Diabetes mellitus age groups. How is diabetes treated in old age with insulin? Why is diabetes so dangerous for older women?

21.04.2019

You can find out the blood sugar level by taking a venous or capillary blood test. At home, you can determine the level of glycemia by using an electrochemical glucometer.

The glucose rate is determined by age. The older the patient is, the higher his glycemic level should be.

If there are deviations up or down, it is required to undergo appropriate diagnostics and treatment. The tactics of therapy are selected based on the underlying cause of hypo- or hyperglycemia.

The norm of blood sugar in men and women: table

Before dealing with the normal indicators of glycemia, you need to identify the difference between a blood test from the "vein" and from the "finger". The main difference is that physicians receive venous blood when sampling from a vein, and capillary blood when sampling from a finger.

In fact, the glycemic norm for any test is the same. But when taking biomaterial from a vein, doctors can get more reliable data. To get accurate results, the patient needs to be trained. First, you need to donate blood exclusively on an empty stomach. It is only allowed to drink purified water without gas. It is advisable not to even brush your teeth before the fence, as the paste may contain sugar.

Also, on the eve of the test, it is undesirable to resort to intense physical activity or eat a lot of high-carbohydrate foods. Alcohol can also distort research results.

Blood sugar levels are normal in women by age:

Blood sugar levels are normal in men by age:

This table will be equally correct regardless of what kind of blood the doctors examined - capillary (from a finger) or venous (from a vein).

Correspondence table of glycated hemoglobin to the average daily sugar level:

HbA1c value (%)	HbA1 value (%)	Average sugar (mmol / l)
4,0	4,8	2,6
4,5	5,4	3,6
5,0	6,0	4,4
5,5	6,6	5,4
6,0	7,2	6,3
6,5	7,8	7,2
7,0	8,4	8,2
7,5	9,0	9,1
8,0	9,6	10,0
8,5	10,2	11,0
9,0	10,8	11,9
9,5	11,4	12,8
10,0	12,0	13,7
10,5	12,6	14,7
11,0	13,2	15,5
11,5	13,8	16,0
12,0	14,4	16,7
12,5	15,0	17,5
13,0	15,6	18,5
13,5	16,2	19,0
14,0	16,9	20,0

During pregnancy, the glycemic norm is 3.3-6.0 mmol / l. Exceeding the 6.6 mmol / L mark indicates the progression of gestational diabetes.

Hypoglycemia: Causes and Symptoms

Hypoglycemia is a pathological condition in which the glycemic level is below 3.3 mmol / l. In diabetics, this condition occurs due to an overdose of insulin or oral hypoglycemic drugs.

When hypoglycemia develops, a diabetic needs to eat candy or other food that contains simple carbohydrates. If the condition was triggered by an overdose of insulin or antihyperglycemic pills, an adjustment to the treatment regimen is required.

Low blood sugar levels can also be triggered by:

Hormonal changes.

Fasting or prolonged abstinence from food (more than 6 hours).

Drinking alcoholic beverages.

Taking medications that enhance the effect of insulin.

Insulinoma.

Autoimmune pathologies.

Cancer diseases.

Viral hepatitis and cirrhosis.

Renal or heart failure.

Only a comprehensive diagnosis will help determine the exact causes of this condition. Additionally, I would like to highlight the characteristic symptoms of low blood glucose levels.

Usually the patient develops dizziness, confusion, chills, hunger, nervousness. The skin becomes pale and the pulse quickens. There is a violation of the coordination of movements. Numbness of fingers is possible. If the blood sugar level falls below 2.2 mmol / l, the patient's speech is impaired, the body temperature drops sharply, and seizures occur.

If appropriate measures are not taken, the patient will fall into. Even a lethal outcome is not excluded.

Hyperglycemia: Causes and Symptoms

Hyperglycemia is a pathological condition in which there is a persistent increase in sugar levels. Hyperglycemia is diagnosed if the fasting glucose level exceeds 6.6 mmol / L.

As a rule, this condition is observed in type 1 and type 2 diabetes mellitus. With insulin-dependent diabetes mellitus (type 1), there is a high likelihood of developing a hyperglycemic coma, since the cells of the pancreas lose the ability to produce enough insulin.

In addition to diabetes, hyperglycemia can be triggered by:

Stress.
The period of bearing a child. With gestational diabetes, persistent increases in blood sugar levels can also occur during breastfeeding.
The use of glucocorticosteroids, oral contraceptives, beta-blockers, glucagon.
Diseases of the cardiovascular system. Elderly patients may experience hyperglycemia after suffering a stroke or heart attack.
Eating large amounts of high-carbohydrate foods. By the way, food with a high GI (glycemic index) can lead to the development of obesity and type 2 diabetes.
Diseases of the hepatobiliary system.
Oncological pathologies.
Diseases of the pancreas. The level of glycemia can increase with the acute course of pancreatitis.
Cushing's Syndrome.
Infectious pathologies.

In diabetics, hyperglycemia often develops when the attending endocrinologist selects the wrong dosage of insulin or a hypoglycemic agent. In this case, it is possible to stop the elevated blood sugar level by correcting the treatment regimen. Insulin replacement can also be done. It is desirable to use human insulin, since it is much better absorbed and well tolerated by patients.

If blood glucose levels rise, a teenager or adult will experience the following symptoms:

Frequent urge to urinate. Glucose appears in the urine.
Intense thirst.
Smell of acetone from the mouth.
Headache.
Clouding of consciousness.
Deterioration of visual perception.
Disorders in the work of the digestive tract.
Numbness of the limbs.
Fainting.
Tinnitus.
Itchy skin.
Abnormal heart rhythm.
Feelings of anxiety, aggression, irritability.
Decrease in blood pressure.

If the above symptoms appear, you should call an ambulance. Before the arrival of doctors, the patient needs to be given a lot of water and wipe the skin with a wet towel.

How to normalize blood sugar levels?

Above, the permissible glycemic indicators have already been indicated. If hypoglycemia is observed, then the patient needs to undergo a comprehensive examination. Normalization of the state can be achieved only after eliminating the root cause of this phenomenon. If hypoglycemia was provoked by an incorrectly selected dosage of insulin or tablets, appropriate adjustments are made.

With an increased blood sugar content, it is also necessary to undergo an additional examination in order to identify the root cause of this condition. If the diagnosis showed that hyperglycemia was provoked by diabetes mellitus, then the patient is recommended:

Apply medications. In type 1 diabetes, the body is unable to produce insulin, so insulin therapy is the mainstay of treatment. With type 2 diabetes, hypoglycemic tablets can be dispensed with (Metformin, Glidiab, Glibenclamide, Januvia, Acarboza). But persistent decompensation of the disease is also an indication for insulin injections.
Monitor blood glucose levels regularly. This can be done by using an electrochemical glucometer. It is advisable to take measurements 3 times a day - on an empty stomach, after breakfast and before bedtime. Any deviations should be reported to the attending physician. Controlling the dynamics of the disease will help avoid diabetic coma and other serious consequences.
Follow a diet. With type 2 diabetes, a more rigid diet is indicated than with type 1 diabetes. For hyperglycemia, only low GI foods should be included in the diet. Diabetics often wonder how much to eat at a time? It is advisable to consume no more than 300-400 grams of food per meal. Fractional meals are mandatory.
Exercise regularly. Patients from the older age group (from 60 years old) can do with walking and exercise therapy. Other sports are also suitable for young diabetics, in particular running, swimming, cycling, athletics, football, basketball. Loads should be moderate, but regular.

Folk remedies can also be used to lower blood sugar levels. A tincture of walnut leaves, a decoction of acorns, juice of Brussels sprouts, a decoction of linden, and a cinnamon-honey mixture have proven themselves well.

Also, for auxiliary purposes, biologically active herbal supplements and multivitamin complexes are prescribed. Such funds can improve the effectiveness of drug treatment and strengthen the immune system.

Diabetes mellitus is a very dangerous and insidious disease. The first symptoms of diabetes mellitus, people may confuse it with mild malaise, the action of an infectious disease. For many, diabetes mellitus can be secretive. As a preventive measure, it is necessary to check the blood sugar level every six months, this will help to detect the disease at an early stage, especially in people who are at risk. The glucose level can be measured at home, for example, using a special device called a glucometer. A blood test in the clinic is usually taken from a finger, but can be taken from a vein. At home, the meter can measure the level from a drop of blood.

After 5 seconds, the device will show an accurate result. If the glucometer test showed a deviation of the sugar level from the norm, it is necessary to take a blood test from a vein at the clinic, in the direction of your doctor. This way, you can clarify whether you have diabetes or not.

To obtain reliable test results, it is necessary to measure blood glucose levels strictly on an empty stomach for several days. It is best to test blood from a vein and finger in the laboratory of a medical institution.

Some men and women make a mistake when, before the analysis, they drastically change their diet, start eating right, "go on a diet."

You can't do that!

This leads to the fact that the true state of affairs with the pancreas is hidden and it will be more difficult for the doctor to accurately diagnose. When getting tested for sugar, take into account your emotional state and other factors.

