese (carrot - 80 g, cottage cheese - 40 g, semolina - 10 g, rye crackers - 5 g, egg - 1 pc.), Boiled fish - 80 g, cabbage - 130 g, vegetable oil - 10 g, tea with a sweetener, such as xylitol.

· At night: drink a glass of yogurt.

Bread for the day - 200-250 g (preferably rye).

CONCLUSION

Diabetes mellitus is a very serious disease, which is understood as a syndrome of chronic hyperglycemia associated with insufficient secretion of insulin or a violation of its action. This disease, as it turned out, is of a heterogeneous nature, which may be based on various factors. The causes of diabetes mellitus are not always clear enough. In the development of insulin deficiency, hereditary pathology plays a role in the first place, a predisposing factor is the birth of a child with a large weight, and it is also possible that viral damage to pancreatic β-cells.

Early diagnosis and adequate treatment of this disease are the most important tasks, since both hyper- and hypoglycemia serve as a starting point for many pathological mechanisms that contribute to the development of severe vascular complications. The goal of diabetes treatment is to achieve levels of glucose in the blood throughout the day that are practically the same as those observed in healthy person. A prospective study in 1993 showed that both the frequency of vascular complications of diabetes and the timing of their onset clearly correlate with the degree of its compensation. By maintaining a normal (or close to normal) blood glucose concentration for a long time, it is possible to delay or delay the onset of late complications.

Unfortunately, neither insulin therapy, nor the use of oral medications, nor diet can fundamentally solve the problem of curing diabetes. Scientists around the world are actively looking for such tools. For example, a method has been proposed for immunosuppression of type 1 diabetes mellitus, which is aimed at suppressing humoral immunity (the formation of autoantibodies to insulin, proinsulin). One of the directions of the search is the transplantation of β-cells of the pancreas, a part of the organ, as well as a complete transplantation of the pancreas. The possibilities of gene therapy are encouraging, as proven by the progress of genetic and molecular technologies. However, the solution of these problems is a matter of the future and, in all likelihood, not far away.

List of used literature

1.E.V. Smoleva, E. Therapy with a course of primary medical and social care / E.V. Smoleva, E.L. Apodiakos. - 9th edition - Rostov n / a: Phoenix, 2011.

2. Smoleva E.V. Nursing in therapy with a course of primary care / E.V. Smoleva; ed. PhD B.V. Kabarukhin. - 6th edition - Rostov n / a: Phoenix, 2008.

3. Fedyukovich N.I. Internal illnesses: textbook / N.I. Fedyukovich. - Ed.7th. - Rostov n / a: Phoenix, 2011.

4. Watkins P. J. Diabetes mellitus / 2nd ed. - Per. from English. M.: Publishing house BINOM, 2006. - 134 p., ill.

5. McMorrey. - human metabolism. - M, World 2006

6.A.S.Ametov, A.S. Modern approaches to the treatment of type 2 diabetes mellitus and its complications - 2012.

7.A.S. Ametov, L.V. Kondratieva, M.A. Lysenko // Clinical pharmacology and therapy. - 2012

8.A.F. Apukhin, M.E. Statsenko, L.I. Inina // Preventive Medicine. - 2012.

9. Dedov I. Butrova S. Platonova N. // Your weight and your health - 2008

10. Stupin V.A., Rumyantseva S.A., Silina E.V. // Multidisciplinary approaches to the treatment of ischemia and hypoxia syndromes in patients with diabetes mellitus - 2011 Moscow

11. Shestakova M.V., Surkova E.V., Maiorov A.Yu. // Education of patients with type 2 diabetes. – 2007 Moscow

In case of violation of metabolic processes, it is necessary to consult a doctor and constant monitoring. The doctor will determine accurate diagnosis and prescribe a treatment regimen, but nursing care is also important for people with diabetes. Junior medical staff spends more time with the patient, monitors diet and prescribed medications, and solves existing and potential problems.

Brief description of the disease

Diabetes mellitus is an endocrine disorder associated with abnormal glucose metabolism. It belongs to the class of sugars, which is why diabetes is called diabetes mellitus. To negative consequences leads to both a deficiency and an excess of glucose in the body. If a lack of sugar can be combated with a special diet, then an excess content is manifested by dysfunctions of various organs and circulatory disorders.

