Diabetes Mellitus (DM) is a prevalent, chronic metabolic condition characterized by the body’s impaired ability to process carbohydrates, fats, and proteins effectively due to insulin resistance or deficiency. This dysfunction leads to elevated blood glucose levels, a hallmark of diabetes. Effective management of diabetes is crucial, and nursing diagnoses play a vital role in guiding patient care. This article delves into diabetes mellitus, focusing on providing comprehensive Diabetes Nursing Diagnosis Examples to aid nurses in delivering optimal patient care.
Types of Diabetes Mellitus
Understanding the different types of diabetes is fundamental for accurate diagnosis and tailored nursing care.
Type 1 Diabetes: Characterized by an autoimmune reaction where the body’s immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. Genetic predisposition and viral infections are considered potential contributing factors.
Type 2 Diabetes: The most common form, developing gradually over time. It results from the body’s cells becoming resistant to insulin, leading to ineffective glucose utilization and elevated blood sugar levels. Lifestyle factors like obesity and inactivity play a significant role.
Gestational Diabetes: Occurs during pregnancy in individuals without a prior diabetes diagnosis. Hormonal changes during pregnancy can lead to insulin resistance. While typically resolving after childbirth, gestational diabetes increases the mother’s risk of developing type 2 diabetes later in life.
Prediabetes: A precursor to type 2 diabetes, indicated by blood glucose levels higher than normal but not yet meeting the diagnostic criteria for type 2 diabetes. Prediabetes is often defined by a fasting blood glucose level between 100-125 mg/dL.
Hypoglycemia
Hypoglycemia, or low blood glucose, is a critical concern in diabetes management. It is defined as blood glucose levels below 70 mg/dL. Prompt recognition and treatment are essential to prevent severe complications.
Causes of Hypoglycemia
Several factors can contribute to hypoglycemia in individuals with diabetes:
- Excessive insulin dosage: Taking too much insulin can lead to a rapid drop in blood glucose.
- Insufficient carbohydrate intake: Skipping meals or not consuming enough carbohydrates can result in hypoglycemia.
- Insulin timing: Improper timing of insulin administration in relation to meals and activities.
- Physical activity: Unplanned or excessive exercise can deplete glucose stores.
- Alcohol consumption: Alcohol can interfere with liver glucose production, especially when consumed without food.
- Weather conditions: Hot and humid weather can affect insulin absorption.
- Puberty and menstruation: Hormonal fluctuations can influence blood glucose levels.
Hyperglycemia
Hyperglycemia, conversely, refers to high blood glucose levels, occurring when there is insufficient insulin in the bloodstream. It is defined as a fasting blood glucose level greater than 125 mg/dL or a blood glucose level above 180 mg/dL one to two hours after eating.
Causes of Hyperglycemia
Hyperglycemia can be triggered by various factors:
- Dietary indiscretions: Consuming excessive carbohydrates or sugary foods.
- Physical inactivity: Lack of exercise reduces glucose utilization by cells.
- Illness and infection: Stress hormones released during illness can elevate blood glucose.
- Stress: Emotional or physical stress can impact blood sugar control.
- Steroid use: Certain medications like corticosteroids can raise blood glucose levels.
- Incorrect medication use: Inadequate insulin dosage or missed doses of oral hypoglycemic agents.
Nursing Assessment for Diabetes Mellitus
A thorough nursing assessment is the cornerstone of effective diabetes care. It involves gathering subjective and objective data to identify patient needs and formulate appropriate nursing diagnoses.
Review of Health History (Subjective Data)
1. General Symptoms:
Assess for symptoms indicative of hypoglycemia:
- Heart palpitations
- Tremors and shaking
- Excessive sweating (diaphoresis)
- Nervousness or anxiety
- Confusion and difficulty concentrating
- Dizziness and lightheadedness
- Intense hunger
And symptoms of hyperglycemia:
- Frequent urination (polyuria)
- Increased thirst (polydipsia)
- Increased hunger, even after eating (polyphagia)
- Blurred vision
- Tingling, burning, or numbness in the extremities (neuropathy)
- Fatigue and lethargy
- Headaches
- Balanitis (penile yeast infection) in men
For women with gestational diabetes, symptoms may be subtle or resemble hyperglycemia:
- Increased urination frequency
- Increased hunger levels
- Increased thirst sensation
- Blurred vision
- Nausea and vomiting
2. Duration and Treatment History:
Inquire about the patient’s diabetes duration, past and current treatments. Long-term diabetes complications are strongly linked to the degree of glycemic control achieved over time.