Fatigue, pregnancy, chronic illness, all of this can significantly affect glucose levels and deviations from the norm. It is not recommended for men and women who will be tested to work overnight, stay up late. Before the test, you should first get a good night's sleep.

Video: Diabetes. Three early signs

Remember!

In a healthy person, the blood sugar level is always measured on an empty stomach, with the exception of the delivery of clarifying tests, when blood can be taken after a meal.

Men and women who are over 40 years old must be tested for sugar, as they are at risk.

In addition, you need to monitor the rate of blood sugar in women during pregnancy, as well as overweight people.

Table of blood sugar norms in women by age

Sugar norms for women and men are basically the same, but there are differences.

The result will depend on some parameters:

The analysis was given on a lean stomach or after eating
The sugar rate changes with age, after 60 years in women and men, the indicator may increase

If a person eats normally, leads an active lifestyle, does not abuse alcohol, is not a drug addict and the analysis shows elevated glucose levels, then the patient can be suspected of developing diabetes mellitus.

The unit of measurement for this blood parameter is millimole per 1 liter of blood (mmol / l). An alternative unit is milligram per deciliter of blood mg / 100 ml (mg / dL). For reference: 1 mmol / L corresponds to 18 mg / dL.

Normal glucose values depend on the age of the patients.

Regardless of gender, both men and women should always take care of their health and monitor the sugar rate, passing prof. examinations, blood and urine tests.

Sugar levels in older women

Check your blood sugar!

This is especially true of the norm of blood sugar in women after 40 - 50 - 60 - 70 years.

Usually, in older women, glucose levels rise exactly two hours after eating, and fasting glycemia remains near normal.

Reasons for an increase in blood sugar in women

This phenomenon has several reasons that act on the body synchronously.

Firstly, this is a decrease in the sensitivity of tissues to the hormone insulin, a decrease in its production by the pancreas. In addition, the secretion and action of incretins will weaken in these patients. Incretins are special hormones that are produced in the digestive tract in response to food intake. Also, incretins activate the production of insulin by the pancreas. With age, the susceptibility of beta cells decreases several times, this is one of the mechanisms of the formation of diabetes, no less important than insulin resistance. Due to their difficult financial condition, older people are forced to gnaw on cheap, high-calorie foods.

Such food contains: an extraordinary amount of rapidly digestible industrial fats and light carbohydrates; lack of complex carbohydrates, protein, fiber.

The second reason for an increase in blood sugar in old age is the presence of chronic concomitant diseases, treatment with potent drugs that adversely affect carbohydrate metabolism.

The most risky from this point of view are considered: psychotropic drugs, steroids, thiazide diuretics, non-selective beta-blockers. They are capable of causing the development of disturbances in the work of the heart, lungs, and musculoskeletal system.

Causes of hyperglycemia

The sugar level can be exceeded due to:

Because of junk food, when a person abuses sweets
alcohol abuse, smoking
due to nervous tension, stress
due to increased activity of the thyroid gland and other endocrine diseases
diseases of the kidneys, pancreas and liver.

Blood glucose can sometimes rise after taking steroids, diuretics, and some birth control pills. In women, sugar levels rise during pregnancy.

When the analysis showed elevated glucose levels (hyperglycemia), the patient is given 200 ml of water with sugar to drink the next time, and after 2 hours, testing is performed again. It happens that a person can rise to the level of blood glucose due to the fact that he has eaten a sweet apple.

Symptoms of hyperglycemia in men and women:

thirst
dry mouth
skin problems, severe itching
the patient is losing weight dramatically
blurred vision
worried about frequent painful urination
shortness of breath, it becomes loud and uneven

For women over 60 years of age, type II diabetes mellitus is most characteristic, which is defined as benign. It mainly goes in a trifling form and is not characterized by severe symptoms. Moreover, a significant part of middle-aged women do not even assume that they have a disease, which is why it is diagnosed late and most often by coincidence.

A distinguishing property that can prompt the doctor that his middle-aged patient has diabetes mellitus is the presence of obesity in her, which indicates disorders in the process of lipid metabolism.
Between the onset of the development of the disease and the formulation of a systematic diagnosis, there have been years during which an elderly madame experiences anguish from the occasionally arising erased symptoms, but does not turn to a medical professional.

The classic symptoms that accompany diabetes in the elderly are:

pathology of sensitivity in the limbs;
the appearance of pustules on the skin;
decreased visual acuity;
the appearance of pain in the region of the heart;
swelling of the face and neck area;
the development of various fungal disorders, etc.

In the interests of older women, the development of trophic changes in the extremities, the appearance of signs of "diabetic foot" is also inherent. Trophic changes develop due to the effect of glucose on the blood walls.

For the elderly, the fairer sex is also characterized by the development of an unexpected and dangerously flowing diabetic coma. Usually, a sudden onset of coma caused by high blood glucose levels is fatal in the elderly.

In more than half of the people whose analysis showed an increase in blood sugar norms, latent pancreatitis (inflammation of the pancreas) was revealed. The insidiousness of the disease is that the symptoms of pancreatitis may not show obvious signs, disguise themselves as other diseases and gradually destroy the pancreatic tissue.

How to lower blood glucose levels

A balanced diet and a balanced diet can significantly reduce sugar levels. It is important to follow a diet for those who already have elevated blood glucose levels. Eliminate from your diet: animal fats, sweets, fast foods, juices, bananas, persimmons, figs, sugary soda, alcohol.

To normalize metabolism in the future, in order to maintain normal glucose levels, it is necessary to include in the menu: seafood, fish, beef, rabbit meat, vegetables, herbal teas, mineral water.

Video: Diabetes mellitus in the elderly

Why is diabetes mellitus so dangerous for older women?

The reason is that patients are unusually poorly tolerated cardiovascular complications, have every chance of dying from a stroke, heart attack, vascular blockage by a thrombus, acute heart failure.

There are also chances of being incapacitated and disabled when irreparable brain damage occurs.

A similar complication can appear at a young age, but a much older person tolerates it very difficult. When a woman's blood sugar rate rises quite often and unpredictably, this becomes the basis for falls and injuries.

Insulin is known as a pancreatic hormone. When the glucose concentration rises, the pancreas increases insulin secretion. In the case when there is no insulin, or not enough insulin, glucose does not begin to transform into fat. If a large amount of glucose accumulates in the blood, diabetes mellitus develops.

The brain at this moment can begin to actively use excess glucose, partially rid us of excess fat.

Over time, sugar can be deposited in the liver (fatty liver). It is just as dangerous when large amounts of sugar begin to interact with skin collagen, which is essential for the smoothness and elasticity of our skin.

Collagen is gradually disrupted, which leads to aging of the skin and the appearance of premature wrinkles.

Elevated glucose can lead to a deficiency of vitamin B. In general, vitamins and minerals are poorly absorbed by the body in diabetes mellitus.

High blood sugar speeds up the metabolism, people have problems with the kidneys, heart, lungs.

Diabetes mellitus weakens the immune system

Sugar gradually destroys the immune system, a person is more and more exposed to infections, viral diseases, the body loses its ability to effectively fight infection.

Thus, in both older women and men, an increase in glucose levels is quite common.

In order to prevent the development of diabetes mellitus, you have time to pay attention to changes in the indicators in the analysis and take appropriate measures. As a preventive measure against the disease, it is important to stick to a diet and maintain a healthy lifestyle.

Video: blood sugar rate in women, table by age

It is important to understand that usually the blood glucose levels in women and men have the same normal values. The level may differ according to age, the presence of a particular disease and the female characteristics of the body. Also, the time of taking the test and the conditions observed at the same time can affect the indicators of the norm of sugar in the blood..

After 50 years for every subsequent 10 years:

Fasting glycemia increases by 0.055 mmol / L

Glycemia 2 hours after eating increases by 0.5 mmol / l

Features of the clinic of diabetes mellitus in the elderly

Asymptomatic course

The predominance of nonspecific complaints (weakness, fatigue, dizziness, memory impairment and other cognitive dysfunctions)

Detection of diabetes by chance during examination for another concomitant disease

The clinical picture of micro- and macroangiopathies at the time of detection of diabetes

The presence of multiple organ pathology

The diagnosis of diabetes mellitus 2 is exposed simultaneously with the identification of late vascular complications.

Impaired recognition of hypoglycemia

Atypical indicators of laboratory diagnostics

Absence of fasting hyperglycemia in 60% of patients;

Prevalence of isolated postprandial hyperglycemia in 50–70% of patients;

Increased renal glucose excretion threshold with age.

Psychosocial

Social isolation

Low material opportunities

Cognitive impairment (memory loss, learning disabilities, etc.)

The goals of treatment for elderly patients with type 2 diabetes depend on:

Average life expectancy of the patient;

The state of the cardiovascular system;

Risk of hypoglycemic conditions;

Preservation of cognitive functions;

General somatic status;

Ability to conduct regular self-monitoring of glycemia.