Types of Diabetes

Reduced synthesis of the hormone insulin leads to an excess of sugar. In this case, insulin-dependent diabetes (type 1) is diagnosed. If insulin is produced in the required amount, but the tissues and organs do not perceive it, then type 2 diabetes mellitus (insulin-independent) manifests itself. The first type is more often observed in people under thirty years of age, the second develops after forty. Of ten patients with diabetes, nine have a second type of disease.

Stages of disease development

To quickly understand what is happening with the patient on different stages illness, taken general classification. When the glucose level is not higher than 7 mmol / l, other blood parameters remain normal. Diabetes mellitus is compensated with the help of special medications and therapeutic diet, the patient has no complications. At the second stage, the disease becomes partially compensated, signs of damage to some organs appear.

The third stage of diabetes mellitus is not amenable to drug therapy and a therapeutic diet. Glucose is excreted in the urine, the indicator reaches 14 mmol / l. The patient has obvious signs of complications: visual acuity quickly decreases, the upper or lower limbs go numb, hypertension is diagnosed (sustained high blood pressure).

The most severe course of the disease (the fourth stage) is characterized by a high level of sugar - up to 25 mmol / l. This state is not corrected. pharmacological preparations, protein and sugar are excreted in the urine. Patients often have kidney failure, diabetic ulcers, and gangrene of the lower extremities.

Symptoms of Diabetes

Diabetes mellitus is characterized by a long development of symptoms. On the initial stages patients feel intense thirst, consume up to 5-7 liters of water per day, dry skin, itching, which is often attributed to psychological manifestations, a constant feeling of dry mouth, sweating, muscle weakness, prolonged wound healing.

After the diagnosis of diabetes mellitus and the start of drug correction, regular headaches, discomfort in the heart area, severe swelling of the lower extremities and face, a significant decrease in the sensitivity of the feet, a decrease in visual acuity, increased performance BP, walking disorder constant pain in the lower extremities), liver enlargement.

Provoking factors

Careful attention should be paid to the control of blood glucose levels in patients who are at risk. These include patients with obesity, pancreatitis, pancreatic cancer, etc. Diabetes mellitus often develops in patients with an unfavorable family history or after viral infections(especially when the patient is at risk for diabetes).

Prevention of diabetes

The role of the nurse in the prevention of diabetes is extremely important (especially in cases where we are talking about patients at risk). To prevent type 1 diabetes, you should try to avoid influenza, rubella, mumps, herpes, stress, exclude canned foods and foods with artificial additives from the diet, and pay attention to examination by an endocrinologist.

To prevent type 2 diabetes, one should control weight, exercise regularly, exclude spicy foods, fatty and fried foods, canned food, sweets from the diet, eat small portions, and chew food thoroughly. Prevention in children is to ensure proper nutrition, prolonged breastfeeding, elimination of stress, protection from infectious diseases.

Stages of patient management

Nursing care for patients with diabetes involves working on a nursing technology that has a scientific and medical justification. The main goal is to improve the quality of life of the patient, providing assistance in solving not only existing problems, but also potential ones. Based on this, a diabetes nursing care plan is drawn up.

The process begins with an examination of the patient. Nursing staff should provide assistance in compiling a complete picture of the disease. Each person should have a medical history in which all observations, test results and conclusions about the state of health are recorded. Therefore, nursing care for diabetes in an inpatient or outpatient setting begins with the collection of information about the patient.

At the second stage (according to the results of the examination), a specific diagnosis is made, which takes into account not only the patient's existing problems, but also potential ones, that is, those that may appear in the course of therapy. First of all, the attention of physicians should be directed to the most dangerous symptoms. The nurse can identify the patient's problems, make a list of manifestations that reduce the quality of life. Checking the medical history and questioning are far from all the ways that you can limit yourself. Preventive and psychological measures are required, including work with the patient's family.

In the future, all the information received is systematized. After that, goals are set, which can be both short-term and long-term. All information is recorded in the medical history. Features of nursing care for diabetes will depend on what problems can be identified. For each individual patient, an individual scheme is usually developed. It all depends on how complex the disease is and what treatment tactics the doctor chooses.

