Med-Surg · chapter 21 · Endocrine System and Endocrine System Disorders
Diabetes Mellitus
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Diabetes mechanism
Characterized by inappropriately levels of high blood glucose, diabetes mellitus (DM) is a disease caused by an imbalance of insulin and glucagon.
Hyperglycemia damage
The excess glucose also bonds to proteins and lipids, causing damage to blood vessels in the eyes, kidneys, and peripheral nerves. The damage can cause complications such as diabetic neuropathy, kidney disease, and peripheral neuropathy (Dapra Bhandari, 2023).
Type 2 risk factors
Risks for T2DM include being overweight, age 45 or older, or of American Indian, Black, Hispanic, Latinx, or Alaska Native descent (CDC, 2022b).
Common diabetes symptoms
Common symptoms associated with DM are polyuria, increased thirst, unplanned weight loss, increased hunger, blurry vision, tingling or numbness in hands or feet, decrease in energy, dry skin, increased infections, and slow wound healing (CDC, 2023).
Hypoglycemia emergency symptoms
Symptoms that indicate a medical emergency include seizures, inability to eat or drink, and loss of consciousness.
Type 2 delayed symptoms
Symptoms may not be present in patients with T2DM, since symptoms can take years to develop.
DKA and HHS mortality
DKA is an acute condition with a low mortality rate. HHS develops slowly, sometimes in weeks, but has a much higher mortality rate.
Diabetes diagnostic testing
DM is diagnosed primarily through evaluation of fasting serum glucose levels, hemoglobin A1c levels, or oral glucose tolerance testing (OGTT).
Gestational diabetes screening
An OGTT is performed in all pregnant patients between 24 to 28 weeks’ gestation as a screening tool for GDM.
Diabetes nursing assessment
Subjective assessment findings may include a patient or family history of obesity, DM, unplanned weight loss, neuropathic pain, polyuria, or polydipsia.
Monitoring for complications
Patients with DM should be continuously monitored for complications, such as signs of hypoglycemia and hyperglycemia.
Illness and glucose checks
A patient with DM that is experiencing stress or an infection doesn’t have the ability to provide that balance, so the nurse should plan to assess the blood glucose levels more frequently.
Medication timing with meals
Onset and peak times of insulin and sulfonylureas, in association with anticipated mealtimes, should always be considered to avoid hypoglycemia episodes.
Acute glucose episodes
If a hypoglycemic episode occurs, the nurse should intervene quickly using the facility’s established hypoglycemia protocol, and the event should be reported to the provider and in handoff or shift report. Symptomatic hyperglycemia should be immediately reported to the provider.
Terms to know
- diabetes mellitus (DM)
- Characterized by inappropriately levels of high blood glucose, diabetes mellitus (DM) is a disease caused by an imbalance of insulin and glucagon.
- insulin
- Produced by beta cells in the pancreas, insulin helps cells absorb glucose for energy, lowering the body’s blood sugar levels, and stimulates protein synthesis and the storage of free fatty acid in adipose tissue.
- glucagon
- Released by alpha cells of the pancreas when the body’s blood glucose is too low, glucagon triggers the liver to release stored glucose to raise glucose levels.
- hyperglycemia
- Because of the imbalance of insulin and glucagon, patients with DM have a risk for hyperglycemia (high blood glucose levels), which can further impair beta cell function and insulin secretion (Dapra Bhandari, 2023).
- osmotic diuresis
- Hyperglycemia can lead to an impaired metabolic state, causing increased urination, or osmotic diuresis, due to the excess glucose concentrations in the kidneys.
- microvascular
- Most complications are microvascular (affect small blood vessels) or macrovascular (affect larger vasculature)
- hypoglycemia
- Common side effects include hypoglycemia, characterized by abnormally low blood glucose levels, and hypokalemia, a deficiency of potassium in the blood.
- Kussmaul respirations
- Possible physical findings may include decreased touch and temperature sensation, blurred vision, hypertension, Kussmaul respirations (rapid, deep breathing at a consistent pace), loss of deep tendon reflexes in ankles, weak dorsalis pedis and posterior tibialis pulses, dry skin, muscle atrophy, foot ulceration, obesity, candida infections, thick hyperpigmentation of the skin under creases or folds, and poor skin turgor.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
At 1845, you intervene for a patient's hypoglycemic episode using the facility protocol. While preparing for the 1900 shift change, you update the nursing note. Which communication plan should you document for this event?
- Notify the provider and include the episode in the handoff report.
- Include the episode in handoff and notify the provider only if another episode occurs.
- Notify the provider and leave the episode details in the chart for the incoming nurse to review independently.
- Record the episode in the glucose monitoring record and defer further reporting until the next routine assessment.
Answer: Notify the provider and include the episode in the handoff report.
The section requires reporting a hypoglycemic episode to both the provider and the nurse receiving handoff. Provider notification alone omits handoff communication, while handoff alone makes provider notification incorrectly conditional on recurrence. Recording the event without these reports does not fulfill the stated communication requirements.
At 0800, you review the care plan for a patient with DM who is experiencing an infection. Which update best reflects the section's guidance for documenting the glucose monitoring plan?
- Increase the frequency of blood glucose assessments during the infection.
- Continue the existing monitoring schedule and add checks only if symptoms develop.
- Use the most recent A1c result to decide whether additional glucose checks are needed during the infection.
- Continue the existing schedule until a glucose result exceeds the patient's target range.
Answer: Increase the frequency of blood glucose assessments during the infection.
Infection can raise blood glucose, and the section recommends more frequent assessments because a patient with DM cannot provide the usual glucose-insulin balance. Waiting for symptoms or an above-target result does not implement that recommendation. A1c reflects glucose levels over three months rather than changes during the current illness.
At 1600, after teaching a patient with DM about the condition, meal planning, glucose monitoring, and acute complications, you complete the evaluation portion of the nursing note. Which entries best document the patient's response to education rather than only the teaching provided? Select all that apply.
- Reviewed meal planning strategies and techniques for monitoring blood glucose.
- Discussed how to identify hypoglycemia and hyperglycemia.
- Explained the underlying mechanisms of diabetes and the goals for blood glucose levels.
- Patient asked questions and actively participated in the education discussion.
- Patient accurately explained the blood glucose monitoring instructions after teaching.
Answer: Patient asked questions and actively participated in the education discussion., Patient accurately explained the blood glucose monitoring instructions after teaching.
The section identifies patient engagement and retention of information as education outcomes to evaluate. Participation documents engagement, and accurately explaining the instructions provides evidence of retention. The other entries describe teaching activities but do not show how the patient responded or what the patient retained.
Where every quote comes from
Section 21.2 Diabetes Mellitus of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.