Nursing Diagnosis for Diabetes- A Student’s Guide

Table of Contents

What are the nursing diagnoses for diabetes and the nursing care plans?
In this nursing care guide, there are lessons about the goals, nursing interventions, as well as nursing diagnoses regarding diabetes mellitus.

Diabetes happens to be a common condition you are bound to come across in your nursing career, and it carries with it many considerations and complications.

When taking into consideration the nursing diagnosis for diabetes, you need to understand the complications involved.

Diabetes is a condition that comes about if the insulin production by the pancreas is inadequate or when the body is unable to utilize the produced insulin effectively.

Consequently, there is an increase in blood glucose concentration (hyperglycemia). Diabetes exists in two forms:

1. Type 1 is brought about by the failure of one’s pancreas to produce insulin.
2. Type 2 sets in due to lack of sufficient use of insulin in the body. This leads to an increase in body weight and reduced physical activity.

Other risks associated with diabetes include fluid balance difficulty, inability to have nutritional plans, healing and skin problems, and having sensory issues.

In choosing a proper nursing diagnosis for your patient, always consider factors such as history, education levels, and social support.

Type 1 DM (Diabetes Mellitus)

It is inherited partly, and some infections also trigger it. Some confirmation points out the virus Coxsackie B4. The genetic elements present in individuals susceptible to the triggers are traceable to certain HLA genes.

However, those who’ve inherited the susceptibility, type 1 diabetes, have triggers in the environment as a requirement.

The Type 1 DM (diabetes mellitus) onset is not related to one’s lifestyle.

Type 2 DM (Diabetes Mellitus)

It is primarily because of one’s genetic factors and lifestyle.

Below is a comprehensive list of other diabetes causes:

1. B-cell functioning genetic defects
   • Diabetes for the young at maturity-onset
   • Mutations of related DNA
2. Insulin action or Insulin processing gene defects
   • Mutating of insulin gene
   • Mutating of insulin receptor
   • Defects in Proinsulin conversion
3. Exocrine pancreatic defects
   • Cystic fibrosis
   • Pancreatectomy
   • Hemochromatosis
   • Fibrocalculous pancreatopathy
   • Chronic pancreatitis
   • Pancreatic neoplasia
4. Endocrinopathies
   • Cushing syndrome
   • Glucagonoma
   • Hyperthyroidism
   • Pheochromocytomay
   • Excess growth hormone
5. Diseases
   • Cytomegalovirus infection
   • Coxsackie B
6. Medicine
   • Glucocorticoids
   • Statins
   • Thyroid hormone
   • β-adrenergic agonists

Diabetes Warning Signs

• Blurred vision
• Fatigue
• Numbness or tingling in feet and hands
• Frequently getting bladder infections
• Wounds taking too long to heal
• Weight gain/Weight loss
• Irritability
• Nausea, vomiting
• Itching

Hypoglycemia

Hypoglycemia is secondary to not having enough food, excess insulin, and exercise.

Signs and Symptoms

• Weakness
• Tachypnea
• Tachycardia
• Shaking pallor or tremors
• Seizures
• Palpitations
• Nervousness
• Irritability
• Incoherent speech
• Hypotension
• Hunger
• Heavy sweating
• Headaches or numbness of lips and tongue
• Fatigue
• Double or blurred vision
• Confusion coma

Treatment

Provide a source of glucose which is rapidly absorbed:

• Graham crackers
• Hard candy
• Cola or fruit juice
• Sugar packets or sugar cubes

When the symptoms continue to improve:

• Provide the patient with a meal that has a source of carbohydrates or complex protein

Hyperglycemia

Hyperglycemia is secondary to illness, excess food, or insufficient insulin

Signs and Symptoms

• Abdominal cramping
• Anorexia
• Coma
• Confusion
• Dry mucous membranes
• Dry or flushed skin
• Fatigue
• Fruity breath
• Hypotension
• Increased temperature
• Irritability
• Kussmall breathing
• Lethargy
• Nausea
• Numbness
• Poor skin turgor
• Tachycardia
• Thirst
• Vomiting
• Weakness

Treatment

Hyperglycemia treatment needs hospitalization. The therapy will entail:

• Lowering blood glucose using regular insulin
• Monitoring: Vital signs, consciousness levels, electrolytes, and food intake as well as output
• Being emotionally supportive
• Replacing electrolytes
• Restoring fluid balance

Diagnostic Procedures

Blood tests are made to indicate blood sugar levels, which is the main test for the diagnosis of diabetes.