3. Age at Diagnosis:
Determine the patient’s age when diagnosed. Type 1 diabetes often presents in childhood or adolescence, while type 2 diabetes is more common in adults over 40.
4. Risk Factor Assessment:
Explore both non-modifiable and modifiable risk factors for diabetes.
Non-modifiable Risk Factors:
- Family history: Diabetes, especially type 2, has a strong genetic component. Specific genetic mutations can cause MODY and neonatal diabetes.
- Race/Ethnicity: Certain racial and ethnic groups, including Black, Hispanic, American Indian, and Asian Americans, have a higher risk of type 2 diabetes.
- Age: The risk of prediabetes and type 2 diabetes increases with age.
- Autoimmune conditions: Autoimmune diseases can trigger type 1 diabetes and LADA by attacking pancreatic beta cells.
- Hormonal imbalances: Conditions causing insulin resistance, like PCOS, increase the risk of gestational and type 2 diabetes.
Modifiable Risk Factors:
- Obesity and Unhealthy Diet: High-fat, high-calorie, and high-cholesterol diets contribute to insulin resistance and increase diabetes risk. Overweight and obese individuals are at higher risk for prediabetes, type 2, and gestational diabetes.
- Smoking: Smokers have a significantly increased risk (30-40%) of developing type 2 diabetes compared to non-smokers. Smoking also exacerbates diabetes management and complications.
- Excessive Alcohol Consumption: Can reduce insulin sensitivity and increase the risk of type 2 diabetes.
- Physical Inactivity: A sedentary lifestyle increases insulin resistance and the risk of prediabetes and type 2 diabetes.
- Chronic Conditions: Conditions like hypertension and hyperlipidemia increase diabetes complications and the risk of type 2 diabetes respectively.
5. Yeast Infections:
Assess for a history of recurrent yeast infections, as high glucose levels promote yeast overgrowth, leading to conditions like vaginal yeast infections and balanitis.
6. Existing Diabetes Complications:
Investigate for the presence of diabetes-related complications, indicating the severity and duration of the condition:
- Cardiovascular Disease: Including coronary artery disease, angina, myocardial infarction, stroke, hypertension, and hyperlipidemia.
- Neuropathy: Diabetic neuropathy, causing nerve damage, leading to pain, numbness, and potential foot problems.
- Renal Disease (Nephropathy): Kidney damage due to diabetes, potentially progressing to kidney failure.
- Retinopathy: Diabetic retinopathy, affecting the blood vessels in the retina, potentially leading to vision loss.
- Foot Damage: Including ulcers, infections, and poor healing due to neuropathy and poor circulation.
- Depression: The emotional burden of managing a chronic condition like diabetes can increase the risk of depression.
7. Blood Glucose Monitoring Records:
Review the patient’s blood glucose monitoring logs from home glucose meters to identify patterns of hypo- and hyperglycemia and assess glycemic control.
Physical Assessment (Objective Data)
Patients with well-managed diabetes might not exhibit overt physical signs.
1. Vital Signs:
- Monitor blood pressure and respiratory rate. Hypertension is common in diabetes. Orthostatic hypotension may indicate autonomic neuropathy. Kussmaul respirations (deep, rapid breathing) suggest diabetic ketoacidosis (DKA).
2. Peripheral Pulses:
- Palpate and document dorsalis pedis and posterior tibialis pulses to assess for peripheral vascular disease, a common complication of diabetes.
3. Foot Examination:
- Perform a comprehensive foot assessment, particularly for sensory neuropathy and foot ulcers. Use the Semmes Weinstein monofilament test to assess sensation, along with reflex and vibration perception testing.
4. Weight Assessment:
- Note weight changes. Unexplained weight loss can occur in type 1 diabetes due to glycosuria and dehydration. Weight gain is common in type 2 diabetes and can worsen insulin resistance.
Diagnostic Procedures
1. Blood Glucose Tests:
Blood glucose levels are central to diabetes diagnosis.
Diagnostic Criteria:
Type 1 DM:
- Fasting plasma glucose ≥ 126 mg/dL
- Random plasma glucose ≥ 200 mg/dL
- HbA1c ≥ 6.5%
Type 2 DM:
- Primarily diagnosed using fasting glucose and HbA1c.
