Diabetes mellitus occurs when there is a decrease in the production of insulin by the pancreas, or the cell does not respond to the insulin present in the body, also known as insulin resistance. Due to this, the body is unable to absorb glucose by the cells.

The 3 main types of diabetes are:

• Type 1 diabetes or Insulin Dependent Diabetes Mellitus, where insulin is not produced in the body and the person is required to take insulin injections
• Type 2 diabetes occurs due to insulin resistance, where the insulin present in the body is not effectively utilized
• Gestational diabetes is when diabetes affects a pregnant woman, who did not have it earlier.

Some other types of diabetes are cystic fibrosis related diabetes, congenital diabetes, diabetes induced due to high doses of glucocorticoids and monogenic diabetes.

Nursing Diagnosis for Diabetes

1. Risk for Infection

Symptoms:

Infection can be caused due to high glucose levels, changes in circulation or decrease in functioning of leukocytes. Existing UTI or respiratory infection can also be a risk factor.

Nursing interventions

• Observe for signs of infection or inflammation.
• Ensure good hygiene is maintained.
• Rotate IV sites and maintain asepsis.
• Provide skin care and keep skin dry.
• Administer antibiotics as required.

2. Risk for Imbalanced Nutrition

The nutritional needs of the body are not met and are less than the requirements.

Symptoms:

• Insulin deficiency
• Reduced intake of food or fluids, which can be caused due to anorexia, nausea, abdominal pain, gastric fullness or altered consciousness
• Stress hormones can also get released
• Weight loss, weakness, diarrhea, dilute urine, frequent urination, and fatigue, etc.

Nursing interventions:

• Weigh the patient daily, get dietary recall and compare with current intake of food.
• Check bowel sounds and make reports of any abdominal discomfort, vomiting and diarrhea.
• Check for any signs or symptoms of hypoglycemia and perform glucose testing.
• Administer glucose and insulin, if required.
• Diet should consist of 60% carbs, 20% from protein and fats.

3. Risk for Disturbed Sensory Perception

There are changes in mental state and disturbances in the visual and tactile perception. Nursing diagnosis for diabetes is needed.

Symptoms:

Changes in the mental state can result in losing orientation and can happen due to imbalance of electrolytes or glucose and insulin.

Nursing interventions:

• Monitor mental status and other vital signs.
• Reorient to time, place, name by speaking slowly and clearly.
• Make them participate in daily activities.
• Monitor blood parameters – glucose levels, Hb/Hct, BUN/Cr.
• Ensure there is cluster nursing time and schedule fixed.

4. Risk for Deficient Fluid Volume

The urine output can reduce during diabetes and it can have other repercussions.

Symptoms:

• Diarrhea, vomiting, nausea, confusion
• Dry skin, poor skin turgor
• Hypotension, sudden weight loss
• Tachycardia, weakness, excessive thirst

Nursing interventions:

• Monitor vital stats like blood pressure, respiratory rate and pattern, temperature, weight.
• Maintain fluid intake and monitor output.
• Ensure comfortable environment.

5. Risk for Activity Intolerance

Nursing diagnosis for diabetes includes intolerance to activities which are related to muscle weakness.

Symptoms:

• Tiredness, inability to perform daily activities
• High pulse rate, high blood pressure
• Decreased muscle strength

Nursing interventions:

• The muscle weakness is different in body parts, hence the muscle strength should be determined in muscles, eye movement, chewing action, cough reflex, swallowing, talking, etc.
• Check the muscle strength before and after administration of medication
• Breaks should be given intermittently and surroundings should be quiet.
• Encourage the patients in actively participating in the treatment regime.

6. Risk for Impaired Skin Integrity

Being immobilized can affect the skin, causing sores or rashes. Diabetic neuropathy can also result in skin disorders. This is important from a nursing diagnosis for diabetes point of view.

Symptoms:

• Wounds that take long time to heal
• Changes in the wound, etc.

Nursing interventions:

• Check the type and characteristics of the wound.
• If the wound has secretions, check them as well.
• Keep the wound clean with sterile gauze and dress it well.
• Ensure there is no pressure on the wound.