Other tests which are used in determining how severe the diabetes is and what type it is:

1. Random blood sugar testing – In this test, a blood sample is taken at any time of the day, notwithstanding the person’s previous meal. Glucose levels of 200mg/dL or above will suggest a diabetes diagnosis.
2. Fasting blood sugar testing – Fasting blood sugar test involves testing blood sugar levels after one has not had a meal or any type of drink for 8-12 hours (usually overnight). A regular test would indicate less than 100mg/dL. A fasting blood sugar of 126mg/Dl suggests diabetes. Repeat the test after some time to re-confirm that blood sugar levels remain abnormally high.
3. Hemoglobin testing – The test shows optimum blood glucose levels between two to three months. Blood glucose levels are monitored for diabetes patients. The test is not for diabetes diagnosis. Normal ranges of A1C come between 4% – 6%. Blood is taken from the fingertip or the vein when performing the test.
4. Oral sugar tolerance test – This happens to be the most delicate test for pre-diabetics as well as diabetes diagnosis. However, this test may not be recommended often due to its inconvenience compared to a fasting blood sugar test.

A standard oral sugar tolerance test is done routinely at 24 to 28 weeks while pregnant to check gestational diabetes. One must take a 50g solution of glucose, and a blood sugar level is checked in an hour.

For the women who experience unusually high blood glucose levels, another test is done a day following the taking of 100g solution of glucose

The blood glucose levels are taken before and between one, two, and three hours of taking the solution.

Nursing Care Plan for Diabetes

In coming up with a suitable nursing care plan for diabetes, always keep in mind the following:

• Evaluation
• The nursing interventions
• The expected outcomes
• The diabetes nursing diagnosis

A properly drafted nursing care plan is an implied version of the nursing process. In every single nursing diagnosis, there are multiple outcomes and interventions.

You are supposed to evaluate each rather than evaluate the whole diagnosis. Think of the problem, the solution that has been proposed, what you perceive might happen, and then what has happened.

Nursing Diagnosis for Diabetes

Fluid and Nutrition Balance

The initial group of nursing diagnoses for diabetes patients includes those who are involved in nutrition and fluid balance.

Diabetes affects the ability of the body to control the cells’ blood glucose levels. Thus, even if the patient consumes sufficient calories, if the body cannot bring the sugar into the cells as energy, it will starve.

We’ll dig into diabetes nursing diagnosis that focuses on fluid and nutrition imbalances.

Imbalanced Nutrition Risks

While a patient could be consuming sufficient calories, the sugars may fail to get absorbed into the body properly. This is typical for insulin-dependent or type 1 diabetics.

Unstable Blood Glucose Risks

If blood glucose is not regulated carefully by a diabetic patient, there is a risk of unstable blood sugar levels.

If diabetics are poorly controlled, they begin to go down the blood glucose roller coaster.

They experience low blood glucose levels, then treat it with too much sugar, and then they have to deal again with high blood sugar levels until they get down again.

The treatment is used for both hypoglycemia nursing diagnosis and hyperglycemia nursing diagnosis.

The risk factors associated with this include:

• Inadequate monitoring of blood glucose
• Failure to adhere to diabetes management
• Little or no knowledge of diabetes management
• Medication management
• Sedentary activity levels
• Excess or insulin deficiency
• Developmental level

The desired outcome, in this case, would be:

• The patient achieves and maintains glucose levels at an acceptable range.
• The patient will acknowledge the crucial factors contributing to varying glucose levels.
• The patient will have their blood glucose indication of less than 180mg/dL; the levels of fasting blood sugar below 140mg/dL; and hemoglobin level is less than 7%.

The nursing rationale and assessment:

1. Check for signs of hyperglycemia which leads to increased hunger, thirst, and increase in urination.
2. Check the blood glucose levels before bedtime and meals.
3. Keep track of the patient’s hemoglobin. It measures the blood glucose for the last 2 to 3 months.
4. The patient should check their weight daily to assess nutritional intake adequacy.
5. Check for tremors, anxiety, and slurring speech. Use 50% dextrose to treat hypoglycemia.
6. Check the feet for color, temperature, pulses, and sensation. It ensures monitoring of neuropathy and peripheral perfusion.
7. Assess the sounds of the bowel and report any bloating, abdominal pain, vomiting, and nausea. Incidences of hyperglycemia affect intervention choices.
8. Monitor serum creatinine and urine albumin for incidences of renal failure. Microalbuminuria is the initial indication of diabetic nephropathy. Renal failure leads to an increase in creatinine to more than 5mg/dL.
9. Assess the physical activity patterns. Physical activity will help lower the blood glucose level. It also reduces cardiovascular complications risks. It also ensures a healthy weight.
10. Check for hypoglycemia signs.
11. Explore what the patient believes about physical exercise and review the program created for exercising with the patient.