Criteria for optimal compensation for type 2 SD in old age and / or with a life expectancy of less than 5 years

Principles of diabetes treatment

1. Insulin therapy (for health reasons) for type 1 diabetes, insulin therapy or PSS drugs for type 2;

2. Physiological individualized diet;

3. Physical activity;

4. Training;

5. Self-control;

6. Prevention and treatment of late complications of diabetes;

7. Psychological assistance.

Diet for diabetes - physiological balanced with normal the ratio of proteins, fats and carbohydrates... The ratio of the main ingredients in the daily diet: 50-60% of the total calorie content of food is covered by carbohydrates, 25-30% by fats and 15-20% by proteins.

Meals should be regulated in terms of total calorie content, the number of its constituents and mealtime

With normal body weight, the diet is isocaloric. With severe weight loss (type 1 diabetes, decompensation), a hypercaloric diet may be recommended

Energy expenditure in the body is determined by the energy expenditure at rest (basal energy balance) and depends on the patient's phenotype.

With diabetes, it is recommended to eat 5-6 times a day, which makes it possible to more adequately model the level of insulin and glucose in the blood in accordance with those indicators that occur in a healthy person.

Diet, especially with type 1 diabetes, implies the calculation of the XE (caloric equivalents), which is necessary to determine the dose of insulin administered before each meal. In general, this is important for intensified insulin therapy. Special calculation tables have been developed, with the help of which you can determine the amount of carbohydrates in XE, the amount of one product, and determine possible substitutions.

The need for insulin per 1 XE can vary depending on the patient's condition (the addition of intercurrent diseases, the presence or absence of compensation), as well as age. Early in the morning 1 XE - 2 units of insulin; at lunchtime - 1.5 U of insulin; dinner - 1 UNIT of insulin.

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nursing elderly diabetes mellitus

Introduction

Conclusion

Applications

Introduction

Diabetes mellitus today is one of the leading medical and social problems. Millions of people in all countries of the world suffer from this disease. Despite intensive research, diabetes mellitus remains a chronic disease that requires constant monitoring in order to prevent complications and premature disability.

Diabetes mellitus is one of the global problems of our time. He is in thirteenth place in the ranking of the most common causes of death after cardiovascular, oncological diseases and steadfastly holds first place among the causes of blindness and kidney failure.

According to the WHO, there are currently about 100 million patients with diabetes mellitus in the world. It is well known that diabetes mellitus in both men and women most often develops at the age of 50-60 years or more. The demographic situation is now such that the number of elderly and senile people in the world has increased significantly. This is the so-called aging process of the population. It is due to the contingent of older people that the number of patients with diabetes mellitus increases significantly, and therefore this pathology is now considered as a problem of age. Factors contributing to the development of diabetes mellitus in old age are a decrease in the synthesis and secretion of insulin, a decrease in energy processes and glucose utilization by peripheral tissues, atherosclerotic vascular damage, and a change in the permeability of cell membranes. It should also be borne in mind that in people over 60 years of age, there is quite often a discrepancy between the decrease in energy expenditure of the body and the consumption of food, as a result of which obesity develops. In this regard, in elderly and senile people, tolerance to carbohydrates decreases and under various adverse effects (diseases of the biliary tract and liver, pancreas, trauma, infections, neuropsychic stress and other types of stress), they develop diabetes mellitus. Therefore, the topic of the course work - the study of the characteristics of nursing care for diabetes to the elderly is very relevant.

The purpose of the course work: identifying the features of nursing care for the elderly with diabetes.

On the basis of theoretical sources, to analyze the factors influencing the incidence of diabetes mellitus in old age.

To reveal the tendency to the incidence of diabetes mellitus in elderly and senile people.

Determine the role of a nurse in caring for elderly and senile patients with diabetes mellitus.

1. The theoretical aspect of the incidence of diabetes mellitus

1.1 Features of diabetes mellitus in older people

Diabetes mellitus is a chronic disease that develops as a result of absolute or relative deficiency of the pancreatic hormone insulin. It is necessary to deliver glucose to the cells of the body, which enters the bloodstream from food and provides the tissues with energy. When there is a lack of insulin or insensitivity to it in the tissues of the body, the level of glucose in the blood rises - this condition is called hyperglycemia. It is dangerous for almost all body systems. Type 1 diabetes mellitus is a condition in which the beta cells of the pancreas die for any reason. It is these cells that produce insulin, so that their death leads to an absolute deficiency of this hormone. Such diabetes is more often found in childhood or adolescence. According to modern concepts, the development of the disease is associated with a viral infection, inadequate functioning of the immune system and hereditary causes. But not diabetes itself is inherited, but only a predisposition to it.

Diabetes mellitus of the second type, as a rule, develops after 30-40 years in people who are overweight. In this case, the pancreas produces insulin, but the body's cells cannot respond to it correctly, their insulin sensitivity is reduced. Because of this, glucose cannot penetrate into tissues and accumulates in the blood.

Over time, with type 2 diabetes, insulin production can also decrease, since long-term high blood glucose levels have a detrimental effect on the cells that produce it.

Factors contributing to the development of diabetes mellitus in old age are a decrease in the synthesis and secretion of insulin, a decrease in energy processes and glucose utilization by peripheral tissues, atherosclerotic vascular damage, and a change in the permeability of cell membranes. It should also be borne in mind that in people over 60 years of age, there is quite often a discrepancy between the decrease in energy expenditure of the body and the consumption of food, as a result of which obesity develops. In this regard, in elderly and senile people, tolerance to carbohydrates decreases and under various adverse effects (diseases of the biliary tract and liver, pancreas, trauma, infections, neuropsychic stress and other types of stress), they develop diabetes mellitus. In the pathogenesis of diabetes mellitus, the key role belongs to insulin deficiency - absolute or relative. Absolute insufficiency is characterized by a decrease in the synthesis and secretion of insulin with a decrease in its content in the blood.

In the genesis of relative insulin deficiency, the main importance is the increased binding of insulin by plasma proteins with its transition to an inactive form, the influence of hormonal and non-hormonal insulin antagonists, excessive destruction of insulin in the hepatic parenchyma, and a violation of the reaction of a number of tissues, primarily fatty and muscle, to insulin. In the genesis of senile diabetes, as a rule, it is these extra-pancreatic factors that dominate and the developing insulin deficiency is of a relative nature.

Age differences in the clinical course of diabetes mellitus are very significant, which led to the allocation of 2 types of it - adolescent and adult. Juvenile diabetes is a relatively rare pathology, the adult type occurs 14-16 times more often. In patients with juvenile diabetes mellitus, the disease usually manifests itself early (before the age of 15-20 years), and with an adult - after 40 years. In most patients with juvenile diabetes, the pathology is hereditary, while in adult diabetes, the presence of diabetes mellitus in the family can only be established in 20-40% of patients. Juvenile diabetes is characterized by an acute onset: no more than a few weeks pass between the onset of the first symptoms of the disease and the establishment of the diagnosis. Young patients complain of weight loss, thirst, polydipsia, polyuria, polyphagia (i.e., complaints due to uncomplicated diabetes). Before the onset of the disease, patients have a normal or reduced body weight. The course of the disease is labile, difficult to control, there is a tendency to develop ketosis and coma. The insulin content in plasma is lowered (absolute insulin deficiency), vascular and dystrophic complications develop 5-10 years after the onset of the disease and progress rapidly. These patients are usually insensitive to oral hypoglycemic drugs, and insulin administration is necessary to compensate for their hyperglycemia and glycosuria.

In elderly and senile patients (adult type of diabetes mellitus), the course of the disease is relatively stable, benign - usually mild to moderate severity. Overweight is observed in 60-80% of patients by the onset of the disease. The onset of the disease is gradual, the clinical symptoms are scarce, and in this regard, between the onset of the disease and the diagnosis, it takes from several months to several years. In these patients, the insulin content in the blood can be not only normal, but even elevated (relative insulin deficiency). Compensation of diabetes mellitus in them is achieved quite easily - in patients with concomitant obesity, one diet is enough; patients respond well to treatment with oral hypoglycemic agents.

A special place in the clinic of diabetes mellitus in elderly and senile patients is occupied by its vascular and trophic complications. If in patients with juvenile tyle the development of specific (microangiopathy) and nonspecific (microangiopathy - acceleration of the development of atherosclerosis) complications of diabetes mellitus are caused by the pathology itself and the disorders of carbohydrate, lipid and protein metabolism that occur with it, then in elderly and senile patients diabetes mellitus develops already against the background of existing atherosclerotic vascular lesions in various areas: coronary, cerebral, peripheral. In this regard, the clinical picture of these patients is dominated by complaints associated with complicated diabetes. This is a deterioration in vision, pain in the heart, pain and paresthesia of the legs, itching, swelling of the face, pustular and fungal skin diseases, urinary tract infection, etc. Coronary atherosclerosis in patients with diabetes mellitus compared with people without this pathology occurs twice as often in men and 5 times more often in women. Much more often patients with diabetes develop myocardial infarction, which in turn complicates the course of diabetes. Atherosclerotic lesion of the vessels of the lower extremities is manifested by their chilliness, pain in the legs like intermittent claudication, paresthesias; the pulse in the posterior tibial and dorsal arteries of the foot is weakened or not detected. In elderly patients with diabetes mellitus, gangrene of the lower extremities is observed 80 times more often in women and 50 times more often in men compared with healthy ones. Vascular lesions of the kidneys ("diabetic nephropathy") are diverse. This is atherosclerosis of the renal arteries with the development of renovascular hypertension, arteriolosclerosis, glomerulosclerosis. With decompensation of the disease, the vascular lesion of the kidneys progresses rapidly, leading to the development of renal failure in elderly and senile patients.