Prediabetes:
- Fasting blood sugar (FBS) level of 100 to 125 mg/dL
- 2-hour post-oral glucose tolerance test (OGTT) glucose level of 140 to 200 mg/dL
Gestational diabetes:
- Screening during 24-28 weeks of gestation.
- 1-hour glucose challenge test (screening)
- 3-hour glucose tolerance test (diagnostic) if 1-hour test is elevated.
2. Additional Lab Tests:
- Urine albumin: To detect early diabetic nephropathy in type 1 DM.
- Serum lipids: Lipid panel to assess cardiovascular risk.
- Thyroid function tests: Annual thyroid testing due to increased risk of hypothyroidism in individuals with diabetes.
Nursing Interventions for Diabetes Mellitus
Effective nursing interventions are crucial for managing diabetes and preventing complications.
Control Glycemia
1. Promote Patient Adherence:
Emphasize the importance of patient participation in diabetes management, including adherence to appointments, medication regimens, diet, and exercise.
2. Diabetes Education:
Provide comprehensive diabetes education, covering treatment options, the impact of diet, stress, medications, and exercise on blood glucose. Consider referral to a diabetes nurse educator for personalized education.
3. Home Glucose Monitoring:
Teach patients how to use and interpret results from home glucose monitoring devices. Accurate monitoring is essential for glycemic control. Discuss continuous glucose monitors (CGMs) as an option.
4. Maintain Target Glucose Levels:
Aim for HbA1c < 7% and pre-meal blood glucose levels of 90-130 mg/dL to minimize long-term complications.
5. Tailored Treatment Plans:
Recognize differences in treatment approaches for type 1 and type 2 diabetes.
Type 1 DM Treatments:
- Insulin injections or pump therapy
- Frequent blood glucose monitoring
- Carbohydrate counting
- Pancreas or islet cell transplantation (in select cases)
Type 2 DM Treatments:
- Lifestyle modifications (diet and exercise)
- Blood glucose monitoring
- Oral hypoglycemic agents
- Insulin (may be needed as the disease progresses)
6. Insulin Administration Education:
Educate patients on proper insulin administration techniques, including different types of insulin, injection techniques, and insulin pen use.
7. Insulin Pump Management:
Provide education and support for patients using insulin pumps, including pump operation, site care, and troubleshooting.
8. Closed-Loop Insulin Delivery Systems:
Discuss and educate on closed-loop systems (artificial pancreas) which automate insulin delivery based on continuous glucose monitoring.
9. Oral Diabetes Medications Education:
Educate patients on different classes of oral diabetes medications, their mechanisms of action, and potential side effects. Classes include: alpha-glucosidase inhibitors, biguanides (metformin), bile acid sequestrants, dopamine-2 agonists, DPP-4 inhibitors, meglitinides, SGLT2 inhibitors, sulfonylureas, and thiazolidinediones.
10. Pancreas Transplant Discussion:
Discuss pancreas transplantation as an option for select individuals with type 1 diabetes who have poor glycemic control or require kidney transplantation.
11. Meal Planning Guidance:
Educate patients on diabetic diets, emphasizing carbohydrate control, portion sizes, and healthy food choices (fruits, vegetables, lean proteins, whole grains).
12. Nutritionist/Dietitian Referral:
Refer patients to a registered dietitian or nutritionist for personalized meal planning and carbohydrate counting education.
13. Promote Physical Activity:
Encourage regular physical activity (at least 150 minutes of moderate activity per week) to improve insulin sensitivity and lower blood glucose.
14. Weight Management:
Support weight loss for overweight or obese patients with type 2 diabetes or prediabetes, as even modest weight loss (7%) can improve glycemic control.
15. Gestational Diabetes Management:
Manage gestational diabetes with blood glucose monitoring, dietary modifications, and potentially insulin or oral hypoglycemic agents. Monitor blood glucose during labor and postpartum.
16. Diabetes Prevention:
Educate individuals with prediabetes on lifestyle modifications to prevent progression to type 2 diabetes. Consider metformin for high-risk individuals.
17. Specialist Referral:
Refer patients to endocrinologists or diabetologists for specialized diabetes management.
Prevent Complications
1. Medical Alert Identification:
Advise patients to wear medical alert jewelry or carry identification indicating they have diabetes, especially crucial in emergencies like hypoglycemia or DKA.
