Diabetes Mellitus: Types, Symptoms, Complications, and Diagnosis

This essay provides a comprehensive overview of diabetes mellitus, a chronic condition characterized by hyperglycemia due to insufficient insulin production. It discusses the pathophysiology, signs, and symptoms of type 1, type 2, and gestational diabetes, highlighting risk factors, diagnostic methods, and potential complications. The essay emphasizes the importance of community awareness and education in managing and preventing diabetes, addressing key concepts such as its prevalence, chronic nature, lack of a cure, and the high cost of treatment. It covers clinical features, diagnostic processes like assessing polyphagia, polydipsia, and polyuria, and both acute and chronic complications such as neuropathy, nephropathy, and ketoacidosis. The information is intended to help healthcare professionals and community members understand and manage diabetes effectively.

Running Head: Diabetes Mellitus 1
Diabetes mellitus
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DIABETES MELLITUS
Introduction
Diabetes mellitus is classified amongst chronic conditions whose characteristics are production
of little amounts of insulin by the pancreas in the human body. Reduced amounts of insulin
results in blood glucose concentration, a situation called hyperglycemia. This leads to poor
metabolism of fats, proteins, and carbohydrates in the body (Rochmawati, 2018). Prolonged
hyperglycemia affects most of the body tissues and is linked to various other diseases of the
organs in the body system, such as the kidneys, the eyes, the body nerves, and the blood vessels.
The rate of prevalence of diabetes in the whole world has been increasing dramatically. It affects
classes of every people and people of all gender from the young to the old. Its onset is mostly at
15 to 16 years of age in children and 40years amongst the middle-aged. The most prevalent
gender towards diabetes is women and girls as compared with men and boys consecutively.
The disease has several aspects, which include its natural history, its prevalence rate, incidences,
mortality, and morbidity in the entire world’s population. When the cause of this disease is
identified, it is possible to come up with its preventive measures amongst the health
professionals and help patients to arrest or delay its onset. There is no part of the world that has
so far not reached to high diabetes proportions.
From the concept map, the four community concepts for diabetes include that diabetes is
common amongst individuals, it is a chronic condition, it has no cure, and its treatment is
expensive. Offering information discussed in the concepts in this paper is very helpful in the
society.

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THE CONCEPT THAT DIABETES IS COMMON AMONGST INDIVIDUALS
Community members should be aware that Diabetes is a condition that is common amongst
individuals in the whole world. The community health nurse has the duty to educate the
community members about the pathophysiology of diabetes, signs and symptoms, and how it can
be managed. the nurse does this in line to diabetes evidence based practice as they offer care and
give information on how the community members can prevent the condition and manage it
amongst the members having it already.
Its pathophysiology is that diabetes mellitus is classified into three types, which include Diabetes
type 1(juvenile diabetes), type 2 diabetes, and gestational diabetes ("Pathophysiology and
Complications of Diabetes Mellitus," 2012).
Diabetes type 1
There are various characteristics of Type1 diabetes. An autoimmune process destroys the beta
cells, which leads to the absolute deficiency of insulin in the bloodstream. There is the presence
of the anti-glutamic acid decarboxylase, insulin antibodies, or islet cells whose function is to
identify the autoimmune processes which lead to the destruction of beta cells. To maintain
normoglycemia, all type 1 diabetes patients need insulin therapy (Walkey, 2018). Diabetes type 1
is linked with HLA on chromosome 6, where the HLA system confers the genetic susceptibility
of type 1 diabetes. The HLA molecules provide presentations of antigens that produce T – helper
cells that initiate specific islet cells autoantigens for an immune response. The T – cells formed
in the immune response can kill the cells producing insulin in the Islet of Langerhans, resulting
in the formation of autoantibodies (Walkey, 2018).