Urinary tract infections are very common (in almost 1/3 of patients) - usually it is acute or chronic pyelonephritis. Ophthalmic complications of diabetes mellitus include diabetic retinopathy, as well as “senile” cataract, which develops in diabetic patients much faster than in healthy elderly and senile people. Damage to peripheral nerves - diabetic neuropathy - is observed in elderly patients, more often in women with a mild but prolonged course of diabetes mellitus. Clinically, it is manifested by pain in the extremities (mainly the legs are affected), aggravated at night, paresthesias (burning, tingling), violation of vibration, tactile and pain sensitivity.

A serious complication of diabetes mellitus is a ketoacidotic coma; it occurs much more often in the juvenile type of the disease against the background of a slight change in the treatment regimen, with the slightest adverse effects. The development of ketoacidosis and coma in elderly and senile patients is promoted by infectious diseases, exacerbation of chronic cholecystitis, pancreatitis, pyelonephritis, purulent infections (carbuncles, phlegmon, gangrene), acute cardiovascular disorders (myocardial infarction, stroke), severe mental or physical trauma , the use of a number of drugs (diuretics, in particular hypothiazide, glucocorticoids, thyroidin, etc.).

Diagnosis of diabetes mellitus in elderly and old patients is often difficult. In connection with age-related changes in the kidneys, there is often a discrepancy between hyperglycemia and glycosuria (the absence of sugar in the urine with its increased content in the blood). Since the complaints of the elderly and old patients are scarce and are usually associated with complications of diabetes, it is desirable to study blood sugar in all patients over 60 years of age with arterial hypertension, ischemic heart disease, atherosclerotic lesions of cerebral and peripheral vessels, chronic pyelonephritis, pustular and fungal skin diseases. On the other hand, it should be borne in mind that overdiagnosis of diabetes mellitus occurs in old and senile age. So, in people over 60 years of age, tolerance to carbohydrates decreases, and therefore, when conducting a glucose tolerance test, the blood sugar level normal for their age is interpreted as a sign of latent diabetes mellitus. As a rule, in elderly and senile patients, concomitant pathology is revealed, and therefore they take drugs that also affect carbohydrate metabolism. This leads to false positive or false negative results when examining people over 60 years of age. So, glucocorticoids, hypothiazide, estrogens, nicotinic acid increase blood sugar levels, while antidepressants, antihistamines, beta-blockers and acetylsalicylic acid, on the contrary, reduce it. In elderly and senile patients, the diagnosis of hyperglycemic coma can be difficult: so , with the progression of ketoacidosis, the appearance of nausea, vomiting, and abdominal pain can simulate a picture of an acute abdomen and lead to an erroneous diagnosis. Shortness of breath due to acidosis can be regarded as a manifestation of heart failure or exacerbation of chronic obstructive pulmonary disease. In turn, when making a diagnosis of diabetic coma, one must not lose sight of the fact that it could develop against the background of a cerebrovascular or cardiovascular catastrophe, uremia.

Diet is most important in treating diabetes mellitus in the elderly and the elderly. Since most of these patients have concomitant obesity, weight loss in itself is an effective measure for them, often leading to the normalization of blood sugar levels. As an independent type of treatment, the diet is used for mild diabetes mellitus. It is prescribed based on the "ideal" body weight (it is determined by special tables) and the amount of work performed. It is known that in a calm state, energy expenditure per day is 25 kcal per 1 kg of body weight, with mental work - about 30 kcal, with light physical - 35 - 40, moderate physical - 40-45, heavy physical work - 50 - 60 kcal / kg. Caloric intake is defined as the product of "ideal" body weight and energy consumption per 1 kg of body weight. The daily calorie intake of food is provided by 50% due to carbohydrates, 20% - proteins and 30% - fats. Elderly people should give preference to dairy foods. With concomitant obesity, the daily calorie intake is reduced to 1500-1700 kcal, mainly due to carbohydrates. Patients with diabetes mellitus are not recommended fatty meats, fish, cheeses, cream, cream, animal fats, spicy snacks and seasonings, wheat bread, pasta, sweet varieties of apples, grapes, bananas, melons, pears, raisins, honey, sugar, pastry products. Recommended are lean meat and fish, eggs, vegetables and fruits (except for sweets), milk and dairy products, vegetable fats, black or special diabetic bread, oatmeal and buckwheat porridge, sugar substitutes - xylitol, sorbitol. Given the choleretic effect of the latter, their use is especially indicated in patients with concomitant cholecystitis, cholecystoangiocholitis. Treatment of patients begins with a low-calorie diet, which is gradually expanded with the normalization of blood sugar levels and the weakening of the clinical symptoms of the disease. If the diet is ineffective, drug treatment is additionally prescribed.

Most elderly and senile patients are sensitive to oral antihyperglycemic drugs - sulfanilamide (butamide, cyclamide, chlorpropamide, chlorocyclamide, bucurban, maninil, etc.) and biguanides (adebit, phenformin, silubin, glucophage, etc.). The main hypoglycemic effect of sulfa drugs is due to the stimulation of insulin secretion by beta cells of the islet apparatus of the pancreas. It is indicated for diabetes mellitus in adults (over the age of 40). Biguanides, unlike sulfonamides, act on extra-pancreatic factors - they potentiate the action of insulin by increasing the permeability of muscle tissue cell membranes for glucose and by increasing its utilization. The main indication for the appointment of biguanides is moderate diabetes, especially if it is combined with obesity. Biguanides are also prescribed for sulfa drug resistance. Oral hypoglycemic drugs are contraindicated in severe diabetes mellitus, ketoacidosis, in diseases of the liver and kidneys, blood, in the period of infectious diseases. Oral hypoglycemic drugs are effective in combination with insulin.

Insulin and its drugs in the treatment of elderly and senile patients have limited use, since among this age contingent, a severe course of the disease is rarely observed. Insulin is prescribed to such patients with resistance or low sensitivity to oral hypoglycemic drugs, during periods of aggravation of the course of diabetes mellitus (against the background of infectious diseases, myocardial infarction, stroke, gangrene of the lower extremities, uremia, with the development of ketoacidosis, during anesthesia, during surgical interventions and etc.).

In elderly and senile patients with drug therapy for diabetes mellitus, the sugar level is usually maintained at the upper limit of the norm or slightly above it. This is due to the fact that with an excessive decrease in sugar levels, an adrenaline reaction is realized, which is expressed in an increase in blood pressure, tachycardia, which, against the background of vascular atherosclerosis, can lead to various thromboembolic complications, including myocardial infarction, stroke.

When treating elderly and senile patients, special attention is paid to combating the complications of diabetes mellitus. In this regard, drugs are prescribed that normalize carbohydrate metabolism - vitamins of group B, C, niacin; fat metabolism - miscleron, cetamifen, iodine preparations, lipocaine, lipoic acid, methionine; protein metabolism - retabolil, protein blood substitutes; mineral metabolism - potassium orotate, panangin, etc. They also use drugs that regulate vascular tone, vascular permeability, blood coagulation: heparin, syncumar, pelentan, hexonium, tetamon; papaverine, dibazol, no-shpu, ATP, angiotrophin, depot-padutin, depot-kallikrein; prodectin, dicinone; trypsin, chemotrypsin, lidase, ronidase, cocarboxylase. Oxygen therapy and physiotherapy exercises are shown.

Epidemiological studies have made it possible to identify a contingent of people at high risk of diabetes. These are people with obesity, patients with atherosclerosis and arterial hypertension, elderly and senile people. Since atherosclerosis, arterial hypertension and obesity are especially often observed in people over 60, it is quite obvious that the risk of diabetes is especially high in them. Prevention of diabetes mellitus should include, first of all, broad health education among elderly and senile people: they need to be familiarized with the causes, clinical picture, treatment of diabetes mellitus, focusing on the danger of excessive consumption of foods rich in carbohydrates, fats, on the need to control weight body, to promote physical activity that contributes to doubling carbohydrates, taking into account age and individual capabilities.

Prevention of diabetes mellitus is also a rational therapy for elderly and senile patients, careful monitoring of the use of antihyperglycemic drugs.

Correctly organized treatment of patients with diabetes mellitus is the prevention of the development and progression of diabetic microangiopathy, atherosclerosis and other complications of this pathology.

1.2 Features of nursing care for the elderly with diabetes mellitus

The nursing process is a method of evidence-based, actionable nursing care for patients.

The purpose of this method is to ensure an acceptable quality of life in a disease by providing the patient with the most accessible physical, psychosocial and spiritual comfort, taking into account his culture and spiritual values.

