Nursing Guide to Diabetes: Nursing Diagnosis, Interventions, & Care Plans

Diabetes mellitus is a chronic metabolic disorder depicted by high blood glucose levels resulting from defects in insulin secretion, insulin action, or both. It is classified into type 1, where the body fails to produce insulin, and type 2, where insulin production is inadequate, or the body cannot use it effectively. Gestational diabetes occurs during pregnancy. Maturity-onset diabetes of the young (MODY) is a disorder identified by non-insulin-dependent diabetes which usually manifests in patients under 25 years of age.   

Diabetes may also be secondary to medication use such as steroid induced diabetes.   Diabetes leads to a range of complications, including kidney disease, cardiovascular disease, neuropathy, and retinopathy, making it a significant public health concern. Nurses help monitor blood glucose levels, manage complications, and provide education to prevent long-term complications. 

Diabetes etiology and epidemiology 

Type 1 diabetes (T1DM): 

• Autoimmune destruction of beta cells in the pancreas leads to insulin deficiency.
• Often diagnosed in children and young adults but can occur at any age. 

Type 2 diabetes (T2DM): 

• Insulin resistance and relative insulin deficiency develop over time.
• Risk factors include increasing age, family history, obesity, sedentary lifestyle, and poor diet. 

Gestational diabetes (GDM): 

• Develops during pregnancy due to hormonal changes leading to insulin resistance.
• Women with GDM are at higher risk of developing T2DM later in life. 

Epidemiology: 

• Over 537 million adults globally are affected by diabetes, with type 2 diabetes accounting for about 90% of all cases.
• Type 1 diabetes is less common, affecting 5% to 10% of people with diabetes.
• Diabetes prevalence is higher in low- and middle-income countries, and rates are increasing in all age groups due to rising obesity and sedentary lifestyles. 

Diabetes ICD-10 code 

The ICD-10 codes for diabetes mellitus are as follows: 

• Type 1 diabetes mellitus: E10.9 (type 1 diabetes mellitus without complications)
• Type 2 diabetes mellitus: E11.9 (type 2 diabetes mellitus without complications)
• Gestational diabetes: O24.4 (gestational diabetes mellitus)  

Diabetes diagnosis 

Diabetes is diagnosed through blood tests that measure blood glucose levels. 

Diagnostic criteria: 

• Fasting plasma glucose (FPG) ≥126 mg/dL (7.0 mmol/L)
• Random plasma glucose ≥200 mg/dL (11.1 mmol/L) with symptoms of hyperglycemia
• Oral glucose tolerance test (OGTT) 2-hour plasma glucose ≥200 mg/dL (11.1 mmol/L)
• Hemoglobin A1c (HbA1c) ≥6.5% 

Additional tests: 

• Urine tests to check for glucose, ketones, and protein, especially in suspected diabetic ketoacidosis (DKA).
• Lipid profile, kidney function tests, and eye exams to monitor for complications. 

Management 

Managing diabetes focuses on controlling blood glucose levels to prevent acute and long-term complications. A combination of lifestyle modifications, medications, and patient education is essential. 

Lifestyle management: 

• Diet: Emphasize a balanced diet with appropriate portions of carbohydrates, fats, and proteins. Patients should understand the importance of glycemic index and carbohydrate counting.
• Exercise: Encourage regular physical activity (at least 150 minutes per week) to improve insulin sensitivity and weight management.
• Weight loss: A modest weight loss of 5% to 10% can significantly improve glycemic control in T2DM. 

Pharmacological management: 

• Type 1 diabetes: This requires lifelong insulin therapy, with basal (long-acting) and bolus (short-acting) insulin regimens.
• Type 2 diabetes: This may be managed with oral hypoglycemic agents (e.g., metformin, sulfonylureas, SGLT-2 inhibitors) or insulin if necessary.
• Gestational diabetes: This is managed with lifestyle interventions and insulin if blood glucose targets are not met. 

Monitoring: 

• Self-monitoring of blood glucose (SMBG): Patients should regularly check blood glucose levels at home to adjust treatment as needed.
• Continuous glucose monitoring (CGM): This provides real-time data for those with T1DM or those with difficulty achieving glucose control. 

