The Basic Biology of Diabetes

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Diabetes Mellitus is a complex, chronic illness that affects millions worldwide and is characterised by high levels of sugar in the blood.

But what exactly causes these elevated levels?

In this post, we’ll delve into the biological mechanisms behind diabetes, exploring the role of the pancreas, insulin and glucose in the body.

Whether you’re a student, a healthcare professional or simply curious about this widespread condition, here’s hoping this post will shed light on the intricate biology of diabetes.

Let’s dive right in!

Table of Contents

Type 1 Diabetes

Type 1 diabetes is a chronic condition characterised by the autoimmune destruction of the insulin-producing β-cells within the islets of Langerhans in the pancreas.

Insulin Production and Destruction

In normal circumstances, insulin is synthesised by the β-cells in response to glucose levels

However, in Type 1 diabetes, these very β-cells become targets of the immune system

Mistakenly identified as foreign, they face an autoimmune attack, leading to their destruction

Consequently, an absolute deficiency of insulin occurs, necessitating lifelong reliance on external insulin sources

Genetic and Environmental Factors

The onset of Type 1 diabetes involves a complex combination of genetic and environmental factors

Genetic predisposition plays a significant role, with a strong association to specific HLA haplotypes and immune system genes

Additionally, an infective or environmental trigger (such as a viral infection) may initiate the autoimmune response in genetically susceptible individuals

Immunological Damage

The development of Type 1 diabetes is gradual and characterised by progressive immunological damage

Insulitis occurs—an invasion of pancreatic islets by T-lymphocytes which ultimately leads to β-cell destruction

Over time, this process results in insulin deficiency

Clinical Diagnosis

Clinically, Type 1 diabetes is often diagnosed based on specific criteria:

Capillary blood glucose levels greater than 11 mmol/L

A history of classic osmotic symptoms (polyuria and polydipsia)

Weight loss

Assessment for the presence of ketones in the blood or urine

Long-Term Implications

Insulin administration is crucial for maintaining blood glucose control

Optimising overall glycaemic control helps prevent micro and macrovascular complications

Elevated blood glucose levels in Type 1 diabetes can lead to premature morbidity and mortality

✾ β-cells: These are special cells in the pancreas that produce insulin, a hormone necessary for regulating blood sugar levels.

✾ Autoimmune: When the immune system mistakenly attacks healthy cells in the body, thinking they are harmful invaders.

✾ HLA haplotypes: These are specific genetic markers related to the immune system. They play a role in determining susceptibility to certain diseases.

✾ Insulitis: Refers to inflammation of the insulin-producing cells (β-cells) in the pancreas.

✾ Micro and macrovascular complications: These are health issues related to small blood vessels (microvascular) and large blood vessels (macrovascular). In diabetes, these complications can affect organs like the eyes, kidneys, and heart.

Type 2 Diabetes

Type 2 diabetes is a metabolic disorder where the body either becomes resistant to the effects of insulin or the pancreas cannot produce enough of it.

Insulin Resistance

Insulin resistance is when the cells in the body do not respond well to insulin.

Even though there is enough insulin in the blood, the cells do not take in enough sugar, leaving too much of that sugar in the blood.

This can happen because of several factors, such as:

Changes in the cell membrane, which affect the transport of sugar and insulin across the membrane

Alterations in the insulin receptor, which reduce the binding and signalling of insulin to the cell

Dysregulation of the intracellular pathways, which impair the glucose uptake and metabolism by the cell

Production of inflammatory cytokines, which interfere with the insulin action and induce insulin resistance

The gut microbiota, which is the collection of microorganisms that live in the digestive tract, can also influence the insulin resistance by affecting the inflammation, immunity and metabolism of the host.

Increased Glucose Production

Increased glucose production is when the liver makes too much sugar, even when the blood sugar levels are already high.

This adds more sugar to the blood and makes it harder to control.

This can happen because of several factors, such as:

Activation of the gluconeogenesis, which is the process of making new sugar from non-carbohydrate sources, such as amino acids, lactate or glycerol

Suppression of the glycogenolysis, which is the process of breaking down the stored sugar (glycogen) in the liver and releasing it into the blood

Stimulation of the glucagon, which is a hormone that increases the blood sugar levels by activating the gluconeogenesis and glycogenolysis

Inhibition of the insulin, which is a hormone that lowers the blood sugar levels by suppressing the gluconeogenesis and glycogenolysis.

The gut microbiota can also affect the glucose production by producing different metabolites, such as short-chain fatty acids (SCFAs), bile acids, and amino acids.

These can influence the glucose metabolism and the secretion of hormones, such as insulin and glucagon-like peptide-1 (GLP-1) that regulate the blood glucose levels.

Beta-Cell Dysfunction

Beta-cell dysfunction is when the cells in the pancreas that make insulin become damaged and stop working overtime.

This leads to less insulin in the blood and more sugar in the blood.

