NLE Endocrine & Metabolic Nursing — Diabetes Mellitus & Its ComplicationsConcept Map

Concept

Pathophysiology & Classification

Sub Concepts

• Type 1 DM (Autoimmune Beta Cell Destruction)
• Type 2 DM (Insulin Resistance + Relative Deficiency)
• Gestational DM (Pregnancy-Related)
• Glucose Metabolism Dysfunction
• Hyperglycemia as Central Problem

Relationship To Central

Defines the underlying mechanism and types of diabetes

Concept

Diagnostic & Monitoring Values

Sub Concepts

• Fasting Plasma Glucose (≥126 mg/dL = DM)
• Random Plasma Glucose (≥200 mg/dL with symptoms)
• HbA1c (≥6.5% diagnostic; <7% treatment target)
• Oral Glucose Tolerance Test (2-hr ≥200 mg/dL)
• Classic Manifestations (3 Ps: Polyuria, Polydipsia, Polyphagia)

Relationship To Central

Critical for identifying and assessing diabetes severity

Concept

Insulin Pharmacology & Management

Sub Concepts

• Rapid-Acting Insulins (Lispro, Aspart, Glulisine)
• Short-Acting Insulin (Regular)
• Intermediate-Acting Insulin (NPH)
• Long-Acting/Basal Insulins (Glargine, Detemir)
• Insulin Administration & Injection Techniques
• Mixing Insulins (Clear before Cloudy Rule)
• Storage & Site Rotation to Prevent Lipohypertrophy

Relationship To Central

Primary therapeutic agent, especially for Type 1; onset-peak-duration determines hypoglycemia risk

Concept

Oral & Non-Insulin Agents

Sub Concepts

• Biguanides (Metformin)
• Sulfonylureas (Glipizide, Glyburide, Glimepiride)
• Meglitinides (Repaglinide, Nateglinide)
• Thiazolidinediones (Pioglitazone)
• DPP-4 Inhibitors (Sitagliptin)
• SGLT2 Inhibitors (Empagliflozin, Dapagliflozin)
• GLP-1 Receptor Agonists (Liraglutide, Semaglutide, Exenatide)

Relationship To Central

Alternative/adjunctive pharmacotherapy for Type 2 DM management

Concept

Acute Complications

Sub Concepts

• Hypoglycemia (Blood Glucose <70 mg/dL)
• Diabetic Ketoacidosis (DKA)
• Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS/HHS)
• Pathophysiology of Each Emergency
• Clinical Manifestations & Diagnosis
• Emergency Management & Nursing Interventions
• Potassium Monitoring & Replacement Protocols

Relationship To Central

Life-threatening emergencies requiring immediate intervention

Concept

Chronic (Long-Term) Complications

Sub Concepts

• Microvascular Complications (Retinopathy, Nephropathy, Neuropathy)
• Macrovascular Complications (Coronary Artery Disease, Stroke, PVD)
• Foot Complications & Amputation Risk
• Diabetic Retinopathy & Blindness Prevention
• Diabetic Nephropathy & Renal Protection
• Diabetic Neuropathy (Peripheral & Autonomic)
• Cardiovascular Disease as Leading Cause of Death

Relationship To Central

Preventable outcomes of prolonged hyperglycemia; require ongoing patient education

Concept

Patient Education & Self-Management

Sub Concepts

• Glucose Monitoring & Self-Monitoring Blood Glucose (SMBG)
• Carbohydrate-Consistent Diet & Meal Planning
• Regular Physical Activity & Exercise
• Medication Adherence & Administration
• Foot Care Daily Inspection & Prevention
• Sick-Day Management & When to Seek Care
• Recognition of Hypoglycemia & Hyperglycemia Symptoms
• Somogyi Phenomenon vs. Dawn Phenomenon

Relationship To Central

Empowers patients to achieve glycemic control and prevent complications

Concept

Nursing Assessment & Interventions

Sub Concepts

• NANDA Nursing Diagnoses in Diabetes
• Physical Assessment for Complications
• Monitoring Glucose, Vitals, Neuro Status, I&O
• Health Teaching & Patient Advocacy
• Compliance with Antidiabetic Medications
• Prevention of Infection & Wound Care
• Psychosocial Support & Disease Acceptance

Relationship To Central

Application of nursing process to diabetes care across all contexts

To

Absolute Insulin Deficiency

From

Type 1 DM

Strength

strong

Relationship

Type 1 DM causes autoimmune destruction of pancreatic beta cells, resulting in absolute inability to produce insulin

To

DKA

From

Type 1 DM

Strength

strong

Relationship

Type 1 DM patients are most susceptible to DKA due to complete lack of insulin production

To

Insulin Resistance

From

Type 2 DM

Strength

strong

Relationship

Type 2 DM is fundamentally characterized by cellular resistance to insulin action combined with progressive beta cell dysfunction