Care for the elderly is carried out in such a way as to carefully monitor the health of an elderly person, especially in cases where he has certain chronic diseases. Diabetes mellitus is one such disease that requires special care for the elderly.

What is the essence of this disease and how to recognize it? As you know, glucose is the main source of energy for most of the cells in our body. Glucose enters the cells with the help of a special hormone - insulin. Diabetes mellitus is a disease in which blood sugar levels remain high and glucose does not enter the cells of the body.

There are usually two main types of diabetes mellitus: insulin-dependent diabetes mellitus ("type I diabetes", "diabetes of young people", "diabetes of thin") and non-insulin-dependent diabetes mellitus ("type II diabetes", "diabetes of the elderly", "obese diabetes").

Type 2 diabetes usually occurs in people over the age of 40.

Here are the main symptoms that may indicate the development of diabetes: increased thirst; an increase in the amount of urine; tendency to infections, pustular diseases; itchy skin; fast weight loss. In men, diabetes mellitus leads to a decrease in potency.

The main treatment for diabetes is to lower blood sugar levels. An increased blood sugar level is the cause of various complications - diseases of the kidneys, eyes, heart, nerves and blood vessels in the legs, etc. It should be remembered that the highest blood sugar level is in the evening, so it is better to determine it yourself using a glucometer or test strips.

How is diabetes care for older people? If we talk about type 1 diabetes, then with this disease it is necessary to constantly inject insulin into the body (its dose is calculated by an endocrinologist). If we talk about type 2 diabetes, then its therapy includes a change in those habits that negatively affect the body affected by the disease. These habits are: overeating, insufficient physical activity, alcohol abuse, smoking, etc. Remember: diabetes is not a death sentence, it is just a different way of life compared to the generally accepted one.

When caring for elderly and senile patients, observance of the norms of medical ethics and deontology is of particular importance. Often, a nurse becomes the only close person for a patient, especially a lonely one. Each patient needs an individual approach, taking into account the personal characteristics of the patient and his attitude to the disease. To establish contact, the nurse must speak in a calm, friendly voice, be sure to greet the sick. If the patient is blind, you should introduce yourself every day, entering the ward in the morning. Patients should be treated with respect, by name and patronymic. It is unacceptable to call the patient familiarly "grandmother", "grandfather", etc.

Injury prevention. Particular attention should be paid to the prevention of possible injuries that can lead to complications of diabetes mellitus, the so-called "diabetic foot".

In diabetes, arteries of all organs and calibers are affected. Microangiopathy is observed in 100% of patients with T2DM, and purulent-necrotic complications occur in 30% of them.

Diabetic foot is the result of a combination of polyneuropathy, micro and macroangiopathies, dermo and arthropathy

* Dryness and hyperkeratosis

* Decreased sensitivity

* Trophic changes in the skin (pigmentation, thinning, vulnerability)

* Weakening or disappearance of arterial pulsation

* Deformity of the joints

* The appearance of trophic ulcers

* Diabetic gangrene

Fig. 1. Diabetic gangrene

Risk factors include:

* the presence of neuropathy and angiopathy;

* deformity of the fingers, limitation of joint mobility and swelling of the foot;

* foot injury;

* history of ulcerative necrotic complications;

* diabetic retinopathy and nephropathy;

* overweight;

* venous insufficiency;

* smoking and alcohol abuse;

* the presence of concomitant pathology, its severity and relationship with the underlying pathology;

* loss of vision due to retinopathy;

* lack of qualified medical care.

When examining a patient, the nurse should pay attention to the following points

... * condition of the skin (thickness, color, presence of ulcers, scars, abrasions, callosities);

* deformation of fingers and feet;

* condition of nails (hyperkeratosis);

* pulsation of the arteries;

* capillary blood flow;

* blood filling of veins;

* hairline;

* muscle tone;

* sensitivity;

* the presence of pain at rest and when walking;

* skin temperature.

In this case, in a comparative plan, both limbs should be examined.

Prevention and treatment of diabetic foot

* Consultation with a podiatrist (diabetic foot specialist)

* Glycemic control

* Feet hygiene

Daily wash

Moisturizers

Avoiding injury

Comfortable soft shoes

* Daily inspection of feet

* Timely damage treatment

It is necessary to conduct a conversation with the patient about the purchase of comfortable shoes, now there are shoes for diabetics of a new generation, as in Figure 1, made of neopreon with a Velcro fastener. Easy to care for, fits perfectly on any foot and has a seamless design. Designed specifically for people with diabetes, taking into account anatomical and functional features. They have optimal fullness, a wider last in the nose, soft edging, increased cushioning, adjustable rise with a special strap. Thanks to the low-flexing sole with a gentle roll, the pressure on the toe is reduced and blood circulation is normalized. Prevent injuries to the lower extremities and provide a tight grip on the surface. Facilitates putting on and taking off and reduces overall stress on the legs.

Fig. 2 Shoes for the prevention of diabetic foot.

A separate, most important component of exercise therapy for diabetic patients is remedial gymnastics for feet for feet. According to this technique, brisk walking is recommended every day for one hour, while the patient should stop until the appearance of pain in the calves, rest for a few minutes and continue walking again. Twice a day for 10-15 minutes it is useful to do squats, deep breaths with maximum retraction of the anterior abdominal wall, walk on toes with a gradual increase in the number of exercises.

In the compensated and subcompensated state of the peripheral circulation, moderate loads are useful (volleyball, cycling, skiing, towns, rowing, swimming).

Massage of the lumbar region or back is effective. Massage of a diseased limb is indicated in the period of remission of the disease in the absence of trophic disorders.

Physiotherapy. Indications for the appointment of physiotherapeutic procedures in diabetic macroangiopathy are the initial stages of the disease in the phase of the inflammatory process subsiding and in the remission phase of the pathological process.

The most effective are impulse currents, magnetotherapy, laser therapy, diadynamic currents, which are assigned to the lumbar region and along the neurovascular bundle on the thigh and lower leg.

Spa treatment is carried out along with physiotherapy. At the initial stages of the disease, when there are no trophic disturbances and exacerbations, it has a double therapeutic effect - due to a change in the usual regime, climate, living conditions and as a result of the use of balneological procedures. The most effective are radon, hydrogen sulphide, narzan, iodine-bromine baths.

Conclusion: of all the complications of diabetes mellitus, one of the most formidable complications is the diabetic foot. Diabetic foot syndrome is the leading cause of limb amputation in diabetes mellitus. Therefore, an important role in its prevention is influenced by the identification of risk factors that can lead to it and their timely elimination. A huge role in this belongs to the nurse, since it is she who carries out the care and supervision.

2. Analysis of the role of a nurse in caring for elderly patients with diabetes mellitus

2.1 Determination of the main problems of elderly and senile patients with diabetes mellitus on the example of a specific situation

Let's consider the patient's problems using an example of a specific situation. A woman was admitted to the intensive care unit - age: 62 years.

Patient complaints.

Complaints of weakness, rapid fatigue, dizziness, occasionally disturbed by thirst, itching, dry skin, numbness of the extremities.

Considers himself a patient since May 2005. Diabetes mellitus was first diagnosed in the post-infarction period, when she was receiving treatment for myocardial infarction, an elevated blood sugar level was found. Since May 2005, the patient has been registered with the dispensary, and treatment has been prescribed (diabetes 30 mg). She tolerates hypoglycemic drugs well.

In addition to diabetes mellitus, the patient suffers from diseases of the cardiovascular system: hypertension for 5 years, in May 2005 suffered a myocardial infarction.

She was born the second child. She grew and developed according to her age. In childhood, she suffered all childhood infections. She worked as an accountant, the work is associated with mental stress. There were no surgical interventions. Prone to colds. There are no diabetes patients among the relatives. The family has a calm atmosphere. No bad habits. Menstruation from the age of 14, proceeded regularly. Material living conditions are satisfactory. Lives in a comfortable apartment.

General inspection (inspectio)

The general condition of the patient: satisfactory.

Consciousness: clear.

Active position.

Physique: normal.

Height 168 cm, weight 85kg.

Facial expression: meaningful

Skin: normal color, moderate skin moisture. Turgor is reduced.

Hair type: female pattern.

The visible mucous membranes are pink, the moisture is moderate, the tongue is white.

Subcutaneous fatty tissue: strongly developed.

Muscles: the degree of development is satisfactory, the tone is preserved.

Bones: painless.

Joints: painful on palpation.

Peripheral lymph nodes: not enlarged.

Respiratory system.

Chest shape: normosthenic.

Chest: symmetrical.

The width of the intercostal spaces is moderate.

The epigastric angle is straight.

The scapula and clavicle are weakly protruding.

The type of breathing is chest.

Breaths per minute: 18

Palpation of the chest: the chest is elastic, the voice tremor is the same in symmetrical areas, painless.

Examination: Heart sounds are muffled, rhythmic, heart rate-72 beats / min. Pulse of satisfactory filling and tension. BP-140/100 mm. rt-st. Disturbed trophism of tissues of the lower extremities as a result of diabetic macroangiopathy.

