Special considerations in Patients with Diabetes Mellitus

Special considerations in Patients with Diabetes Mellitus

• Stress that compliance with the prescribed program is essential. Emphasize the effect of blood glucose control on long-term health.
• Watch for acute complications of diabetic therapy, especially hypoglycemia (vagueness, slow cerebration, dizziness, weakness, pallor, tachycardia, diaphoresis, seizures, and coma). Immediately give carbohydrates in the form of fruit juice, hard candy, or honey; if the patient is unconscious, subcutaneous, I.M. or I.V. glucagon or I.V. dextrose may be given.
• Be alert for signs and symptoms of ketoacidosis (acetone breath, dehydration, weak and rapid pulse, Kussmaul’s respirations) and hyperosmolar coma (polyuria, thirst, neurologic abnormalities, stupor). These hyperglycemic crises require I.V. fluids, insulin and, usually, potassium replacement.
• Monitor diabetic control by obtaining blood glucose levels.
• Watch for diabetic effects on the cardiovascular system, such as cerebrovascular, coronary artery, and peripheral vascular impairment, and on the peripheral and autonomic nervous systems.
• Treat all injuries, cuts, and blisters (particularly on the legs or feet) meticulously.
• Be alert for signs of urinary tract infection and renal disease.
• Urge regular ophthalmologic examinations to detect diabetic retinopathy.
• Assess for signs of diabetic neuropathy (numbness or pain in the hands and feet, footdrop, neurogenic bladder). Stress the need for personal safety precautions; explain that decreased sensation can mask injuries. Minimize complications by maintaining strict blood glucose control.
• Teach the patient to care for his feet by washing them daily, drying carefully between the toes, and inspecting for corns, calluses, redness, swelling, bruises, and breaks in the skin. Urge him to report any changes. Advise him to wear nonconstricting shoes and to avoid walking barefoot.
• Teach the patient how to manage his diabetes when he has a minor illness such as a cold, flu, or upset stomach.
• To delay the clinical onset of diabetes, teach persons at high risk to have good weight control, exercise regularly, increase the whole grains, fruits, and vegetables in their diet, and employ stress management techniques. Advise genetic counseling for young adult diabetics who are planning families.