Diabetes nursing care plan 

Nursing considerations 

Nurses must assess for signs of hyperglycemia (elevated blood sugar) and hypoglycemia (low blood sugar) and monitor for complications like diabetic ketoacidosis, neuropathy, and infections. They also educate patients on medication adherence, proper diet, and lifestyle changes to manage diabetes effectively. 

Assessment 

• Blood glucose monitoring: Regular checks using a glucometer or CGM to assess trends and detect hypo- or hyperglycemia. 
• Skin and foot care: Examine regularly for signs of ulcers, infections, or poor wound healing, as patients are at increased risk for foot complications. 
• Neuropathy assessment: Monitor for numbness, tingling, or burning sensations, especially in the extremities. 
• Dietary habits: Evaluate the patient’s understanding of carbohydrate counting and meal planning. 
• Medication adherence: Assess how well the patient follows their prescribed medication regimen. 

Nursing diagnosis/risk for 

• Risk for unstable blood glucose levels related to inappropriate insulin or medication administration as evidenced by fluctuating glucose readings. 
• Risk for infection related to hyperglycemia, which impairs immune function. 
• Risk for impaired skin integrity related to decreased sensation and delayed wound healing in diabetic patients. 
• Deficient knowledge regarding disease management, diet, and medication. 

Diabetes interventions 

• Administer insulin/oral hypoglycemics as prescribed, ensuring the correct dose and timing. 
• Educate on blood glucose monitoring. Teach patients how to check their glucose levels, interpret the results, and adjust their diet or medications accordingly. 
• Provide foot care education. Instruct patients on proper foot hygiene, regular inspections for injuries, and the importance of wearing well-fitting shoes. 
• Support dietary modifications. Work with dietitians to help patients plan meals and understand the role of nutrition in glucose management. 
• Monitor for signs of complications. Assess for diabetic ketoacidosis (DKA), hypoglycemia (shakiness, confusion, sweating), and other diabetes-related issues. 

Expected outcomes 

• The patient maintains blood glucose levels within target ranges as evidenced by SMBG or CGM readings. 
• The patient demonstrates an understanding of diabetes management, including diet, exercise, and medication use. 
• The patient experiences no episodes of severe hypoglycemia or hyperglycemia. 
• The patient maintains intact skin, particularly in the feet, without signs of ulceration or infection. 

Individual/caregiver education 

• Blood glucose monitoring: Teach patients how to use glucometers or CGMs and interpret results. 
• Diet and exercise: Educate on the importance of a balanced diet and regular exercise to help control blood sugar. 
• Medication adherence: Stress the importance of taking medications as prescribed and recognizing signs of hypoglycemia (e.g., shakiness, sweating) or hyperglycemia (e.g., excessive thirst, frequent urination). 
• Foot care: Encourage daily inspection of feet for cuts, blisters, or sores and wearing supportive footwear to prevent injury. 
• Complication prevention: Emphasize the importance of regular medical checkups to watch for long-term complications, such as neuropathy, retinopathy, and kidney disease. 

Additional Information

Course Contributor

Ann M. Dietrich, MD, FAAP, FACEP, Professor of Pediatrics and Emergency Medicine for the University of South Carolina School of Medicine Greenville, has over 30 years of experience in pediatric emergency medicine. Throughout her career, Dietrich has helped educate medical students, residents, fellows, and junior attendings, including as an educator at Ohio State University and the American College of Emergency Physicians. She also collaborated on several research projects, including one on concussions and one on improving mental healthcare for children. Dietrich helped develop guidelines on the impact of concussions on children and worked with trauma surgeons to enhance care for pediatric trauma patients.

Resources 

• American Diabetes Association (ADA): This association provides patient education resources and management guidelines. 
• Centers for Disease Control and Prevention (CDC): This agency offers information on diabetes prevention and management. 

References 

• ICD10data.com. (n.d.). ICD-10-CM code E11.9 diabetes mellitus, type 2 without complications. Retrieved from https://www.icd10data.com/ 
• Sapra A, Bhandari P. Diabetes. [Updated June 2023]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK551501/