This can happen because of several factors:

Exposure to high levels of sugar, which can cause oxidative stress and inflammation in the beta cells, leading to their death or dysfunction

Exposure to high levels of fatty acids, which can cause lipotoxicity and apoptosis in the beta cells, leading to their death or dysfunction.

Exposure to high levels of inflammatory cytokines, which can cause immune-mediated damage and dysfunction in the beta cells, leading to their death or dysfunction.

Exposure to high levels of amyloid, which is a protein that can accumulate and form toxic aggregates in the beta cells, leading to their death or dysfunction.

The gut microbiota can also affect the beta-cell function by modulating the immune and inflammatory responses, and by producing certain metabolites, such as SCFAs, that can protect or enhance the beta-cell survival and function.

Inflammation and Fat Accumulation

Inflammation and fat accumulation are when the body has too much fat, especially around the belly, which can cause inflammation and release certain proteins that interfere with insulin action.

This makes the cells more resistant to insulin, and can happen because of several factors:

Excess intake of calories, which can lead to weight gain and obesity, which are major risk factors for type 2 diabetes

Imbalance in the adipokines, which are proteins that are produced by the fat cells and that can affect the insulin sensitivity and glucose metabolism of the body

Accumulation of ectopic fat, which is fat that is stored in or around the organs, such as the liver and the pancreas, and that can impair their function and induce insulin resistance

Activation of the innate immune system, which can trigger the production of inflammatory cytokines and reactive oxygen species, which can damage the cells and tissues and induce insulin resistance

The gut microbiota can also influence the inflammation and fat accumulation by affecting the energy balance, the fat storage, the adipokine secretion and the immune activation of the host.

✾ Inflammatory Cytokines: Proteins that are secreted by immune cells and other cell types to promote inflammation, which is a protective response to infection or injury.

✾ Gut Microbiota: The collection of microorganisms that live in the digestive tract

✾ Gluconeogenesis: The process of making new sugar from non-carbohydrate sources, such as amino acids, lactate or glycerol

✾ Glycogenolysis: The process of breaking down the stored sugar (glycogen) in the liver and releasing it into the blood

✾ Short Chain Fatty Acids (SCFAs): Fatty acids with fewer than six carbon atoms. They are produced by the bacteria in the gut when they ferment fibre. SCFAs are important for colon health as they provide energy to the cells lining the colon. SCFAs also have various benefits for metabolism, inflammation, immune system and blood sugar control.

✾ Lipotoxicity: A metabolic syndrome that occurs when excess lipids, such as fatty acids, accumulate in non-adipose tissues, such as the liver, heart or pancreas leading to cellular dysfunction and even cell death

✾ Adipokines: Proteins that are produced by the fat cells and that can affect the insulin sensitivity and glucose metabolism of the body

Gestational Diabetes

Gestational diabetes mellitus (GDM) is a condition that affects some pregnant women, who develop high blood sugar levels due to impaired glucose metabolism.

It is one of the most common complications of pregnancy, and its prevalence is increasing worldwide.

GDM is the result of two major metabolic disorders that occur during pregnancy:

Chronic Insulin Resistance

This is when the cells of the body become less responsive to insulin, the hormone that regulates glucose uptake from the bloodstream.

This leads to hyperglycaemia, or elevated blood glucose levels.

Insulin resistance is a normal physiological adaptation of pregnancy, as it allows more glucose to be available for the growing foetus.

However, in some women, the insulin resistance becomes too severe and exceeds the compensatory increase in insulin secretion by the pancreas.

β-cell Dysfunction

This is when the β-cells of the pancreas, which produce and secrete insulin, fail to function properly.

This impairs the ability of the pancreas to produce enough insulin to overcome the insulin resistance.

β-cell dysfunction is a key factor in the development of both GDM and Type 2 diabetes mellitus (T2DM).

Several risk factors, such as advanced maternal age, overweight, obesity, westernised diet, ethnicity, intrauterine environment, hypertension, family history of GDM or T2DM, and personal history of GDM or polycystic ovarian syndrome, can affect the β-cell function and/or insulin sensitivity, either directly or indirectly.

Therefore, GDM can be seen as a transient manifestation of underlying metabolic abnormalities that may predispose women to develop T2DM later in life.

(In short, GDM is basically a sneak peek of what could happen to your metabolism later in life).

✾ Gestational Diabetes Mellitus is influenced by both genetic and environmental factors, and it can have short-term and long-term consequences for both the mother and the offspring.

You won’t be expected to know everything immediately, so start with the basic biology, particularly the endocrine system, as it is crucial for understanding diabetes.

Steroid Induced Diabetes

Steroid-induced diabetes is caused by two main problems in your metabolism.

Steroids make your muscle and fat cells resist insulin, which means they don’t take up glucose from your blood.

It makes your liver resist insulin, which means it keeps making more glucose (gluconeogenesis and glycogenolysis) even when you don’t need it.

Steroids also make your pancreas produce and release less insulin, which means you can’t lower your blood sugar level.

