What is Diabetes Mellitus?
Diabetes mellitus (DM) is a chronic disease characterized by insufficient production of insulin in the pancreas or when the body cannot efficiently use the insulin it produces. This leads to an increased concentration of glucose in the bloodstream (hyperglycemia). It is characterized by disturbances in carbohydrate, protein, and fat metabolism. Sustained hyperglycemia has been shown to affect almost all tissues in the body and is associated with significant complications of multiple organ systems, including the eyes, nerves, kidneys, and blood vessels.
Diabetes mellitus has a few types:
- Type 1 diabetes is characterized by destruction of the pancreatic beta cells.
- Types 2 diabetes involves insulin resistance and impaired insulin secretion.
- Gestational diabetes mellitus is when a pregnant woman experiences any degree of glucose intolerance with the onset of pregnancy.
Nursing Care Plans for Diabetes Mellitus
Nursing care planning goals for patients with diabetes include effective treatment to normalize blood glucose and decrease complications using insulin replacement, balanced diet, and exercise. The nurse should stress the importance of complying with the prescribed treatment program. Tailor your teaching to the patient’s needs, abilities, and developmental stage. Stress the effect of blood glucose control on long-term health.
Here are 13 nursing care plans (NCP) and nursing diagnoses for diabetes mellitus (DM):
- Risk for Unstable Blood Glucose
- Deficient Knowledge
- Risk for Infection
- Risk for Disturbed Sensory Perception
- Risk for Ineffective Therapeutic Regimen Management
- Risk for Injury
- Imbalanced Nutrition: Less Than Body Requirements
- Risk for Deficient Fluid Volume
- Risk for Impaired Skin Integrity
- Other Possible Nursing Care Plans
- Deficient Knowledge
May be related to
- Unfamiliarity with insulin injection
- Dietary modifications
- Exercise for normoglycemia
- Unfamiliarity with information
Possibly evidenced by
- Requests of information
- Statements of concern
- Inadequate follow-through of instructions
- Development of preventable complications
- Before discharge, patient will demonstrate knowledge of insulin injection, symptoms, and treatment of hypoglycemia and diet.
|Explain that long-acting insulin (Lantus) only need to be injected once or twice daily.||Long-acting insulin does not have a peak of action. Insulin glargine is effective for over 24 hours.|
|Explain that regular prandial insulins (Humulin) should be injected 30 mins before meals. Rapid-acting insulins (Novolog, Humalog) may be injected before or after eating.||Dosage may be adjusted based on the actual amount of food ingested because rapid-acting insulins can be given after a meal.|
|Explain that insulin dosages may need to be adjusted.||Insulin dosage should be reduced when fasting for surgery, when not eating, or when hypoglycemia occurs. Illness or infection may increase insulin requirements.|
|Teach patient to rotate insulin injection sites.||Multiple injections in the same site may cause fat deposits.|
|Explain the importance of inserting the needle perpendicular to the skin.||This ensures deep subcutaneous administration of insulin.|
|Verify that the patient understands and demonstrates the technique and timing of home monitoring of glucose.||Monitoring provides data on the degree of glucose control and identifies the need for changes in the insulin dosage.|
|Teach patient to follow a diet that is low in simple sugars, low in fat, and high in fiber and whole grains.||A diet low in fat and high in fiber helps to control cholesterol and triglycerides. Three daily meals and an evening snack is recommended. Refined and simple sugars should be reduced, and complex carbohydrates, such as cereals, rice, should be increased.|
|Teach patient that anxiety, tremors, and slurred speech are signs of hypoglycemia.||These are indicators of hypoglycemia, which causes seizures, coma, and death.|
|Teach patient to treat hypoglycemia with crackers, a snack, or glucagon injection.||Hypoglycemia should be treated with a carbohydrate snack. If the patient is unconscious, glucagon should be given IM by a caregiver.|
References and Sources
References and recommended sources for this care plan guide for Diabetes Mellitus:
- Ackley, B. J. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. Elsevier Health Sciences.
- Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier. [Link]
- Brunner, L. S., & Suddarth, D. S. (2004). Medical surgical nursing (Vol. 2123). Philadelphia: Lippincott Williams & Wilkins. [Link]
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. FA Davis. [Link]
- Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences. [Link]
- Rosenberg, C. S. (1990). Wound healing in the patient with diabetes mellitus. The Nursing clinics of North America, 25(1), 247-261. [Link]
- White, P. (1974). Diabetes mellitus in pregnancy. Clinics in perinatology, 1(2), 331-348.
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Endocrine and Metabolic Care Plans
Nursing care plans related to the endocrine system and metabolism:
- Acid-Base Balance
- - Respiratory Acidosis Nursing Care Plan
- - Respiratory Alkalosis Nursing Care Plan
- - Metabolic Acidosis Nursing Care Plan
- - Metabolic Alkalosis Nursing Care Plan
- Addison's Disease | 3 Care Plans
- Cushing’s Disease | 6 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Diabetes Mellitus Type 2 | 13+ Care Plans
- Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) | 4 Care Plans
- Eating Disorders: Anorexia & Bulimia Nervosa | 7 Care Plans
- Fluid and Electrolyte Imbalances | 10 Care Plans
- - Fluid Balance: Hypervolemia & Hypovolemia
- - Potassium (K) Imbalances: Hyperkalemia and Hypokalemia
- - Sodium (Na) Imbalances: Hypernatremia and Hyponatremia
- - Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
- - Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 4 Care Plans
- Thyroidectomy | 5 Care Plans