Palpation:

The apical impulse is located in the 5th intercostal space 1.5-2 cm lateral to the left midclavicular line (normal force, limited).

The lips are pale pink, slightly moist, no cracks or ulcerations. The mucous membranes are pale pink, moist, no pathological changes were found. The tongue is pink, moist, with a whitish coating, the papillae are well developed. Gums pink, no bleeding or ulceration.

The abdomen is normal, symmetrical, not swollen, protrusions, depressions, no visible pulsation. The abdominal wall is involved in the act of breathing, there are no scars, there is no visible peristalsis.

With superficial palpation, there is no tension in the abdominal wall, no pain, no seals.

Stool: 1 time in 2-3 days. Constipation is common.

Spleen: no visible enlargement.

Preliminary diagnosis

On the basis of complaints, clinical and laboratory data, the diagnosis was made: type 2 diabetes mellitus, moderate, subcompensated, polyneuropathy.

Survey plan:

1.General analysis of urine and blood

2. BH blood test

3. Test for fasting blood glucose - every other day. Glycemic profile

4. Fluoroscopy of the chest.

6. Consultations of narrow specialists: ophthalmologist, neuropathologist, dermatologist.

Laboratory research data.

General blood test 15.08.05

Erythrocytes 4.6 * 1012 / l

Hemoglobin 136 g / l

Color Index 0.9

Leukocytes 9.3 * 109 / l

Lymphocytes 36%

Monocytes 8%

ESR 40 mm / hour

General urine analysis 08/15/05

Color pale

Specific weight 1022

Neutr reaction.

Protein neg.

Sugar 0.5%

Acetone neg

Transparency transparent

BH lab-ya15.08.05

Daily fluctuation in sugar

1.fasting 7.3 mg /%

2.after 2 hours 10.0 mmol / l

3.After 4 hours 7.0 mmol / L

Fluctuations in glucose

Unit time

7 hours - 6.0 mmol / l

12 hours - 7.0 mmol / l

17 hours - 6.5 mmol / l

22 hours - 7.0 mmol / l

CSW for syphilis "-" 08/19/05

HIV infection not detected 08/19/05

Examination of specialists

1. Ophthalmologist from 17.08.05

Complaints: flashing before the eyes of flies, a feeling of fog, blurred objects, decreased visual acuity.

Conclusion: diabetic angioretinopathy.

2. Neurologist from 19.08.05

Complaints: pulling, dull pain, tingling sensation, crawling creeps, numbness, chilliness, occasionally cramps in the calf muscles, tired legs during physical exertion, impaired sensitivity.

Conclusion: distal polyneuropathy

Final diagnosis:

Diabetes mellitus type 2, non-insulin dependent, subcompensated, moderate severity. Complications: angioretinopathy, distal polyneuropathy.

Medical purposes:

The number of bread units for the patient per day is 20 XE

Breakfast 1 (5 XE): - kefir 250 mg

Bread 250 mg

Boiled porridge 15-20 g

Carrots 3 pcs

Breakfast 2 (2 XE): -dried fruit compote

Damn big

Lunch (5 XE): - a glass of milk

Dumplings

Green peas

Afternoon snack (2 XE): - apple juice

Dinner 1 (5 XE): - fried potatoes

Boiled sausage

Dinner 2 (1 XE): - banana

2. Oral hypoglycemic drug:

Diabeton MV 30 mg

3.The drug used in diabetic angioretinopathy

Diabeton 0.5 g (2 times a day)

4. The drug used for polyneuropathy

Berlitlon 300 mg (1-2 times a day)

5. Vitamins of group B and C.

Rice. 3 Structure of primary disability due to diabetes mellitus, taking into account age in the Russian Federation in dynamics over 10 years (in%)

As can be seen from Figure 3, the risk of disability due to diabetes is most likely in older age groups.

Complications of diabetes mellitus

The lack of appropriate treatment for diabetes mellitus leads to the development of serious complications in patients. Often, as we have already noted, it is complications for many of them that become an indicator that there is a problem such as diabetes. In the overwhelming degree, the nervous system and blood vessels are affected in diabetes mellitus. Due to the negative impact, atherosclerosis develops, the brain, eyes, heart, kidneys, and legs are affected. Target organs in Figure 4.

Major Areas of Lesions in Complications of Diabetes Mellitus

Fig. 4 Target organs

A feature of complications of diabetes mellitus is that they can develop practically without symptoms - the patient for years may not be aware of the "wrong", while the pathological process only progresses. In order to avoid such consequences, one should systematically undergo a prophylactic examination, focused on identifying complications of the disease. The greatest risk of disabling occurs precisely because of the complication "diabetic foot".

Diabetic foot is considered as a rather serious complication associated with diabetes mellitus. This pathology causes malnutrition of the lower extremities in patients with diabetes with the formation of ulcerative lesions and deformation of the foot area. The main reason for this is that diabetes affects the nerves and blood vessels of the legs. Obesity, smoking, long-term diabetes, arterial hypertension (high blood pressure) are predisposing factors for this. Trophic ulcers in diabetic foot can be superficial (with skin lesions), deep (skin lesions with tendons, bones, joints). In addition, their occurrence can be defined as osteomyelitis, which means damage to the bones in combination with the bone marrow, as localized gangrene, accompanied by numbness in the patient's fingers, or gangrene, in which the foot is completely affected, as a result of which its amputation is required.

Neuropathy, namely, it acts as one of the main causes of the formation of trophic ulcerative lesions, is diagnosed in about 25% of patients. It manifests itself in the form of pain in the legs, a feeling of numbness in them, tingling and burning. In the indicated number of patients, it is relevant for the number of patients whose diabetes course occurs within a period of about 10 years, in 50% of cases, neuropathy is relevant during the course of the disease over a period of 20 years. With proper treatment, trophic ulcers have a favorable prognosis for cure; treatment is carried out at home, averaging 6-14 weeks. In case of complicated ulcers, hospitalization is indicated (from 1 to 2 months), even more severe cases necessitate hospitalization of the part of the leg that has been affected.

Rice. 5 Diabetic foot: main symptoms

2.2 Drawing up an algorithm for the care of elderly and senile patients with diabetes mellitus

Nursing process for diabetes mellitus:

Patient problems:

A. Existing (present):

Polyuria:

Itchy skin. dry skin:

Weight loss;

Weakness, fatigue; decreased visual acuity;

Heartache;

Pain in the lower extremities;

The need to constantly follow a diet;

The need for constant administration of insulin or taking antidiabetic drugs (maninil, diabeton, amaril, etc.);

Lack of knowledge about:

The essence of the disease and its causes;

Diet therapy;

Foot care;

Calculation of bread units and preparation of the menu;

Using a glucometer;

Complications of diabetes mellitus (coma and diabetic angiopathy) and self-help for coma.

B. Potential:

Development risk:

Gangrene of the lower extremities;

Acute myocardial infarction;

Chronic renal failure;

Cataracts and diabetic retinopathy with visual impairment;

Nursing interventions for diabetes mellitus and prevention of complications.

Purpose: The patient will be aware of possible complications and will observe independently the prevention of complications, thereby increasing his standard of living.

Conduct conversations with the patient and relatives about the features of the disease.

Teach the patient in therapeutic exercises for the feet, conduct a training lesson with him (an example is given in Appendix No. 3)

3. Conduct a conversation with the patient's relatives about the need for psychological support throughout his life.

4. Introduce the patient's family to another family, where the patient is also sick with diabetes, but is already adapted to the disease.

5. To select popular literature on the lifestyle of a patient with diabetes mellitus and to introduce it to relatives.

6. Explain to relatives the need to attend the Diabetes School (if there is one).

7. Ensure that the doctor's prescriptions are followed.

Based on the patient's previously identified problems, an algorithm for nursing care for diabetes mellitus was compiled

Table 1 - Algorithm of nursing care for diabetes mellitus, the solution to the problem is the risk of complications.