Glucocorticoid Receptor (GR) Activation

Steroids, especially the ones called glucocorticoids, stick to special proteins called glucocorticoid receptors (GRs) in different parts of your body, like your liver, muscle, and fat tissue.

When GRs are activated by steroids, they change the way your genes work, affecting how your body handles sugar.

In your liver, GR activation makes your genes produce more enzymes that make glucose from scratch (gluconeogenesis).

In your muscle and fat tissue, GR activation makes your genes produce less proteins that help your cells take up glucose from your blood (such as GLUT4).

Insulin Resistance

Steroids make your body ignore insulin, the hormone that tells your cells to take up sugar from your blood.

GR activation stops a molecule called insulin receptor substrate-1 (IRS-1) from working properly, breaking the chain of signals that insulin sends to your cells.

When IRS-1 doesn’t work, your cells can’t take up glucose or store it as glycogen (a form of sugar storage).

Hepatic Gluconeogenesis and Glycogenolysis

Steroids make your liver produce more glucose.

GR activation makes your genes produce more enzymes that make glucose from scratch (gluconeogenesis) or from glycogen (glycogenolysis).

Glycogenolysis is when your liver breaks down glycogen, the stored form of sugar, into glucose.

Beta-Cell Dysfunction

Steroids make your pancreas produce and release less insulin.

GR activation makes your genes produce less insulin and release less insulin.

Your pancreas cells may die (apoptosis) if you take steroids for too long.

Adipokines and Inflammation

Steroids change the way your fat tissue releases hormones called adipokines.

Some adipokines are bad for you, like TNF-alpha and IL-6, because they cause inflammation and make your body resist insulin.

Your fat tissue may also get inflamed, which makes your blood sugar level worse.

Alterations in Gut Microbiota

There is some evidence that steroids may affect the bacteria in your gut (gut microbiota).

Having a balanced gut microbiota is important for your health, but steroids may cause an imbalance (dysbiosis).

A dysbiotic gut microbiota may make your body resist insulin and cause inflammation.

Individual Variability

✾ Not everyone who takes steroids gets steroid-induced diabetes.

✾ Your genes, how long you take steroids, your overall health, and other factors can affect your risk of getting steroid-induced diabetes.

So there you have it.

The biology of Type 1, Type 2, gestational and Steroid induced diabetes.

Going through your biology will always bring you one step closer to understanding what is going on and why, allowing you to provide the most effective care.

Question Time

Read the questions and if you have the answers, flaunt your knowledge and share your thoughts and experiences in the comment section below.

How would you explain the concept of insulin resistance to someone learning about diabetes for the first time?

If you could invent a new treatment for diabetes based on its biology, what would it be?

What is one aspect of diabetes biology that you find most intriguing and why?

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A Basic Care Plan for Diabetes

September 1, 2024 (updated October 22, 2024) Published by intunursing

Connecting Nurses Worldwide

A Basic Care Plan for Diabetes

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We’ve looked at the causes and the risk factors of diabetes.

We’ve even gone through the signs, symptoms and conditions associated with diabetes.

But as a nurse, how would you apply this knowledge to the short-term, and long-term care of your patients?

Table of Contents

What is the Expected Nursing Outcome for Diabetes?

One of the first things you need to ask yourself when thinking of a care plan for your patient is ‘What is the Expected Outcome?’

What is the goal that needs to be set to deal with the presenting condition?

For diabetes, the ultimate outcome will always be to:

“Achieve and maintain glycaemic control within the correctly identified ranges and continuous blood glucose monitoring.”

Nursing Assessment

The main, and most basic, nursing assessment that should be done for a diabetic patient should be to monitor their blood glucose levels.

You can use a blood glucose meter to check their levels before and after meals, at bedtime, and whenever they feel unwell.

This should be done in regular intervals (usually just before a meal), and even more often if your patient is on a Variable Rate Intravenous Insulin Infusion (VRIII) – previously known as a sliding scale.

And in the case of a patient with Diabetic Ketoacidosis (DKA), as part of the nursing assessment, you will also need be monitoring their ketone levels.

Document these blood glucose levels, as well as your patient’s medication adherence according to local policy.

✾ A nursing assessment that may sometimes be missed is to carry out a regular assessment of your patient’s skin.

This will especially contribute towards the nursing care of a diabetic patient with neuropathy, as these patients are prone to unrecognised injuries on their feet.

Nursing Interventions

Looking back at the main nursing outcome for a diabetic care plan creates the question of ‘How?’.

Most people can carry out the necessary assessments, but how do you apply this to your patients care the proper way?

It can be brought down to a few points:

Prevent hyperglycaemia (high blood glucose) and hypoglycaemia (low blood glucose):

Hypoglycaemia is when the blood glucose level is too low, usually below 4 mmol/L. It can cause symptoms such as sweating, shaking, dizziness, confusion and even loss of consciousness.

