Diabetes Mellitus Nursing Diagnosis & Care Plan

What is Diabetes Mellitus?

Diabetes Mellitus is a chronic metabolic disorder in which the body is unable to process carbohydrates, fats, and proteins due to an ineffective use of insulin within the body. This then results in high blood glucose levels in the bloodstream.

Types of Diabetes Mellitus

Type 1 – This type of diabetes is believed to be due to an autoimmune reaction in the body that prevents the body from producing insulin

Type 2 – This type of diabetes develops over time. It is the result of the body’s inability to use the insulin it produces in a manner that allows for normal blood glucose levels.

Gestational Diabetes – This form of diabetes develops during pregnancy in individuals that otherwise have never been diagnosed with diabetes in the past. It typically resolves after the woman gives birth; however, it increases her risk of developing type 2 diabetes mellitus later in life.

Prediabetes – This form is a stage in which blood glucose levels are higher than the normal range but not high enough to be classified as type 2 diabetes mellitus. Prediabetes is a fasting blood glucose level of 100-125mg/dL.

Hypoglycemia

Hypoglycemia is the medical term used for low blood glucose and is measured at a value below 70mg/dL. If this occurs it needs to be treated immediately otherwise it could develop into a medical emergency for the patient.

Causes of Hypoglycemia

There are a variety of circumstances that could cause an individual’s blood glucose level to become low including: taking too much insulin, not eating enough carbohydrates, timing of insulin administration, physical activity, alcohol, weather (hot/humid), puberty, or menstruation

Signs and Symptoms of Hypoglycemia

The following signs and symptoms can be associated with hypoglycemia: elevated heart rate, report of palpitations, shaking, sweating, state of nervousness/anxiousness, confusion, dizziness, or hunger. It is important to be aware of these potential signs and symptoms so if noticed treatment can be administered quickly.

Hyperglycemia

Hyperglycemia is the medical term used for high blood glucose levels and occurs as a result of too little insulin being present in the patient’s blood. Hyperglycemia is a fasting blood glucose level greater than 125mg/dL or a blood glucose level of 180mg/dL one to two hours after eating.

Causes of Hyperglycemia

Hyperglycemia can be the result of various factors including: diet choices, activity levels, illnesses, stress, other medications such as steroids, or inappropriate use of diabetic medications (insulin or oral medications).

Signs and Symptoms of Hyperglycemia

Signs and symptoms to be aware of that can potentially indicate hyperglycemia include: frequent urination, increased thirst, blurred vision, fatigue, and headaches. If hyperglycemia is left untreated symptoms can progress and the patient may then develop fruity-smelling breath, nausea and vomiting, shortness of breath, weakness, confusion, or coma. This can become a medical emergency and therefore should be monitored closely and appropriate treatment administered if blood glucose levels are elevated.

Complications (Type 1 and Type 2) 

If left untreated or poorly managed, diabetes can lead to other complications related to blood vessels including:  

  1. Cardiovascular Disease – High blood glucose levels can result in damage to blood vessels and nerves that affect the heart. This can result in hypertension and high levels of cholesterol. This then puts the patient at risk of developing coronary artery disease, angina, myocardial infractions, and cerebrovascular accidents.    
  1. Neuropathy – High blood glucose levels can also damage the walls of capillaries leading to nerve damage. This can then cause tingling, numbness, or a burning pain that begins in the extremities and moves inward and upward.   
  1. Renal Disease – Diabetes can also damage the small vessels in the body’s filtering system. This then leads to kidney damage that if severe enough, can become permanent and require the patient to be on dialysis or need a kidney transplant. 
  1. Retinopathy – Diabetes can also damage the blood vessels in the eyes which can result in diabetic retinopathy. Individuals diagnosed with diabetes are more at risk of developing glaucoma or cataracts. If left untreated it can eventually lead to blindness.  
  1. Foot Damage – This is common due to the nerve damage previously discussed as well as poor blood circulation in the feet. This can ultimately lead to foot ulcers that can be slow to heal and increase the patient’s risk of infection. 
  1. Depression – This is also common due to the complexity of managing diabetes. Depression can lead to additional stress which can further challenge the management of blood glucose levels.