Some of the oral hypoglycemic medications the patient can take are:

Sulfonylureas:

It stimulates insulin secretion and is mainly used by Type 2 patients to control blood glucose levels. It also enhances insulin sensitivity, decreasing the synthesis of glucose by the liver to store glycogen from amino acids.

Meglitinides:

Stimulates pancreatic insulin secretion.

Biguanides:

They decrease the production of glucose by the liver and also better insulin sensitivity. This drug also improves receptor sensitivity to insulin.

Phenylalanine derivatives:

Useful for stimulating insulin secretion and reducing blood sugar increase that occurs after meals.

Alpha-glucosidase inhibitors:

This drug inhibits glucose production by the liver and helps in increasing the body’s sensitivity to insulin. It controls the levels of blood glucose in type 2.

Thiazolidinediones:

Help sensitize the body tissues to insulin and stimulate the insulin receptor in lowering blood glucose, thus improving insulin action.

Incretin modifiers:

Prolongs increases incretin action, leading to an increase in insulin secretion and decreasing glucagon levels.

Advice the patient, to take insulin injections as directed:

Short-acting insulin –

It has an onset action within the first 30 minutes of administration.

Rapid-acting insulin –

It has an onset action of 15 minutes after administration. In this case, the patient should have a meal immediately to avoid hypoglycemia.

Intermediate-acting insulin –

Once administered, the duration of action is 18-26 hours.

Long-acting insulin –

This type of insulin after administration has an onset of one hour and has no peak action. This is because insulin release is at a constant rate.

Rapid and intermediate –

It is a pre-mixed concentration whose onset is similar to that of rapid and intermediate.

Imbalanced or Deficient Fluid Volume Risks

In the event of an increase in blood sugars, there is an attempt by the body to do away with the excess sugar through the rise in the release of fluid. It is done through thirst or excessive urination.

The increase causes the body to get dehydrated and thus have electrolyte imbalances. When selecting a diagnosis, you may choose either imbalanced or deficient fluid volume depending on the patient’s situation.

Skin Integrity

When the blood vessels and nerves become exposed to high levels of blood sugars, they get damaged. This causes peripheral vascular disease and diabetic neuropathy.

Thus, these conditions lead to increased infections and wounds in the body, especially in the feet. Increased blood sugars will also lead to the affecting of neutrophil functioning.

It is among the essential white blood cells which take part in the fight against bacterial infections. Consequently, this causes difficulty and delay in the process of healing.

Impaired Skin Integrity

If there is peripheral neuropathy in the patient because of diabetes, there is an increase in the risk of developing an ulcer or wound significantly.

More often than not, patients who develop peripheral neuropathy experience lower pain sensation. This means they could realize a little late that they have a wound on their feet or a developing pressure ulcer.

Thermal Injury Risks

The patient’s inability to experience high temperatures can be due to peripheral neuropathy. The patients have high chance of experiencing a burn or scald, and they may not realize it.

The scalds or burns may take time to heal, and they stand a very high chance of getting infected due to the slow healing process. Essentially, this is caused by the suppressed immune system due to the decrease in the functioning of neutrophils.

Infection Risks

Hyperglycemia leads to suppressing the immune system in fighting the body’s infections and the body’s ability to defend itself against infections of the skin.

Furthermore, impairment of blood flow is caused by peripheral vascular disease, which drags the time infections and ulcers take to heal.

Delayed Healing After Surgery

If a patient undergoes surgery, this nursing diagnosis will apply to their situation. When the blood glucose levels are very high, the circulatory and immune systems face impairment.

When proper blood circulation is not taking place, wounds take a longer time to heal. Thus, the longer they take, the higher the chances of infection.

Coupled with a suppressed immune system, the diabetic patient will experience difficulty recovering from surgery and wound healing.

Health Management

Diabetes is a complicated condition to manage. It depends on the patient’s level of education and social and economic status. It helps with learning how to manage the situation.

Knowledge Deficiency

If a patient is diagnosed with diabetes and has minimal understanding of the disease, understanding first is the priority.

Not all patients will have an education, so it could be a struggle to understand all the necessary concepts of the disease.

Re-analysis and repetition will be required in such instances to ensure that the patient fully understands diabetes.