Hyperglycaemia is when the blood glucose level is too high, usually above 11 mmol/L. It can cause symptoms such as thirst, dry mouth, frequent urination, blurred vision, fatigue, headache, nausea or fruity breath.

Preventing and treating complications and conditions related to diabetes:

Although the main outcome for diabetes, as a whole, is focused on maintaining glycaemic control, there are additional nursing aspects of care that consider a much wider range of factors.

This includes the prevention and treatment of complications that are acute and life-threatening, such as diabetic ketoacidosis (DKA), which is a condition where the body produces too many ketones, which are acidic substances that can poison the blood and organs.

Other complications are chronic and progressive, such as cardiovascular diseases, diabetic retinopathy, chronic kidney disease, infection and neuropathies, which can damage the heart, blood vessels, eyes, kidneys, skin and nerves.

These can cause problems such as heart attack, stroke, blindness, kidney failure, amputation and disability.

To manage these key points, and take charge of your plan, you will need to focus on the following:

Insulin Therapy

Assess your patients’ blood glucose levels regularly and escalate any concerns when necessary.

You should aim to keep their blood glucose levels within the target range recommended by their doctor or diabetes care team.

Learn about the different types of insulin and how to use them safely and effectively.

Know the benefits and risks of each type of insulin, such as rapid-acting, short-acting, intermediate-acting, long-acting and mixed insulins.

Know how to store, prepare and inject insulin correctly using the appropriate devices and techniques, such as syringes, pens or pumps.

It is important to rotate your patient’s injection sites, such as the abdomen, thighs or arms to prevent problems such as lipohypertrophy, which is characterised by stiff, lumpy skin and can result in inconsistent absorption of the insulin.

Administering Oral Antidiabetic Agents

Oral antidiabetic agents are pills that help lower blood glucose levels in people with type 2 diabetes who still produce some insulin.

They work by different mechanisms, such as stimulating the pancreas to produce more insulin, reducing the liver’s glucose production, improving the cells’ insulin sensitivity or slowing down the digestion of carbohydrates.

As a nurse, you should help them follow their medication regimen as prescribed and encourage them not to refuse doses.

By having the knowledge and being able to explain the benefits of your patient taking their antihyperglycaemic medication (and the risks of not taking it), it will give your patient confidence in your nursing care.

You may need to manage the possible side effects of oral antidiabetic agents.

This includes stomach upset, weight gain or hypoglycaemia.

Help your patients manage these side effects by giving them some tips, such as eating small and frequent meals and drinking plenty of water.

Restoring Fluid, Electrolyte, and Acid-Base Balance

Patients with diabetes can lose a lot of fluid and minerals from their body due to high blood sugar levels that make them urinate and drink more often.

This can affect their fluid, electrolyte, and acid-base balance, which is important for the normal functioning of their cells and organs.

If this balance is disturbed, it can cause problems such as weakness, confusion, irregular heartbeat and can even lead to a coma.

Therefore, you should monitor and record the patient’s fluid balance, address any concerns you have to the medical team and give them fluids or electrolytes as prescribed.

Managing Pain and Discomfort

Patients with diabetes may experience pain and discomfort due to various causes, such as neuropathy, foot ulcers or infection.

Pain and discomfort can affect the patient’s mood, sleep, appetite and overall quality of life.

Therefore, nurses should assess the patient’s pain and discomfort level and provide appropriate relief and comfort measures. Some of the ways to manage pain and discomfort include:

Using a pain scale, such as the numerical rating scale (NRS) or the faces pain scale (FPS), to measure the intensity and location of the pain and discomfort.

Giving the patient analgesics as prescribed.

Applying non-pharmacological methods, such as heat, cold or distraction to reduce the pain and discomfort.

Encouraging the patient to report any changes or problems with their pain and discomfort.

Diabetes Foot Care

People with diabetes are more likely to develop foot problems, such as ulcers or infections (which may lead to amputations), because of the damage that high blood glucose levels can cause to the nerves and blood vessels in the feet.

Nursing care should include:

Inspect your patients’ feet every shift for any problems, such as cracks, sores, corns, calluses or nail problems.

Help your patients wash their feet with warm water and soap. Dry them gently, especially between the toes.

Apply a thin layer of moisturizer to keep the skin soft and prevent cracking BUT avoid putting moisturizer between the toes as this can cause fungal infection.

You can also advise your patients to trim their toenails (straight across and file the edges with a nail file, whilst avoiding cutting the nails too short or digging into the corners, as this can cause ingrown toenails or infection).

If they have trouble cutting their nails, or you do not feel confident to do it correctly, then you can and should make a referral to a podiatrist as they will have much more training in this area.

Encourage your patients to wear comfortable, well-fitting shoes and socks that protect their feet and allow them to breathe.

Shoes that are too tight, too loose, or have seams or rough edges can rub or cause blisters, and should be avoided.

They should avoid wearing sandals, flip-flops and walking around with their bare feet, as these can expose their feet to injury or infection.