Complications (Gestational Diabetes) 

Gestational diabetes can also have its own set of potential complications. Complications related specifically to gestational diabetes include: 

  1. Excess growth due to the extra glucose passing through the placenta to the baby. This can result in more C-sections for woman with gestational diabetes.  
  1. Hypoglycemia for baby shortly after birth because the woman’s body has been used to producing extra insulin during pregnancy.  
  1. Increased risk of developing type 2 diabetes later in life (for babies of mothers with gestational diabetes) 
  1. Preeclampsia 
  1. Gestational diabetes in successive pregnancies  
  1. Death in baby if gestational diabetes is left untreated throughout the pregnancy 

Treatment 

Treatment of diabetes is multidimensional. First and foremost, patients will need to be educated and trained on how to monitor blood glucose levels at home.  Likely, patients will be started on diabetic medications. This could be in the form of oral medications and/or insulin injections. Additional teaching will be needed regarding these medications, as well as, how and when to take them in timing with their meals. Lastly, diet is a huge part of the management of diabetes and patients will need thorough education on items that are appropriate for a diabetic diet and how to successfully and accurately count carbohydrates.

Nursing Care Plan for Diabetes

Nursing Diagnosis: Risk for unstable blood glucose levels related to insufficient diabetes management or adherence to diabetes management plan

Outcome: The patient will achieve and maintain blood glucose levels within the normal range.

Intervention Rationale 
Assess for signs or symptoms of hypoglycemia Hypoglycemic events are extremely dangerous and should be corrected as quickly as possible. 
Assess for signs or symptoms of hyperglycemia  Being aware of signs and symptoms of hyperglycemia will allow for prompt administration of medication if necessary. 
Monitor/perform blood glucose checks  Monitoring the blood glucose level closely will prevent hypoglycemic and/or hyperglycemic events from occurring. Likewise, it will assist in determining if the medication regimen is appropriate or requires dosage adjustments. 
Administer diabetic medications (oral and insulin) as prescribed  Appropriate medication administration will assist in maintaining optimal blood glucose levels. 
Count carbohydrates for all meals and snacks  When carbohydrates are metabolized in the body they are broken down into glucose and therefore will cause a rise in the blood glucose level. Counting carbohydrates ensures the appropriate dose of insulin can be given with each meal or snack.  
Assess patient’s level of understanding/knowledge of diabetes Being aware of patient’s current knowledge level in the management of diabetes will assist in determining additional education needs and allows for all education to be tailored to each individual. 
Educate patient on chronic condition of diabetes mellitus Diabetic education is vital to the patient’s overall treatment plan. Education on what diabetes is, how it is managed, hypoglycemia vs hyperglycemia, and signs and symptoms will assist to empower the patient and allow him/her to feel more confident in his/her ability to manage a chronic condition. 
Educate patient on how to monitor blood glucose levels Diabetic patients will need to be able to monitor blood glucose levels independently at home to ensure proper diabetic management and adherence to the treatment plan. 
Educate patient on dietary restrictions/carbohydrate counting/meal planning Educating patients on dietary restrictions and carbohydrate counting will increase the patient’s understanding of the condition and assist in gaining confidence in the independent management of this condition. 
Assess patient’s support system Having a stable support system will assist patients in being able to monitor and manage diabetes.  

References 

  1. Ackley, B.J., Ladwig, G.B., Flynn Makic M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th edition). Mosby.  
  1. Centers for Disease Control and Prevention (2020, June). What is diabetes? https://www.cdc.gov/diabetes/basics/diabetes.html 
  1. Centers for Disease Control and Prevention (2021, May). Diabetes and your heart. https://www.cdc.gov/diabetes/library/features/diabetes-and-heart.html 
  1. Cleveland Clinic (2020, February). Hyperglycemia (high blood sugar). https://my.clevelandclinic.org/health/diseases/9815-hyperglycemia-high-blood-sugar 
  1. Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span (10th edition). F.A. Davis Company.  
  1. Mayo Clinic (2021). Hyperglycemia in diabetes?  https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631?p=1 
  1. Mayo Clinic (2020, October). Diabetes. https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444
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Tabitha Cumpian, BSN, MS, RN

Tabitha Cumpian is a registered nurse with a passion for education. She completed her BSN at Edgewood College Nursing School and her MSN with an emphasis in Nursing Education at Herzing University. She has a vast clinical background from years of traveling the United States providing nursing care. The majority of her time has been spent in cardiovascular care. She loves educating others in her field, as well as, patients and their family members through healthcare writing.