Consider an evaluation of whether your patient can read or consider alternative means of teaching the patient.

Ineffective Management of Health

Diabetes can be deemed as complicated in its management. Often, patients get used to elevated glucose levels or are scared of hypoglycemia. In this case, they choose to keep their blood glucose levels higher than usual.

Understanding the reasons your patient is mismanaging the disease is crucial. Consider employing strategies to help your patient manage diabetes is necessary when coming up with a diabetes mellitus nursing care plan.

Chronic Pain

Many patients who have diabetes, in most cases, will develop peripheral neuropathy. They suffer chronic pain in their feet and hands.

The pain experience is severe and, most times, challenging in managing. It affects independence and quality of life. At times it may also lead to a patient’s inability to move around.

Developing a strategy to ensure your patient’s mobility and ability to manage chronic pain will significantly improve the quality of life.

Diabetes is a common condition that affects many patients. Understanding the proper nursing diagnosis helps in developing a comprehensive plan for caring for your patients.

It will help them achieve the anticipated health goals and recovery from illnesses or surgery.

Fatigue

Fatigue is evidenced by impairment, inability to concentrate, lack of energy, becoming accident-prone, or a lack of interest in one’s surroundings.

Some of the nursing interventions include:

• Have a conversation about the importance of physical activity. Create a suitable schedule with the patient.
• Alternate physical activity with periods of uninterrupted rest and sleep.
• Evaluate ways of energy conservation. A patient can achieve more with the use of less energy.
• Discuss the need for physical activity with the patient.
• Have well-ventilated areas around the patients to increase oxygenation.
• Provide comfort and safety measures.
• Administer oxygen as required.

Disturbed Sensory Perception

It leads to an electrolyte, glucose, and insulin imbalance. The nursing interventions in this case include:

• Monitoring the mental status and vital signs.
• Cluster and schedule nursing interventions and time.
• Reorient the patient, call them by their name, and give explanations when need be.
• The patient’s routine should be kept as consistent as possible. Encourage the patient to participate in activities of daily living as much as they can
• Keep the patient protected from injury at all costs. Put the bed in a low position and keep the rails padded if the patient is prone to seizures.
• Keep in check the visual acuity.
• Assist the patient with changing the position and ambulation.
• Monitor the lab values like osmolality, blood glucose, and serum. This is because imbalances will impair mentation.

Diabetes vs. Diabetes Mellitus

Diabetes Mellitus encompasses the diseases focused on how the body will interact with glucose, produce insulin, and convert it to energy.

Ordinarily, when talking about diabetes, someone is referring to diabetes mellitus. At the same time, diabetes insipidus is about the function of the kidneys.

Diabetes only happens to be a disease in simple terms.

Nursing Intervention

• Safeguard skin integrity by taking care of feet from breaking down.
• Advise the patient to check their blood glucose levels before engaging in exhausting activities. They should also snack on carbohydrates beforehand to stay clear of hypoglycemia.
• Advice the smoking patients to quit smoking to enhance the flow of peripheral and reduce vasoconstriction.
• Advice on the importance of exercising to reduce or maintain weight.
• Advise the patients on why it is essential to have a meal plan solely for them. It will assist in achieving their weight loss goals and compliance to a proper diet.
• Explain and demonstrate the procedure for insulin self-injection. Help the patient in mastering the technique.
• Make an assessment of legs and feet for their temperature, tissue injuries, sensation, corns, dryness, calluses, and deep tendon reflexes.
• Review time and dosage of the injections concerning activity, meals, and time for going to bed. This will be based on the individual insulin regimen.
• Instruct your patient on how essential it is to master the accuracy in insulin preparation. It is also necessary to learn to do meal timing as they seek to avoid hypoglycemia.
• Evaluate the patient for sensory and cognitive impairment, which will hinder the accurate administering of insulin.
• Administer insulin (prandial and basal).
• Report blood pressure which is more than 160mm (Hg). Keeping the blood pressure in check will prevent issues such as stroke.
• Instruct the patient on how to rotate the insulin injection sites properly. It will reduce the risk of reduced absorption of insulin if administered on the same spot.
• Make a patient understand the importance of storing insulin appropriately.
• Make obese patients understand the importance of weight loss.
• For the patients using insulin pumps, make them understand their patency.

Conclusion

There is no known cure for diabetes mellitus. When managing the disease, the focus is on controlling serum glucose levels which prevent or delays complication development.

Persons with type 1 will require the administration of subcutaneous insulin. Patients who suffer from mild diabetes mellitus or type 2 can manage it through their diet alone.

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