Their shoes and socks should be checked for any objects, such as stones, nails or pins, that can hurt their feet.

If possible, you should ask a patient’s relatives to bring this suitable footwear in.

Promoting Wound Healing and Prevention

Patients with diabetes are more prone to developing wounds, especially in the feet, due to the damage that high blood glucose levels can cause to the nerves and blood vessels.

Wounds can impair the patient’s mobility and increase the risk of infection and amputation.

Therefore, nurses should promote wound healing and prevention by doing these things:

Inspecting the patient’s feet and other areas of the body for any signs of wounds, such as cuts, blisters, sores or ulcers and escalating when necessary.

Cleaning and dressing the wounds properly and regularly, using aseptic technique and the appropriate dressings.

Monitoring the wound healing process and looking for any signs of infection, such as redness, swelling, pain, or pus and treating them promptly with antibiotics or other medications as prescribed.

Educating the patient and the family about the importance of wound care and prevention, and how to do it at home, such as by keeping the wounds clean and dry, changing the dressings as instructed, and avoiding pressure or friction on the wounds.

Providing Emotional Support Through Effective Coping

People with diabetes may experience various emotions and stress related to their condition, such as anger, sadness, fear, guilt or frustration.

These can affect their mood, self-esteem and well-being, which could make it harder for them to manage their diabetes for themselves.

You can help your patients with diabetes cope with their emotions and stress by providing them with emotional support:

Listen to your patients and empathize with their feelings

Avoid judging, criticizing, or blaming them for their condition or their actions. Instead, offer them encouragement, praise and positive feedback for their efforts and achievements

Teach your patients how to cope with stress and relax. Stress can worsen their blood glucose control and affect their physical and mental health.

Help them recognize the sources and signs of stress in their life and find ways to reduce or manage their stress, such as planning, prioritizing, delegating or simply by saying no.

Teach them relaxation techniques, such as breathing, meditation or yoga.

Encourage them to do something they enjoy, such as reading, gardening or playing games.

Support your patients in building and maintaining a strong social network.

Having a good support system can help them cope with their diabetes and improve their well-being.

Help them involve their family, friends and even co-workers in their diabetes care, such as by educating them about their condition or asking for their help.

Help them find and access community resources, such as diabetes educators, counsellors, or social workers.

Collaborating with Primary Care and Specialist Teams

Patients with diabetes need a team approach to get the best care possible.

You should work closely with the primary care providers and specialists who are involved in the patient’s diabetes care, such as the diabetic nurse, doctors, dietitians, pharmacists or podiatrists.

You should communicate with them regularly, share information, and coordinate care plans.

This way, you can ensure that the patient gets comprehensive and consistent care for their diabetes and any related conditions.

✾ Humulin, the first insulin made from human cells, was invented by scientists in 1978. This insulin has the same structure as the insulin that the human body makes.

Things to Consider When Caring for a Diabetic Patient

Each patient’s situation will be different, so it would be your job to tailor the diabetic care plan to suit each individual.

Here are some of the things you may need to consider:

For a Diabetic Patient Requiring Nasogastric (NG) or Percutaneous Endoscopic Gastronomy (PEG) Feeding

Make sure you are well-trained and educated on how to provide adequate nutrition to patients with diabetes who need NG or PEG feeding.

You should know the type, amount and timing of the feed, as well as how to monitor and adjust it according to the patient’s blood glucose levels and needs.

Prevent and treat any infections that may affect the patient’s nutrition and glucose control, such as gastroenteritis, by following the infection prevention and control guidelines, such as washing your hands, wearing gloves and aprons, and cleaning and disinfecting the equipment and the environment.

You should also monitor the patient for any signs and symptoms of infection, such as fever, diarrhoea, vomiting, or abdominal pain and escalate if necessary.

For a diabetic patient who is nil by mouth (NBM)

Chances are that if you have a diabetic patient who is NBM, they will be put on the variable rate intravenous insulin infusion (VRIII) protocol.

This protocol is used to maintain the patient’s blood glucose levels within the target range of 5-10 mmol/L, by giving them a continuous infusion of insulin and glucose.

You should follow the protocol carefully and adjust the insulin and glucose rates according to the patient’s blood glucose levels, which will usually be checked hourly.

Caring for a Diabetic Patient who is Confused

When caring for a confused diabetic patient, regular mental status assessments are crucial.

Providing a safe environment and having strategies to manage behavioural disturbances are also important. Effective communication with the healthcare team and family members is key.

Caring for a Diabetic Patient When there is a Language Barrier

For patients with a language barrier, it’s helpful to use simple, non-medical language and visual aids to communicate with your patient about their diabetes.

Translation services can be utilized if available, and cultural differences should be considered.

Caring for a Diabetic Patient who is Non-Compliant

In the case of a non-compliant patient, it’s important to identify and address barriers to compliance (which usually is related to a lack of understanding).

Education about the importance of medication compliance and the consequences of noncompliance can definitely be beneficial.