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There are also Islet cell antibodies (ICA) that act against the antigens found in the cytoplasm of
endocrine cells in pancreatic islets. Insulin autoantibodies are commonly found in the diseases of
the immune system at the onset of diabetes type one in toddlers. The presence of ICA and IAA
increases the risk of developing type 1 diabetes in an individual. Environmental factors also
facilitate the development of diabetes type 1 in individuals such as cow’s milk, viruses such as
mumps, and various chemicals emitted into the environment (Tripathi & Saboo, 2019).
According to Skyler et al. (2016), between 2001 and 2009, the number of youth with diabetes
type 1 in the U.S increased by 21%, and its prevalence rate is increasing per year in the globe by
3%. Its diagnosis occurs at childhood, while the adults who live with it are 84%. Both genders
are affected equally by this disease, and the life expectancy of an individual is decreased by 13%.
The incidences and prevalence rate of diabetes type 1 is different across the globe where for
example, the extremes of the diabetic cases have been reported to be 0.1 /100 000 and
0.6/100,000 in China and Finland consecutively. Diabetes type 1 is reported to progress during
the colder seasons where many people have a diabetes diagnosis, and the islet autoimmunity
appears to increase during the winter and autumn season than it is in summer and spring. The
members of the community should be made aware of this type of diabetes and its associated
signs and symptoms to enable its management on time. Diabetic management teams in the
community should perform this task together with the community health care nurses. Its signs
and symptoms include increased thirst, frequent urination, unintended loss of weight, extreme
hunger, mood changes, and irritability, the onset of bedwetting, especially in children who did
not wet the bed earlier, fatigue, weakness, and blurred vision (ScholarlyBrief, 2013). When the
members of the community identify such signs and symptoms at individual levels, they should

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visit the nearest health facility to get tested for their blood glucose levels and, at the same time,
get the right education on how to manage this type of diabetes.
Diabetes type 2
This disease develops when B-cells fail to secrete enough insulin to keep up with the body’s
demand due to increased insulin resistance (ScholarlyBrief, 2013). Most of the people diagnosed
with type 2 diabetes do not have islet autoimmunity. The main risk factor for diabetes type II is
obesity, associated with complex genetic, environmental aetiology. Due to ectopic fat deposition
in the liver and body muscles, there develops insulin resistance. At the same time, there might be
an accumulation of fat on the pancreas that leads to the declined functioning of the B-cell,
inflammation of the islet, and consequential death of the B-cell. There are different levels of
body fat composition that type II diabetes occurs in individuals. For example, it happens at a
lower BMI in Asians and Asian Americans whereas in the susceptible people; a fat threshold
may occur due to epitopic fat accumulation that leads to a worsened resistance of insulin that and
B-cel decompensation (ScholarlyBrief, 2013). Due to weight loss sensitivity of insulin in the
skeletal muscle and the liver increases, which results in the accumulation of pancreatic fat. There
are insulin secretion defects, which are partially reversible with restriction of energy and weight
loss in prediabetes and onset of type II diabetes. Most of the people suffering from type II
diabetes experience intra-abdominal obesity due to insulin resistance. This individual also suffers
from hypertension and dyslipidemia. Diabetes type II is associated with family history, older age,
obesity, and failure to engage in exercise activities. It is common in women, especially those
who have ever suffered gestational diabetes, the Blacks, native Americans, the Hispanics.
Environmental factors also lead to type II diabetes. This information is essential to the
community members to enable them to seek medical check-up when they note the signs and

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symptoms of diabetes type two which include increased thirst, excessive hunger, increased
frequent urination, blurred vision, tiredness, slow healing of wounds, dark skin patches, pain,
numbness or tingling in the feet or the hand (ScholarlyBrief, 2013).
Gestational diabetes mellitus
This diabetes is mostly common in expectant women, and it is not life-threatening to the baby or
the mother. It happens due to neonatal morbidity, incidence jaundice, macrosomia, and neonatal
hypoglycemia. The pathophysiology of this diabetes is unknown though research shows its
causative factors include diabetes mellitus family history, previous pregnancy complications,
obesity, and advanced age in the mother. Most women who develop GDM during pregnancy
experience it in the third trimester of pregnancy, and after birth, the condition disappears.
Pregnant women should always get advice on the need to visit antenatal clinics where through
doctor’s check, the signs and symptoms of gestational diabetes can be identified. The community
diabetes team should mobilize its people and give them information about gestational diabetes to
avoid worries at pregnancy. Other signs and symptoms of gestational diabetes include high level
of thirst, frequent urination, vomiting, nausea, fatigue, blurred vision and frequent infections
such as skin and bladder infections. Sugar is found in urine when tests are done in the lab.
Other specific types of diabetes mellitus
These groups are heterogeneous and include infection-induced diabetes mellitus, other
endocrinopathies, genetic defects in insulin actions, drug or chemical induced diabetes mellitus,
exocrine pancreas diseases, and B-cell functioning defects. There are rare forms of immune-
mediated diabetes.