Existing patient problems

The real (existing) problems of the patient usually include:

• dry skin and itching;
• increased appetite;
• thirst;
• pain in the heart and lower extremities;
• decreased visual acuity;
• weakness, fatigue;
• the need to constantly follow a therapeutic diet, regularly inject insulin or take special medications.

Patients often face a lack of knowledge about the nature of the disease and risk factors for diabetes, self-help for hypoglycemia, diet therapy, foot care for pain, using a glucometer, making menus and calculating bread units, possible complications. In the work of a nurse must show professionalism, sensitivity, attentiveness and care.

Potential Issues

Potential problems need to be anticipated by medical staff - this is one of the features of diabetes nursing care. There is a risk of developing acute myocardial infarction, gangrene of the lower extremities, coma and pre-coma, secondary infections, complications of insulin therapy, slow wound healing (including postoperative), chronic insufficiency kidneys, cataracts and retinopathy with visual acuity deterioration.

Collection of information during the initial examination

Nursing care for type 1 or type 2 diabetes involves asking the patient about:

• following a diet (medical No. 9 or physiological);
• ongoing treatment;
• insulin therapy (dosage, duration of action, name of insulin, treatment regimen);
• taking tablet preparations (name, dosage, features, tolerability);
• keeping a diary of observations;
• hereditary predisposition to diabetes;
• concomitant diseases;
• complaints at the time of inspection.

The nurse must make sure that the patient knows how to use the table of bread units and correctly compose the menu, knows the places where insulin is administered, is familiar with measures to prevent complications, can use an insulin syringe or syringe pen, and has a glucometer. During the examination, the color and moisture of the skin, the presence of scratches are assessed, body weight is determined, blood pressure is measured, and the pulse is determined.

Nursing Interventions

The nurse should conduct a conversation with the patient and his close relatives about the features of nutrition and regimen. Nursing care for type 2 diabetes involves familiarization with several samples of the menu for the day. It is necessary to convince the patient to follow the diet prescribed by the doctor and not to ignore moderate exercise.

A conversation should be held about the causes, essence of the disease and possible complications, inform the patient about insulin therapy (the beginning and duration of the drug action, storage features, connection with food intake, side effects, types of syringes, and so on), ensure the timely administration of the required doses and the intake of tablets. It is necessary to control the pulse and blood pressure, body weight and condition of the skin, diet, and recommend regular monitoring of glucose.

Working with close relatives of the patient is especially important in nursing care for diabetes in children. Parents or guardians need to be taught how to calculate daily bread units, administer insulin with a syringe, help with hypoglycemia, measure blood pressure, and draw up an optimal menu. Preventive consultations with an ophthalmologist, cardiologist, surgeon, and nephrologist, as well as classes at the Diabetes School, should be recommended.

Features of caring for a patient with diabetes

Nursing care for people with diabetes is just as important as regular medical consultations. The process is carried out in accordance with accepted standards. Features of nursing care for diabetes mellitus are that complex therapy is used, so the specialist needs to simultaneously control several aspects of treatment.

Yes, diet therapy is effective. Patients are shown to reduce carbohydrate intake. The diet is effective only in combination with drug therapy. An adequate regime of work and rest should be ensured, ensuring a decrease in body weight to optimal levels. Insulin replacement therapy is used drug therapy, regular monitoring of indicators is necessary.

Control of sugar levels

In type 1 diabetes, sugar control is necessary once a week. According to indications, it is additionally carried out before each meal and two hours after meals, in the morning and at night.

With type 2 diabetes, you need to analyze several times a month at any time of the day. For convenience, you can keep a diary in which to record sugar readings, time and date, food intake and doses of medications taken.

Emergency conditions

Violation of the regimen can cause a lack or excess of glucose, which is dangerous for the patient's life. It is necessary to take into account these features in nursing care for diabetes mellitus. With hypoglycemia, the patient feels sudden weakness and headache, convulsions, dizziness, there is an acute feeling of hunger. In this case, you need to give the patient sugar (sweets, honey, sugar in the form of syrup, sweet tea). Symptoms should pass within ten minutes. With an excess of glucose, nausea and vomiting occur, there is no appetite, severe thirst, fatigue and lethargy appear.