Problem	Nurse actions
Risk of foot microtrauma.	It is necessary to wash your feet daily, wipe gently without rubbing. We must not forget about the interdigital spaces - they must also be thoroughly rinsed and dried. Examine your feet every day to look for cuts, scrapes, blisters, cracks, or other lesions that could allow infection to penetrate. The soles can be viewed with a mirror. In case of poor eyesight, it is better to ask a family member to do this. Inspect shoes daily to prevent blisters and other damage that can be caused by foreign objects in the shoe, wrinkled insole, torn lining, etc. Change socks or stockings every day, wear only the right size, avoid tight elastic bands and darned socks. Shoes should be as comfortable as possible, fit well on your feet, you cannot buy shoes that need to be worn out. In case of significant deformity of the feet, specially made orthopedic shoes will be required. Outdoor shoes should not be worn on bare feet, sandals or sandals with a strap between the toes are contraindicated. Do not walk barefoot, especially on hot surfaces. In case of injuries, iodine, alcohol, "potassium permanganate", "brilliant green" are contraindicated - they have tanning properties. It is better to treat abrasions, cuts with special means - miramistin, chlorhexidine, dioxidine, in extreme cases, with a 3% hydrogen peroxide solution and apply a sterile bandage.
	Do not injure the skin of the legs. Do not use drugs and chemicals that soften calluses, remove calluses with a razor, scalpel and other cutting tools. Better to use a pumice stone or foot files. Only trim your nails straight without rounding the corners. Do not cut off thickened nails, but file them. If your vision is poor, it is best to seek help from family members. With dry skin, the legs must be lubricated daily with a fat cream (containing sea buckthorn, peach oil), but the interdigital spaces cannot be lubricated. You can also use creams containing urea (Balsamed, Callusan, etc.) Quitting smoking, smoking can increase the risk of amputation by 2.5 times.
Weakness due to reduced nutrition	Provide the patient with adequate nutrition. Monitor body weight (weigh the patient every other day). Assist the patient in moving (if necessary)
Poor cold tolerance	Do not expose your feet to very low or very high temperatures. If your feet are cold, it is better to put on socks, do not use heating pads. The water in the bathroom must first be checked with your hand and make sure it is not too hot.
Risk of falls and injury due to muscle weakness	Provide assistance to the patient while moving. Provide the possibility of emergency communication with the medical staff. Lower the bed to a low level. Provide lighting in the ward at night. Provide a walker, a stick as additional support when moving. Provide the patient with a vessel and urine collection bag. Clear passageways and corridors. Make sure that handrails are made in the necessary places.

	Motivation
Provide food according to diet number 9.	To normalize carbohydrate metabolism.
Provide the patient with a curative and protective regime.	To relieve psycho-emotional stress, anxiety, timely self-diagnosis of precoms.
Conduct a conversation with the patient about the nature of his illness.	For the active participation of the patient in the treatment.
Ensure control over blood and urine sugar levels.	To adjust the dose of insulin.
Provide hygienic skin care.	To prevent the attachment of infections.
Train the patient on the rules for performing insulin injections.	For the treatment of the disease and the prevention of complications at the outpatient stage.
Monitor the condition and appearance of the patient (pulse, blood pressure, NPV, state of consciousness).	For the timely detection of complications and the provision of emergency care in a precomatose state.

Conduct a conversation with the patient about what kind of shoes to wear for patients with diabetic feet.

1. Seamless or minimal number of seams.

2. The width of the shoe should not be less than the width of the foot.

3. The volume should be adjusted with laces or Velcro.

4. Unbendable rigid outsole with roll-over.

5. The material of the top and lining must be elastic.

6. The footwear must have additional volume to accommodate the insertion of the orthopedic insole.

7. The front edge of the heel should be chamfered.

8. Thick and soft insole at least 1 cm thick.

When buying and wearing shoes, you must adhere to the following rules:

1. It is advisable to buy shoes in the afternoon - by this time they swell and you can more accurately determine the size

2. Shoes are better to buy, soft, wide, comfortable and well-fitting, made of natural materials. It should not cause discomfort during the first fitting, the foot should not be pinched.

3. If the sensitivity is reduced, it is better to use a footprint for fitting (for this, put your foot on a sheet of thick paper or cardboard, circle and cut out the print). This insole must be inserted into the shoe - if it bends at the edges, the shoe will crush and cause chafing or blisters.

4. Correctly lace up shoes - parallel, not crosswise.

5. Never wear shoes without socks.

Evaluation of effectiveness: the patient notes a significant improvement in the general condition; demonstrate knowledge of their illness, possible complications and diet. The goal has been achieved.

Conclusion: using the theoretical knowledge of the first chapter, risk factors for the occurrence of complications in diabetes mellitus in older age groups were identified. Using the example of this patient, they demonstrated the importance of preventing such a formidable complication as “diabetic foot”, since it can lead to disability and death. This course shows how to prevent this complication and how important the role of the nurse in it.

Conclusion

A diabetic nurse is a nurse with extensive knowledge and experience in the supervision, education, communication and consultation of patients with diabetes mellitus, treatment of this pathology and scientific research skills. This definition was obtained on the basis of clinical experience, experience of teaching patients with diabetes mellitus.

The goal of complication prevention education for diabetics is to help them translate theoretical knowledge into practical skills that make up an individually tailored plan. With diabetes mellitus, microcirculation worsens and this leads to various complications.

The prevention of "diabetic foot" is based on the treatment of diabetes mellitus as an underlying disease. Best of all, if the sugar level approaches the norm - no higher than 6.5 mmol / l, for this it is necessary to strictly follow the diet and recommendations of the attending physician on taking medications, frequent self-monitoring of blood glucose levels. It is also necessary to visit a doctor in a timely manner to monitor the effectiveness of the treatment and, if necessary, review and replace drugs.

Maintaining vascular health, which is achieved by controlling the level of blood pressure - not higher than 130/80 mm, also plays a large role in the prevention of complications of diabetes mellitus. rt. Art., the level of cholesterol in the blood is not higher than 4.5 mmol / l, complete cessation of smoking.

Foot care for diabetes mellitus differs from the usual hygiene measures in people without diabetes. These rules take into account the fact that with diabetes mellitus, the sensitivity of the feet is reduced, and any, even the smallest damage, can lead to serious consequences. Gymnastics for the feet, massage and self-massage will help reduce pain, restore sensitivity.

As a result of the study, it was revealed that the incidence of diabetes is more common:

In women aged 50 and over;

For persons with secondary general, special and higher education;

In persons undergoing increased neuro-emotional stress;

In persons who consume an increased amount of table salt, sugar, have excess nutrition;

In persons who prefer predominantly animal food, the use of which leads to excess body weight.

The scope of duties of a nurse, which includes both the implementation of the interventions prescribed by the doctor and her independent actions, is clearly defined by law. All performed manipulations are reflected in the nursing documentation.

In this course, the role of a nurse in improving the quality of life of patients with diabetes mellitus and the prevention of possible complications was revealed.

Having studied the effect of this disease on individual organs and systems of the body, it can be concluded that diabetes mellitus is the cause of disability and high mortality from vascular complications, which include myocardial infarction, cerebral stroke, gangrene of the lower extremities, vision loss and kidney damage - nephropathy.

Early diagnosis and the adequacy of the treatment of this disease are the most important tasks, since both hyper- and hypoglycemia are the starting point for many pathological mechanisms that contribute to the development of severe vascular complications.

List of used literature

1. Balabolkin M.I. Endocrinology M.: Medicine, 2008

2. Balabolkin M.I. Diabetes. M.: Medicine, 2004.

3. Balabolkin M.I., Gavrilyuk L.I. Diagnostic reference book of an endocrinologist. Kishenev, Medicine, 2004.

4. Balabolkin M.I. The state and prospects of combating diabetes mellitus. Endocrinology Problems. M.: Medicine 2007.

5. Balabolkin M.I. Diabetology. M .: Medicine, 2010.

6. Brin V. B. Human physiology in diagrams and tables. - Rostov, N / A: Medicine, 2009.

7. State report on the state of health of the population of the Chelyabinsk region in 2012. - Chelyabinsk, 2013, 200 p.

8. Dedov I.I. Suntsov Yu.I. Epidemiology of non-insulin dependent diabetes mellitus. Endocrinological problems. M .: Eksmo, 2008.

9. Dedov I.I., Suntsov Yu.I. Epidemiology of insulin-dependent diabetes mellitus: Textbook.-M .: Eksmo, 2008.

10. Drzhevetskaya I.A. Fundamentals of the physiology of metabolism and the endocrine system. - M .: GEOTAR-MED, 2004.

11. Edemskaya E.A. Clinical and socio-hygienic characteristics of modern type 1 and 2 diabetes mellitus: Abstracts. Dokl. 4. Scientific-practical conference of doctors (Novosibirsk) April 20 - 21, 2004. 142 - 148.

12. Lisitsin A.S. Basics of hygiene and health care. -M .: Medicine, 2012.

13. Okorokov A.N. Diagnostics of diseases of internal organs. -M. : Olma-Press, 2012.

...

Features of diabetes in old age and its causes

According to experienced experts, diabetes in older people occurs against the background of:

a decrease in the production and action of hormones due to age-related changes;
decreased insulin synthesis;
decrease in the sensitivity of tissues and structures to insulin.

Due to the poor susceptibility of body cells to insulin, in the absence of proper treatment, insulin resistance develops, which is fraught with the appearance of type 2 diabetes mellitus in elderly patients. People with obesity are especially susceptible to the development of pathology.

Diabetes and pressure surges will be a thing of the past

Diabetes is the cause of nearly 80% of all strokes and amputations. 7 out of 10 people die due to blockages in the arteries of the heart or brain. In almost all cases, there is only one reason for such a terrible end - high blood sugar.

It is possible and necessary to knock down sugar, otherwise there is no way. But this does not cure the disease itself, but only helps to fight the effect, not the cause of the disease.

The only medicine that is officially recommended for the treatment of diabetes and is also used by endocrinologists in their work is this.