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Clinical features of diabetes mellitus
Most of the signs and symptoms in diabetes are common but show the degree of variations in
diabetes type I whose symptoms appear to be very typical. The clinical features of diabetes type I
include constipation, fatigue, candidiasis, polyphagia, polyuria, loss of weight, polydipsia, and
blurred vision. Patients who suffer from diabetes type I are susceptible to microvascular
complications and diseases such as heart disease, coronary artery, and peripheral vascular
diseases.
The clinical features of diabetes type II cases are diagnosed as a result of complications.
Individuals suffering from this disease suffers from hypertension, hyperlipidemia, and obesity
due to an increased rate of atherosclerosis (Veves, 2012). They experience cardiovascular
complications, renal diseases, and other problems that lead to morbidity and mortality. Clinical
features of gestational diabetes mellitus are related to abnormal levels of blood sugar, displayed
through fatigue, increased irritation, and excessive thirst.
Complications of diabetes mellitus
Diabetes mellitus is accompanied by acute and chronic complications. Chronic complications
include neuropathy, nephropathy, retinopathy and microvascular disease. Acute complications
include ketoacidosis, hyperglycemic hyperosmolar state (HHS), retarded growth and
development and autoimmune conditions like hypothyroidism (Veves, 2012).
Diagnosis of diabetes
The process of diagnosis starts with an assessment of polyphagia, polydipsia, and polyuria,
which are the major symptoms of diabetes mellitus. They are also called the three p’s of diabetes.
Polyphagia includes accessing the eating habits of an individual where they suffer increased

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appetite. In polydipsia, the rate of fluid intake is accessed where individuals suffer increased
thirst and high fluid intake. In polyuria, clinicians assess the need of the patient to urinate
frequently.
Polyphagia
It is caused by depression, stress, anxiety, hypoglycemia, hyperglycemia, and diabetes mellitus.
In cases where diabetes has been uncontrolled, the blood glucose levels remain high, where
glucose from the blood cannot enter the body cells as a result of insulin resistance. This means
that the body cannot convert the food a person eats into energy. Lack of energy leads to
increased hunger (polyphagia), which cannot be reduced by eating as eating food will lead to
high levels of blood glucose. In this case, blood glucose is lowered through exercise, which, in
return, will stimulate the production of insulin and reduce the blood sugar levels. Increased
appetite may result from hypoglycemia, where the blood glucose reads below 4 mol/l, and the
body responds by releasing the glucose stored in the liver, which raises the glucose levels back to
normal. This is treated through control of sugar levels in the body.
Polydipsia
It is another symptom of diabetes that is displayed through prolonged or temporary dryness of
the mouth, causing one to feel thirsty all the time irrespective of the amount of water that they
take. It happens as a result of the loss of fluid during exercise, eating spicy or salty foods,
diarrhea, vomiting, use of particular medications, and significant loss of blood. When excessive
thirst results from diabetes mellitus, the clinicians test blood glucose to assess the blood sugar
levels of the patients, especially when they are thirsty to determine whether their blood sugars
are very high.

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Polyurea
It is another symptom of type I and II diabetes, where an individual passes frequent large
amounts of urine in comparison to the daily urine output in an individual. When a person passes
more than 3 liters of urine per day, it is a symptom of polyuria. As a sign of diabetes mellitus, the
kidneys filter the blood to make urine but do not reabsorb all the blood sugar to the bloodstream.
This produces excess glucose that ends up in the urine where the glucose draws more water,
making a person urinate more than usual. Clinicians assess these symptoms by looking at the
frequency of urination of a person
A patient with diabetes mellitus suffers various risks, which include the risk of unstable blood
glucose, risk of infections, risk of injuries, and fatigue. They also suffer the risk of ineffective
therapists regimen management, risk of deficient fluid volume, impaired integrity of the skin and
disturbed sensory perception
Risk of unstable blood glucose
In a diabetic patient, their blood glucose may alleviate the normal, leading to the person's
compromised health. There are several risk factors associated with unstable blood glucose in the
body. This includes inadequate monitoring of the blood glucose lack of adherence to the
management of diabetes, failure to manage medications properly, and insufficient knowledge
about diabetes management. Other risk factors may include stress, sedentary lifestyle, excess or
reduced insulin, and failure to accept the diagnosis. When treating diabetes mellitus, the desired
outcomes are reducing a patient’s blood glucose to a reading of 180 mg/dl, haemoglobin A1C
level that is less than s to 7%, and fasting blood glucose levels of less than 140 mg/dl. Diabetes
type I and II are diagnosed using a random plasma test, fasting plasma glucose test. Random