Providing support and resources to help the patient overcome barriers to compliance, along with regular follow-up to monitor progress can also be helpful.

If you come across a patient who has a complex care plan, don’t stress in silence. When in doubt, ask someone to help you out.

Patient Education in Diabetes Management

Diabetes management is a lifelong process that requires the involvement and commitment of the person with diabetes and their care team.

If a patient can only rely on others to provide care for their diabetes, then the long-term risk of mismanagement and future complications increases significantly.

As a nurse, you can help your patients with diabetes manage their condition by providing them with patient education on diabetes management.

What Should Your Patients Be Taught About Diabetes?

Nurses need to know the basics about a wide range of conditions, but a patient will only really need to know about their own.

This means that everything you should know, they should know too.

Take each aspect of your diabetic nursing care plan and find a way to transform it into a suitable piece of learning that your patient can take away with them.

For example, whilst administering insulin injections for your patient, you can explain them step-by-step what you are doing and even test their knowledge (such as asking them about the rotation of injection sites).

Even better, you should use your own judgement and could allow your patient to self-administer the insulin injection.

This promotes independence and gives them the confidence to carry this task out by themselves, without having to rely on others.

This form of educating your patients can apply to many aspects of diabetic care including medication management, self-hygiene, wound care, nutritional balance and weight management.

Addressing Challenges in Self-Management

Your Patient’s Attitude Towards Learning:

You should always assess your patient’s motivation to learn and tailor your education to their needs, preferences and goals.

Doing this helps your patient to retain the information they are taught, rather than you both going through a never-ending cycle of confusion and frustration.

You can use various tools and methods to assess their readiness to learn, such as asking open-ended questions or using motivational language.

Try use different formats and materials to deliver your education, such as verbal, written, visual or interactive.

You can also involve your patients in setting their own goals and action plans and provide them with feedback and reinforcement.

Your Patient’s Ability to Learn:

Consider the specific needs and challenges of different age groups, such as children and older adults.

Children and older adults with diabetes may have different learning styles, cognitive abilities, physical limitations, emotional issues and social support than other age groups.

You can adapt your education to their developmental stage, functional status, mental capacity and cultural background.

You can also involve their family, caregivers or peers in their education and care.

Some patients may find it hard to manage their condition, especially if they are older or have other conditions that affect their memory, mobility or mood.

You should provide support and resources to help these patients manage their diabetes effectively.

This could be done by teaching them how to use devices, apps or reminders, involving their family or caregivers or referring them to support groups or programs.

✾ You will undoubtedly come across a few patients who will refuse their medication or neglect their own care.

✾ It might be frustrating at the time, but usually there is a reason. So, be patient and maybe even try to find out why.

So there you have it.

The nursing assessments and interventions that can be included in a care plan for your patient with diabetes, including a way that helps to promote their independence.

With this, you should be able to come across a diabetic patient and create a care plan that is perfect for them.

Question Time

Read the questions and if you have the answers, flaunt your knowledge and share your thoughts and experiences in the comment section below.

What are some of the latest trends and innovations in diabetes care that you find exciting or useful?

How do you educate and empower patients with diabetes to take an active role in their care and prevent complications?

What are some of the best practices and resources that you use to provide effective and person-centred care for patients with diabetes?

Latest Blog Posts

What to Expect as a Nurse | Truths, Myths and Stereotypes

The Basic Biology of Diabetes

Subcutaneous Injection: The Basics

A Basic Care Plan for Diabetes

The Basics of Diabetes Mellitus

How to Stay Fit and Healthy as a Registered Nurse

Join the

intuYou

Community

Interviews

Discover More

About

Read All About It

Updates

Stay in the Loop

Connecting nurses worldwide

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The Basics of Diabetes Mellitus

July 12, 2024 (updated October 22, 2024) Published by intunursing

Connecting Nurses Worldwide

The Basics of Diabetes Mellitus

–

You don’t need to be a nurse or healthcare professional to have even the smallest amount of knowledge about diabetes.

Over 4 million people in the UK are affected by diabetes.

Now, times that by a hundred and you start getting closer to what the worldwide statistics for diabetes are looking like.

(And that’s only the people who have had confirmed diagnoses).

So, with those numbers, the chances are highly likely that you know someone or have come across a patient with diabetes already.

But how much can you say that you really know about diabetes?

And as a healthcare professional, are you confident that if a student nurse, colleague, patient or their relative asked you the following questions that you would be able to give them the most basic answers:

Table of Contents

What is Diabetes Mellitus?

Diabetes is a metabolism disorder that affects how your body uses sugar – glucose – for energy.

Glucose is essential for your health as it fuels your cells and organs.

But too much or too little glucose can cause problems.

Normally, your pancreas produces a hormone called insulin which helps glucose move from your blood into your cells.

But if you have diabetes, either your pancreas cannot make enough insulin, or your cells cannot use it properly.

This leads to high blood sugar levels which can damage your heart, blood vessels, eyes, kidneys and nerves.

