Diabetes Mellitus

A chronic metabolic disorder of hyperglycemia from insulin deficiency or resistance

Definition

Diabetes Mellitus (DM) is a group of metabolic disorders characterized by chronic hyperglycemia from inadequate insulin secretion (Type 1), insulin resistance (Type 2), or both.

Type 1 vs Type 2

Type 1: Autoimmune beta-cell destruction; insulin-dependent; often juvenile onset; DKA risk.
Type 2: Insulin resistance + relative deficiency; adult onset (now also pediatric); HHNS risk.

Diagnostic Criteria

Fasting glucose ≥ 126 mg/dL × 2; random glucose ≥ 200 + symptoms; A1C ≥ 6.5%; OGTT 2-hour ≥ 200.

Complications

Acute: DKA (Type 1), HHNS (Type 2), hypoglycemia.
Chronic: Retinopathy, nephropathy, neuropathy, cardiovascular disease.

Nursing Interventions

Blood glucose monitoring, insulin or oral agents as ordered, dietary counseling (carb counting), exercise education, foot care (daily inspection, no walking barefoot), annual eye exam, regular A1C check (target less than 7% for most). Sick day rules: continue insulin, check BG frequently, test for ketones if BG > 240.

NCLEX Relevance

Differentiate Type 1 vs Type 2 and DKA vs HHNS. Classic 3 P's: polyuria, polydipsia, polyphagia.