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plasma test does not require fasting before the test is done. 200mg/dl of blood glucose in this test
means that diabetes is present but should be reconfirmed. The fasting plasma glucose test is done
after 8 hours of fasting, where if more than 126mg/dl of glucose is displayed in 2 or more tests
done on different days means that diabetes is present.
Nursing interventions
The rationale that assesses signs of hyperglycemia is that hyperglycemia occurs when there is an
inadequate amount of insulin in the blood glucose (Perry, Potter, & Ostendorf, 2015). This
excess blood glucose is what creates an osmotic effect in the blood, leading to increased thirst,
increased hunger, and urination. The patient may report nonspecific symptoms, which include
blurred vision and fatigue. The rationale for assessing the levels of blood glucose at bedtime and
before meals is looking at the levels of the patient’s blood glucose, which should range between
140 to 180 mg/dl. The blood glucose of intensive care patients should be maintained at below
140 mg/dl pre-meal levels. The rationale for monitoring the patient’s GBA 1c- glycosylated
hemoglobin includes measuring the blood glucose of the patient in the last two to three months,
which should be 6.5 to 7 %. To assess anxiety, tremors, and slurring of speech, the rationale
includes looking at these signs of hypoglycemia, which are treated through 50% dextrose. The
health practitioner should assess the temperature of the patient’s feet, the pulse rate, the color,
and the sensation. The rationale, in this case, involves monitoring the peripheral perfusion and
neuropathy. The patient’s current knowledge and understanding about the prescribed diet should
be assessed by the rationale of non-adherence to guidelines for eating habits that can lead to
hyperglycemia where they should recommend a diet plan for the patient. The patient’s exercise
levels should be assessed by addressing their physical activity participation patterns under the
rationale that the physical activity shall lead to reduced levels of blood glucose. Regular

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exercises and physical activities are essential for diabetes management, for it brings lower risks
of cardiovascular complications. The health practitioner should also monitor the signs of
hypoglycemia under the rationale that a patient with type 2 diabetes under the use of insulin in
the treatment plan is at a high risk of hypoglycemia. Hypoglycemia manifests itself differently in
individuals but, at the same time consistent to a similar individual. The signs of hypoglycemia
are due to high adrenergic activity and decreased levels of glucose delivered to the brain. The
patient, thus, may experience tachycardia, headache, visual changes, dizziness, and diaphoresis.
Administration of basal and prandial insulin should be done by the rationale of adhering to a
therapeutic regimen that promotes the perfusion of the tissue. Glucose should be kept at the
normal ranges, which slows down the microvascular disease progress. Another intervention
includes reporting a BP higher than 160mm Hg and administer hypertensive as put down. People
with diabetes mostly suffer hypertension, and its control leads to the prevention of coronary heart
disease, nephropathy, retinopathy, and stroke.
The patient should be instructed about avoiding heating pads and always to wear closed shoes
because they have a decreased sensation in their extremes due to peripheral neuropathy. The
albumin and serum creatinine should be monitored to identify renal failure where renal failure
leads to a creatinine higher than 1.5 mg/Dl microalbuminuria, which is the first sign of diabetic
nephropathy.
Gestational diabetes aim of treatment aims at restoring the bloods glucose to normal levels via
meal plans, physical activities, testing of blood glucose and insulin injections.
THE CONCEPT THAT DIABETES IS A CHRONIC CONDITION

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The members of the community should be aware that diabetes is a chronic condition which once
its onset in the human body, cannot be treated but controlled. The diabetic patients are efficiently
taught by healthcare professionals about how to monitor their blood sugar levels responses to
life. These patients can access oral agents, regimens, and insulins that are currently available in
the management of diabetes. With the intensive treatment of type 1 and type 2 diabetes, strict
glycemic control, and treatment of chronic microvascular complications can lead to delayed
diabetes or prevented diabetes. There are many complications associated with diabetes that the
members of the community should be aware of and control them in the community in the highest
manner possible. This is done through the right counseling and the education process where the
people who have diabetes are taught how to manage the condition at their own homes, in
learning institutions, at work or in other activities with no need to call the health practitioner.
This makes the control of diabetes in an individual more cost-effective in terms of finances, and
the person can offer him/herself the appropriate level of care needed. Managing diabetes at the
community level keeps the person at the wellness level role, which helps in their future
psychosocial and psychological wellbeing.
The community diabetes management team is taught on how to offer good treatment services for
diabetes, and skill training is offered to the family members, the patient, and the carers and is
enabled to access communication with the health practitioners and the diabetes team. The vital
Support in the community is mostly given by the groups such as the Diabetes Associations at the
place where care is offered in the community. Diabetes patients are urged to join diabetes
Associations through which the patients help each other to manage their condition through
diabetes exercises, healthy eating, using the right medications, help each other take medicines at