2. Ophthalmologist Referral:
Recommend annual eye exams by an ophthalmologist to screen for retinopathy, cataracts, and glaucoma.
3. Vaccination Promotion:
Encourage recommended vaccinations, as diabetes can impair immune function.
4. Foot Care Education:
Educate on daily foot inspections, proper foot hygiene (washing, drying, moisturizing), and avoiding walking barefoot. Emphasize regular podiatry visits, especially for neuropathy or nail care issues.
5. Blood Pressure and Cholesterol Management:
Promote lifestyle modifications and medications to manage blood pressure and cholesterol to reduce cardiovascular risk.
6. Oral Hygiene Education:
Educate on meticulous oral hygiene (brushing, flossing, regular dental checkups) to prevent gum disease.
7. Smoking Cessation:
Strongly advise smoking cessation due to the significantly increased risk of diabetes complications in smokers.
8. Moderate Alcohol Consumption:
Educate on the effects of alcohol on blood glucose and recommend moderation (no more than 1-2 drinks per day with food).
9. Stress Management Techniques:
Teach stress-reduction techniques, as chronic stress can negatively impact blood glucose control.
10. Diabetes Nurse Educator Consultation:
Refer patients to diabetes nurse educators for ongoing support and education.
11. DSMES Program Referral:
Recommend Diabetes Self-Management Education and Support (DSMES) programs to improve self-efficacy, coping skills, and health outcomes.
Diabetes Nursing Diagnosis Examples and Care Plans
Nursing diagnoses provide a framework for individualized patient care. Here are examples of diabetes nursing diagnosis examples, expanding on those from the original article, with related factors, defining characteristics, expected outcomes, assessments, and interventions.
1. Risk for Unstable Blood Glucose Level
This risk nursing diagnosis highlights the patient’s vulnerability to fluctuations in blood glucose levels.
Related to:
- Unfamiliarity with diabetes management
- Inadequate blood glucose monitoring practices
- Incorrect insulin administration technique
- Non-adherence to prescribed antidiabetic medications
- Insufficient dietary intake or inappropriate meal planning
- Alterations in physical activity levels
- Pregnancy-related hormonal changes
- Presence of illness or infection
- Stressful life events
- Excessive weight gain or loss
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected Outcomes:
- Patient will maintain blood glucose levels within the target range as individualized.
- Patient will verbalize understanding of factors that influence blood glucose levels.
- Patient will demonstrate appropriate self-management behaviors to prevent blood glucose instability.
- Patient will identify and verbalize symptoms of hypoglycemia and hyperglycemia and appropriate actions to take.
Assessments:
- Assess for risk factors: Identify specific factors from the “Related to” list that are present for the patient.
- Evaluate patient’s knowledge: Assess the patient’s current understanding of diabetes, its management, and factors affecting blood glucose.
- Review blood glucose monitoring technique: If applicable, observe the patient’s technique for blood glucose monitoring and insulin administration.
- Assess lifestyle factors: Inquire about diet, exercise habits, and stress levels.
- Identify support system: Determine the availability of support from family or caregivers.
Interventions:
- Educate on diabetes management: Provide comprehensive education on diabetes pathophysiology, treatment plan, self-monitoring, medication management, diet, and exercise.
- Teach blood glucose monitoring: Instruct on proper use of a glucometer and/or CGM, frequency of monitoring, and interpretation of results.
- Insulin administration training: Provide thorough training on insulin administration, including different types of insulin, injection sites, techniques, and storage.
- Medication adherence strategies: Discuss strategies to improve medication adherence, such as pill organizers, reminders, and incorporating medication into daily routines.
- Dietary counseling: Provide guidance on meal planning, carbohydrate counting, and making healthy food choices. Refer to a dietitian as needed.
- Exercise recommendations: Discuss appropriate exercise types and frequency, emphasizing the importance of consistency and monitoring blood glucose before, during, and after exercise.
- Hypoglycemia and hyperglycemia management: Educate on recognizing symptoms of hypo- and hyperglycemia and appropriate treatment protocols (e.g., 15/15 rule for hypoglycemia).
- Stress management techniques: Teach stress-reducing techniques such as deep breathing, relaxation exercises, or mindfulness.
- Refer to DSME programs: Recommend enrollment in a Diabetes Self-Management Education program for comprehensive support and education.