✾ The term “Diabetes” derives from a Greek word meaning “to pass through” which refers to the excessive urination of uncontrolled diabetes.

✾ “Mellitus” is a Latin word for “sweet” or “honey” which was added when it was discovered that the urine from people with diabetes contains glucose by curious doctors who tasted the pee and found out it was sweet!

What are the Different Types of Diabetes?

People often forget to differentiate between the types of diabetes, including the varying causes and treatments.

However, it is vital that anybody in charge of the care of someone with diabetes can understand the difference.

The most common types of diabetes are:

Type 1 Diabetes

This is an autoimmune disease where the immune system attacks and destroys the cells in the pancreas that make insulin.

For this type of diabetes, the person will need to take insulin injections or use an insulin pump to manage their blood sugar levels.

Type 1 diabetes usually develops in childhood or adolescence, but it can occur at any age.

Type 2 Diabetes

This is a metabolic disorder where the body becomes resistant to the effects of insulin, or the pancreas cannot produce enough of it.

A type 2 diabetic may need to take medication, such as tablets or injections, to lower their blood sugar levels.

Type 2 diabetes is more common in adults, especially those who are overweight or obese, have a family history of diabetes or have an overall unhealthy lifestyle.

Non-diabetic Hyperglycaemia (or Pre-Diabetes)

This is where the patient’s blood sugar levels are higher than normal, but not high enough to be diagnosed as having diabetes.

This is a warning sign that they are at risk of developing type 2 diabetes in the future, but they can still prevent it by making some lifestyle changes.

Gestational Diabetes

This is a temporary condition that occurs during pregnancy, when the hormones affect how the body uses insulin.

It usually goes away after the woman gives birth, but it can increase their risk of developing type 2 diabetes later in life.

Monitoring of blood sugar levels and following a healthy diet and exercise plan may be needed to manage their condition.

Steroid Induced Diabetes

Steroids, also known as corticosteroids, are artificial versions of hormones that are naturally produced by your body.

They are used to reduce inflammation and can help to treat a wide range of conditions, including severe asthma, cystic fibrosis, arthritis, inflammatory bowel disease and some types of cancers.

However, a side effect of steroids is the impact it can have on blood sugar levels.

They can make your body produce more glucose, prevent glucose from being used by your cells, and make your insulin less effective.

This leads to too much glucose in your blood which can cause damage to your body over time.

Most people will only have steroid-induced diabetes while they are taking steroids. Their blood sugar level usually goes back to normal when they stop.

But others may have steroid-induced diabetes even after they stop their treatment, especially if they have some risk factors for type 2 diabetes.

The World Health Organisation (WHO) classifies diabetes into four categories:

✾ Type 1 is an autoimmune disorder that destroys insulin-producing cells.

✾ Type 2 is a condition of insulin resistance or deficiency, often linked to obesity and inactivity.

✾ Gestational diabetes occurs during pregnancy and usually resolves after delivery.

✾ Other specific types are rare forms of diabetes caused by various factors.

What are the Causes and Risk Factors of Diabetes?

Type 1 Diabetes

The exact trigger for this autoimmune response is still a mystery, but it can be said to be:

Genetic

Related to their environment – Dietary habits, exposure to vitamin D, obesity, early exposure to islet inflammation-causing viruses.

Type 2 Diabetes

This is a common and preventable type of diabetes where the patient’s lifestyle choices affect how their body uses insulin.

There are a number of factors that can raise the risk of developing type 2 diabetes:

Being overweight or obese (especially around the waist)
Being physically inactive
Having a family history of type 2 diabetes
Being from certain ethnic backgrounds (such as Asian, African or Afro-Caribbean)
Having metabolic syndrome, which is a combination of health problems, such as high blood pressure, high cholesterol, fatty liver disease and blood clots
Having a diet that is low in fibre and high in sugar
Having polycystic ovary syndrome

✾ It’s important to note that while these factors can increase the risk of developing diabetes, they do not guarantee that an individual will develop the condition.

✾ The good news is that a person can also change these factors to improve their health and prevent complications.

What are the Signs and Symptoms of Diabetes?

Polyuria (Increased Urination)

The kidneys are responsible for filtering the blood and removing any waste products, such as excess glucose.

When someone’s blood sugar levels are too high, the kidneys have to work harder to get rid of the extra glucose.

This means that they draw more water from the diabetic body, which makes the urine more diluted, producing even more urine and therefore increasing the frequency of needing to go toilet.

Polydipsia (Increased Thirst) and Having a Dry Mouth

The brain is constantly monitoring fluid levels and sending signals to the body to maintain a balance.

When a person loses fluid from their urine, the brain detects that they are dehydrated and tells them to drink more water.

This is why a diabetic person would feel thirsty and have a dry mouth.

Feeling Tired and Weak

The body normally uses insulin to help glucose move from the blood into the cells.

But if someone has diabetes, either their pancreas cannot make enough insulin, or their cells cannot use it properly.