The effectiveness of the drug, calculated according to the standard method (the number of recovered to the total number of patients in a group of 100 people undergoing treatment) was:

Sugar normalization - 95%
Elimination of venous thrombosis - 70%
Eliminating palpitations - 90%
Getting rid of high blood pressure - 92%
Increasing vigor during the day, improving sleep at night - 97%

Manufacturers are not a commercial organization and are funded with government support. Therefore, now every resident has an opportunity.

Due to severe socio-economic factors, pensioners have to eat irrationally, giving preference to high-calorie foods, harmful industrial carbohydrates and fats. Such food is low in protein and dietary fiber, which are digested for a long time.

You cannot ignore the concomitant chronic diseases that a person has acquired throughout life. Taking certain medications to combat ailments, the patient might not even suspect that they have a negative effect on carbohydrate metabolism. The most dangerous drugs leading to type 2 diabetes mellitus in old age are:

steroids;
thiazide diuretics;
psychotropics;
beta blockers.

Due to limited physical activity, which can be caused by some diseases, pathological processes occur in the respiratory, musculoskeletal, cardiovascular systems. As a result, muscle mass decreases, which is a prerequisite for the onset of insulin resistance.

An important role in the appearance of the disease is played by:

hereditary predisposition;
obesity;
stressful situations;
hypodynamia;
poor nutrition.

Diabetics in old age need the care of loved ones.

Of the huge number of retirees, only a few lead a healthy lifestyle and eat right from a young age. Therefore, in old age, everyone is at risk of developing type 2 diabetes mellitus.

Important! The main feature of the disease in the elderly is that on an empty stomach in more than half of the victims, hyperglycemia is completely absent, which complicates the diagnosis of the disease.

But after a meal, the blood sugar level rises sharply. This means that in order to identify pathology, the indicators should be monitored not only on an empty stomach, but also after eating.

Symptoms and signs

Early signs of diabetes in older patients are difficult to detect. In most people, the disease is detected by chance, when they offer to pass it in combination with other general tests in the treatment of any chronic ailment. Diabetes in the elderly is often asymptomatic.

Patients complain about:

chronic fatigue;
lethargy;
feeling thirsty (the main symptom);
a tendency to pulmonary diseases;
poorly healing wounds on the skin;
inflammatory diseases;
obesity.

The patient's condition deteriorates markedly against the background of such provoking factors as:

excitement, anxiety, stressful situations;
infectious pathologies;
hypertensive crisis;
heart attack or stroke;
ischemia.

What is the danger of diabetes for an elderly person?

At any age, type 2 diabetes mellitus is very dangerous, but for the elderly affected it is the most dangerous. With this ailment, vascular disorders are pronounced.

Patients suffer from:

Macroangiopathy, the cause of which lies in atherosclerosis. At the same time, there is a progressive development of ischemia, a tendency to heart attack, vascular lesions of the main organ of the nervous system.
... In elderly diabetics, this ailment develops earlier than in young patients. Vision decreases, the kidneys are noticeably affected, the microvessels of the lower extremities are affected.
... Due to a significant decrease in sensitivity, microcracks form on the foot, the skin dries up, flakes, loses its elasticity and firmness, and edema occurs. The shape of the foot changes. In the future, non-healing wounds appear on it and. In advanced cases, surgery is required, in which the limb has to be amputated.
(suffering of many nerves), in which the nervous system is affected. There is soreness in the limbs, a feeling of creeping creeps, numbness of the skin, decreased reflexes and sensitivity.

Elderly people often suffer from loneliness, social disorder, helplessness, and financial difficulties. These circumstances become the main cause of psychoemotional disorders, depression, anorexia. Diabetes mellitus in elderly patients is often complicated by memory difficulties, impaired concentration, and other problems with brain activity. The risk of developing Alzheimer's increases. Often for such patients, an important task is not the treatment and disposal of diabetes mellitus, but attention, care, general medical care provided by others.

How to treat diabetes in the elderly

To begin treatment, it is necessary to diagnose the disease and conduct a lot of additional studies on the concentration of glucose in the blood and urine. In addition, acetone in urine is determined, kidney function is diagnosed. The patient is referred for examination to an ophthalmologist, neuropathologist, blood flow in the lower extremities and the brain is assessed.

Diabetes in the elderly requires complex treatment. It is imperative to take sugar-reducing drugs, adhere to a special diet, therapy with folk remedies is not excluded. Treatment of the disease is based on certain guidelines that help to approach each patient individually and provide maximum assistance:

tendency to a complicated course of the disease;
cardiovascular disorders;
diabetic complications;
the ability to independently follow the doctor's prescriptions.

Drug treatment

A number of medications have been developed for the treatment of this pathology. Most often, elderly diabetics are prescribed:

considered the number one drug in the treatment of type 2 diabetes in the elderly. The medication is prescribed with normal kidney function and the absence of diseases that provoke oxygen starvation of the renal tissues and structures. The drug lowers blood sugar and has a beneficial effect on the well-being of a diabetic.
Thiazolidinediones, which increase the sensitivity of tissues to the action of insulin. Preparations of this series are not recommended for renal and heart diseases.
Mimetics, subcutaneous injections. These drugs can promote weight loss.
Acarbose, a medication that reduces the processing of complex carbohydrates. As a result, less sugar is released into the bloodstream.

In addition, doctors prescribe elderly patients, which significantly improves their well-being.

Nutrition and diet

Eating a healthy diet is an essential part of managing type 2 diabetes. Proteins, fats and carbohydrates that enter the body must be clearly balanced. With a normal weight of the patient, a low-calorie table is indicated. At the stage of decompensation, a hypercaloric diet is recommended - study.

Experts advise eating small meals 5-6 times a day, which will allow the blood glucose level to equalize normal values. In type 1 diabetes, the calculation of bread units is carried out, which is needed to determine the dose of insulin administered before each meal (in one dose should not be more than 6-7 XE).

prevent obesity;
eat seafood, as they contain valuable mineral elements that contribute to the normal production of insulin;
consume no more than 10 g of table salt per day;
refuse fermented milk drinks with a high percentage of fat, smoked meats, spices, pickles, preferring less fatty and more healthy foods.

Physiotherapy

Exercising for elderly patients helps to effectively carry out therapy. Each is determined by his own intensity of stress, taking into account chronic and concomitant ailments. You don't have to do push-ups or complex exercises like a young gymnast.

Elderly diabetics just need to start with a half-hour walk. In the future, they begin the physical exercises themselves, which:

increase the sensitivity of tissues to insulin;
prevent atherosclerosis;
normalize blood pressure.

Each patient chooses the appropriate type of exercise so that the exercises are not only useful, but also enjoyable.

Doctor of Medical Sciences, Head of the Institute of Diabetology - Tatyana Yakovleva

I have been studying diabetes for many years. It is scary when so many people die, and even more become disabled due to diabetes mellitus.

I hasten to tell you the good news - the Endocrinological Research Center of the Russian Academy of Medical Sciences managed to develop a drug that completely cures diabetes mellitus. At the moment, the effectiveness of this drug is close to 98%.

More good news: The Ministry of Health has secured an approval that compensates for the high cost of the drug. Diabetics in Russia until March 19 (inclusive) can get it - For only 147 rubles!

Physical education for elderly diabetics will have to be postponed when:

ketoacidosis;
angina pectoris;
vascular damage that disrupts the blood supply to the retina;
renal failure in chronic form.

Folk remedies for type 2 diabetes for the elderly

Elderly people often trust alternative medicine, and are happy to use folk remedies in the fight against various ailments, including type 1 and type 2 diabetes. There is a fairly effective herbal collection that has been used since ancient times. Before such treatment, it is necessary to consult a diabetologist, since the herbal ingredients in the composition can harm a person if at least one of them is contraindicated for him.

Below are 2 popular recipes from alternative treatments for diabetes.

First recipe

Celery and dandelion root, aspen bark, dioecious nettle, beans (valves), mulberry foliage are thoroughly chopped and mixed. 15 g of phyto-collection is dissolved in cool boiled water, infused for an hour and boiled over a slow flame for 6-7 minutes. The resulting healing potion is poured into a thermos, waited for 8-12 hours, filtered. Add to the resulting liquid 50 drops of tincture of peony roots, Eleutherococcus and nettle juice 15 drops.

Take the infusion three times a day, a large spoonful for 1.5 months. Then they are interrupted and, if necessary, repeat the treatment course.

Second recipe

Jerusalem artichoke tincture is prepared as follows:

60 g of ground peeled root crops are stirred in 1 liter of cold boiled water;
the liquid is placed on a small flame, brought to a boil and boiled for 1 hour;
insist for 3 hours.

They drink a quarter of a glass three times a day.

Explore 2 more folk recipes:

The main thing to remember is that in elderly patients, as in young people, diabetes mellitus develops due to an improper lifestyle. In order not to face an illness in old age, you need to give up bad habits, play sports, maintain an internal mood in high tones, eat balanced and complete, avoid excess weight, systematically control blood pressure and sugar.

Be sure to explore! Think life-long pills and insulin are the only way to keep your sugar in check? Not true! You can verify this yourself by starting to use ...