- Regularly review and adjust plan: Periodically reassess the patient’s understanding, skills, and adherence and adjust the care plan as needed.
2. Ineffective Peripheral Tissue Perfusion
This is an actual nursing diagnosis focusing on compromised blood flow to the extremities, a common diabetes complication.
Related to:
- Hyperglycemia-induced endothelial damage
- Peripheral vascular disease (PVD)
- Diabetic neuropathy
- Impaired oxygen transport
- Interruption of arterial or venous blood flow
- Sedentary lifestyle
- Smoking
As evidenced by:
- Weak or absent peripheral pulses (pedal, posterior tibial)
- Cool or clammy skin in extremities
- Pallor or cyanosis of extremities
- Delayed capillary refill (>3 seconds)
- Numbness, tingling, or pain in extremities
- Non-healing wounds or ulcers on lower extremities
- Difference in blood pressure between extremities
- Decreased hair distribution on lower extremities
- Shiny, thin skin on lower extremities
Expected Outcomes:
- Patient will demonstrate improved peripheral tissue perfusion as evidenced by palpable peripheral pulses, warm and dry extremities, and capillary refill time < 3 seconds.
- Patient will report reduced or absent symptoms of numbness, pain, or coldness in extremities.
- Patient will demonstrate behaviors to improve peripheral circulation (e.g., proper foot care, smoking cessation).
- Patient will experience timely healing of any existing wounds or ulcers.
Assessments:
- Assess peripheral pulses: Palpate and document the quality of peripheral pulses (dorsalis pedis, posterior tibial, femoral, popliteal). Use Doppler ultrasound if pulses are weak or non-palpable.
- Evaluate skin characteristics: Assess skin color, temperature, texture, and presence of hair distribution on lower extremities. Note any shiny, thin skin or areas of discoloration.
- Assess capillary refill: Check capillary refill time in nailbeds of toes and fingers.
- Sensory assessment: Assess for neuropathy using monofilament testing, vibration perception, and assessment of light touch and pain sensation in extremities.
- Pain assessment: Inquire about pain in extremities, including location, character, intensity, and relieving/aggravating factors.
- Wound assessment: If wounds are present, assess location, size, depth, drainage, and signs of infection.
- Blood pressure measurement: Measure blood pressure in both arms to identify any significant differences.
- Assess lifestyle factors: Inquire about smoking history, activity level, and dietary habits.
Interventions:
- Optimize glycemic control: Implement strategies to maintain blood glucose levels within target range through medication management, diet, and exercise.
- Foot care education: Teach meticulous foot care practices, including daily inspection, washing, drying, moisturizing (avoiding between toes), proper nail trimming, and appropriate footwear.
- Promote circulation: Encourage regular, moderate exercise (walking, cycling) to improve peripheral blood flow. Advise against crossing legs for prolonged periods.
- Smoking cessation support: Provide resources and support for smoking cessation, emphasizing the detrimental effects of smoking on peripheral circulation.
- Positioning: Instruct patient to avoid prolonged standing or sitting and to elevate legs when sitting to promote venous return.
- Avoid constrictive clothing: Advise against wearing tight socks, stockings, or shoes that can impede circulation.
- Maintain warm environment: Keep extremities warm, but avoid direct heat application that could cause burns due to neuropathy.
- Pain management: Implement pain management strategies for neuropathic pain, including medications as prescribed and non-pharmacological approaches like massage or relaxation techniques.
- Wound care: Provide meticulous wound care for any ulcers or non-healing wounds, following established protocols and consulting with a wound care specialist if needed.
- Referral to podiatry/vascular specialist: Refer to a podiatrist for routine foot care and management of foot problems. Refer to a vascular specialist if PVD is severe or requires further evaluation.
3. Decreased Cardiac Output
This actual nursing diagnosis addresses the risk of reduced heart function related to diabetes and associated cardiovascular complications.