To

HHNS

From

Type 2 DM

Strength

strong

Relationship

Type 2 DM patients are more prone to HHNS because enough residual insulin prevents ketosis but cannot prevent severe hyperglycemia

To

Chronic Complications

From

Hyperglycemia

Strength

strong

Relationship

Prolonged hyperglycemia directly causes endothelial damage leading to micro- and macrovascular complications

To

Hypoglycemia Risk

From

Insulin Administration

Strength

strong

Relationship

Insulin peak times determine when patients are at highest risk for hypoglycemia; nursing monitoring must align with peak periods

To

IV Administration

From

Regular Insulin

Strength

strong

Relationship

Regular insulin is the only insulin formulation that can be safely administered intravenously; essential for DKA/HHNS management

To

Cloudy Appearance

From

NPH Insulin

Strength

strong

Relationship

NPH insulin's cloudy appearance indicates suspension of protamine zinc; vial must be gently rolled to redistribute particles before use

To

Never Mix

From

Glargine Insulin

Strength

strong

Relationship

Long-acting glargine must never be mixed with other insulins in the same syringe; always given separately to maintain peakless profile

To

Contrast Dye Studies

From

Metformin

Strength

strong

Relationship

Metformin must be held around contrast-dye procedures due to risk of lactic acidosis and acute kidney injury

To

Hypoglycemia

From

Sulfonylureas

Strength

strong

Relationship

Sulfonylureas stimulate pancreatic insulin release; significant hypoglycemia risk, especially with fasting or alcohol use

To

Potassium Shift

From

DKA

Strength

strong

Relationship

In untreated DKA, acidosis drives potassium out of cells causing falsely high serum levels; insulin and fluids reverse this, causing dangerous hypokalemia

To

IV Fluids First

From

DKA & HHNS

Strength

strong

Relationship

Normal saline 0.9% is the first priority in both acute emergencies to restore intravascular volume and improve perfusion

To

Tight Glucose Control

From

Retinopathy

Strength

strong

Relationship

Microvascular damage to retinal capillaries is preventable with HbA1c <7%; regular eye exams are essential screening

To

ACE Inhibitors/ARBs

From

Nephropathy

Strength

strong

Relationship

ACE-I and ARB medications provide renoprotection in diabetic kidney disease by reducing glomerular pressure independent of glucose control

To

Foot Ulcer Risk

From

Neuropathy

Strength

strong

Relationship

Sensory neuropathy causes loss of protective sensation; combined with poor circulation and infection risk, minor trauma becomes serious ulcers

To

Daily Inspection

From

Diabetic Foot Care

Strength

strong

Relationship

Neuropathic patients cannot feel pain or pressure from injury; daily visual inspection is the primary prevention strategy for foot complications

To

Never Barefoot

From

Foot Care

Strength

strong

Relationship

Patients with neuropathy lack protective sensation; going barefoot increases trauma risk exponentially, requiring strict prevention education

To

Nocturnal Hypoglycemia

From

Somogyi Phenomenon

Strength

strong

Relationship

Somogyi phenomenon occurs when nighttime hypoglycemia triggers counter-regulatory hormone surge causing morning hyperglycemia

To

Early Morning Hormones

From

Dawn Phenomenon

Strength

strong

Relationship

Dawn phenomenon is morning hyperglycemia from normal early-morning cortisol and growth hormone surge WITHOUT preceding nocturnal hypoglycemia

To

Rule of 15

From

Hypoglycemia

Strength

strong

Relationship

Rule of 15 (15g carbs, recheck in 15 min, repeat if needed) is the evidence-based protocol for conscious patient treatment

To

IV Dextrose or IM Glucagon

From

Unconscious Hypoglycemia

Strength

strong

Relationship

Unconscious patients cannot receive oral intake (aspiration risk); must receive IV D50 in hospital or IM/SC glucagon in field settings

To

Treatment Target

From

HbA1c

Strength

strong

Relationship

HbA1c reflects average glucose over 2-3 months; diagnostic threshold ≥6.5%, treatment target <7% for most patients

To

Patient Empowerment

From

SMBG (Self-Monitoring Blood Glucose)

Strength

moderate

Relationship

Regular SMBG allows patients to understand insulin effects, food impacts, and activity relationships; essential for improving self-management

To

Leading Cause of Death

From

Cardiovascular Disease

Strength

strong

Relationship

Macrovascular complications (CAD, stroke, PVD) account for 85% of diabetes deaths; CV risk reduction is as important as glycemic control

To

Meal Timing

From

Rapid-Acting Insulin

Strength

strong

Relationship

Rapid-acting insulins peak in 30 min-1.5 hours and must be given WITH meals (food ready first) to prevent hypoglycemia

To

Nocturnal Hypoglycemia Risk

From

Intermediate Insulin (NPH)

Strength

strong

Relationship

NPH peaks at 6-12 hours; evening doses peak overnight, increasing nocturnal hypoglycemia risk requiring 2-3 AM glucose checks