This means that glucose stays in your blood and your cells do not get enough of it.

As the cells are not functioning properly, due to the lack of glucose, and as it is not producing energy as it should, it leads to fatigue.

Unexplained Weight Loss, but Experiencing Hyperphagia (Constant Hunger)

When the cells do not get enough glucose, they start to break down other sources of energy, such as fat and muscle, leading to unplanned weight loss and a constant feeling of hunger.

Blurry Vision

The eyes have a clear lens that helps to focus on what you see.

But when the blood sugar levels are too high, it can cause fluid to move in and out of different parts of the eye.

This can make your lens swell and change its shape, which affects how well it can focus light onto the retina (part of the eye that converts light into signals that the brain can understand), which leads to the vision becoming blurry and distorted.

Also, high blood sugar levels can damage the blood vessels that supply the retina itself with oxygen and nutrients.

This can cause bleeding, swelling or scarring of the retina, which can affect the vision and even lead to blindness.

Numbness or Tingling in the Hands or Feet

The nerves are like wires that carry messages from the brain to the body, and from the body to the brain.

But with high blood sugar levels caused by diabetes, it can damage the nerves and affect their ability to send and receive signals.

This can cause pain, numbness, tingling or weakness in the hands and feet.

Slow Healing Sores or Cuts

The blood vessels carry oxygen and nutrients to the tissues, and waste products away from them.

But the blood vessels can become damaged from diabetes and make them narrow or clogged and reduce blood flow.

Along with the poor circulation, there is the added issue of nerve damage and a weakened immune system which all contribute to the interference of the body’s ability to heal wounds, especially in the feet and legs.

This can cause ulcers, which are open sores that do not heal easily.

Ulcers can be painful, get infected, or can even lead to amputation if not treated properly.

Itching or Thrush in the Genitals

The genitals have a natural balance of bacteria and fungi, such as yeast, that keep them healthy and clean.

But when the blood sugar levels are too high, it can cause excess glucose to spill into your urine and onto your genitals.

This can create an ideal environment for yeast to grow and multiply, upsetting the natural balance.

These symptoms can affect anyone, regardless of their age or gender. But some of them are more common in people with type 1 diabetes, and they can appear very quickly.

✾ These symptoms are entirely dependent on the person and that not everyone with diabetes will experience these symptoms.

You know exactly what to look for, so if you experience any signs and symptoms, look after yourself and go see your GP. Healthcare professionals aren’t immune to diabetes.

What Conditions are Commonly Associated with Diabetes?

Heart Disease

Diabetes can damage the blood vessels and make them narrow or clogged. This can reduce the blood flow to the heart and brain and increases the risk of having a heart attack or stroke.

Nephropathy (Kidney disease)

Diabetes can damage the kidneys and make them less able to filter the blood and remove excess fluid and waste. This can cause swelling, high blood pressure and kidney failure.

Retinopathy (Eye Problems)

Diabetes can damage the eyes and affect the vision. This can cause blurry vision, cataracts, glaucoma or diabetic retinopathy, which is a serious eye disease that can lead to blindness.

Neuropathy (Nerve Damage)

Diabetes can damage the nerves and affect how a person feels and moves. This can cause pain, numbness, tingling or weakness in the hands and feet. It can also affect the digestion, bladder and sexual function.

Foot Problems

Diabetes can damage your feet and make them more prone to infections and ulcers.

This can be caused by nerve damage, poor circulation or high blood pressure.

If left untreated, foot problems can lead to amputation.

Gum Disease and Other Mouth Problems

Diabetes can affect a person’s oral health and make their mouth more susceptible to bacteria and plaque. This can cause gum disease, tooth decay, bad breath or a dry mouth.

Sexual Problems

Diabetes can affect sexual health by making it harder to enjoy sex. This can be caused by nerve damage, blood vessel damage or hormonal changes.

It can affect both men and women, and cause problems such as erectile dysfunction, vaginal dryness or low libido.

Coeliac Disease, Thyroid Disease, and Haemochromatosis

These are some of the other conditions that can be linked to diabetes. They are caused by problems with the immune system, hormones or iron levels. They can affect the digestion, metabolism or blood cells.

✾ Necrobiosis lipoidica diabeticorum is a rare dermatological condition that manifests as red or brown lesions on the legs, often triggered by diabetes.

So there you have it.

You should now be able to confidently give information to anybody who asks you about the different types of diabetes, why people get it, the sign and symptoms, and even some of the most common conditions caused by diabetes.

Question Time

Read the questions and if you have the answers, flaunt your knowledge and share your thoughts and experiences in the comment section below.

How confident are you that you can answer a student nurse, colleague, patient or relative about a diabetes-related question now?

Without searching or scrolling up, can you list all the signs and symptoms of diabetes that you can remember?

Do you have any memorable stories about a patient or someone you know with diabetes? (Make sure to maintain confidentiality or if you want to keep it anonymous, then share it to ‘Nursing Tales’).