Related to:
- Hyperglycemia-induced cardiomyopathy
- Coronary artery disease (CAD) secondary to atherosclerosis
- Hypertension
- Fluid volume overload
- Myocardial ischemia or infarction
- Dysrhythmias
- Impaired myocardial contractility
- Increased systemic vascular resistance (afterload)
As evidenced by:
- Tachycardia or bradycardia
- Dysrhythmias (e.g., atrial fibrillation, PVCs)
- Hypotension or hypertension
- Tachypnea, dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND)
- Decreased oxygen saturation (SpO2)
- Edema (peripheral, pulmonary)
- Fatigue, weakness
- Change in level of consciousness, confusion, restlessness
- Decreased activity tolerance
- Decreased urine output
- Weak peripheral pulses
- Jugular venous distention (JVD)
- S3 or S4 heart sounds
Expected Outcomes:
- Patient will maintain adequate cardiac output as evidenced by stable vital signs (heart rate, blood pressure, respiratory rate within acceptable limits), adequate urine output, strong peripheral pulses, and absence of dyspnea, edema, and altered mentation.
- Patient will participate in activities that reduce cardiac workload.
- Patient will adhere to prescribed medications and lifestyle modifications to manage cardiac function.
Assessments:
- Monitor vital signs: Assess heart rate, blood pressure (including orthostatic measurements), respiratory rate, and oxygen saturation frequently.
- Cardiac rhythm monitoring: Continuously monitor cardiac rhythm via ECG, especially if dysrhythmias are suspected or present.
- Auscultate heart sounds: Assess for abnormal heart sounds (S3, S4, murmurs).
- Respiratory assessment: Assess respiratory rate, depth, effort, and breath sounds. Monitor for signs of pulmonary edema (crackles, wheezes).
- Fluid balance monitoring: Monitor daily weight, intake and output, and assess for edema (peripheral, sacral, pulmonary). Assess for jugular venous distention.
- Assess level of consciousness: Evaluate level of consciousness, orientation, and presence of restlessness or confusion.
- Activity tolerance: Assess patient’s ability to tolerate activity and note any symptoms of fatigue, dyspnea, or chest pain with exertion.
- Peripheral pulse assessment: Palpate and document quality of peripheral pulses.
- Review cardiac history: Obtain a thorough history of pre-existing cardiac conditions, risk factors for heart disease, and current cardiac medications.
- Laboratory data review: Review relevant lab data, including electrolytes, BUN, creatinine, BNP, and cardiac enzymes.
Interventions:
- Optimize glycemic control: Maintain blood glucose levels within target range to minimize hyperglycemia-induced cardiac damage.
- Administer medications as prescribed: Administer cardiac medications as ordered, such as ACE inhibitors, beta-blockers, diuretics, antiarrhythmics, and SGLT2 inhibitors (which have cardioprotective benefits).
- Oxygen therapy: Administer supplemental oxygen as needed to maintain adequate oxygen saturation.
- Fluid management: Monitor fluid balance closely and manage fluid overload with diuretics as prescribed. Restrict sodium intake as ordered.
- Positioning: Position patient in semi-Fowler’s or high-Fowler’s position to ease breathing and reduce preload.
- Rest and activity balance: Promote rest periods and reduce physical exertion to decrease cardiac workload. Space out nursing activities to allow for rest.
- Monitor for signs of heart failure: Closely monitor for worsening signs and symptoms of heart failure, such as increasing dyspnea, edema, or fatigue.
- Dietary modifications: Educate on a heart-healthy diet, low in sodium, saturated and trans fats, and cholesterol.
- Smoking cessation: Reinforce the importance of smoking cessation for cardiovascular health.
- Emotional support: Provide emotional support to address anxiety and fear related to cardiac condition.
- Patient education: Educate patient and family about diabetes and its impact on cardiac health, medication regimen, lifestyle modifications, and signs and symptoms to report.
- Referral to cardiology: Refer to a cardiologist for specialized cardiac management and follow-up.
These diabetes nursing diagnosis examples provide a starting point for developing individualized care plans. Nurses should always tailor diagnoses and interventions to the unique needs and circumstances of each patient with diabetes. Continuous assessment, patient education, and collaborative care are essential for achieving optimal outcomes in diabetes management.
References
- American Diabetes Association. (2023). Standards of medical care in diabetes—2023 abridged for primary care providers. Clinical Diabetes, 41(1), 4–31.
- Buttaro, P. J., Trybulski, J., Polgar-Bailey, P., Sandberg-Cook, J., & Hull, V. (2017). Medical-surgical nursing: Concepts for interprofessional collaborative care (9th ed.). Elsevier.
- Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, and outcomes (9th ed.). Elsevier.
- Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, K. H. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care (9th ed.). Elsevier.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (n.d.). Diabetes mellitus. Retrieved from https://www.niddk.nih.gov/health-information/diabetes
