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Millions of people around the world suffer from Diabetes Mellitus. It is a chronic disease in which the body cannot produce enough insulin or the body is resistant or abnormally responds to the insulin being produced. The result of these complications involve the individual becoming hyperglycemic, meaning the sugar in their blood is elevated, which can secondarily lead to more serious health problems. There are different types of Diabetes Mellitus and they include; Type 1-Also known as Insulin Dependent Diabetes and it is suggested that it is an autoimmune disorder. It most commonly affects children and adults (20-40 years old). It also most commonly affects non-hispanic whites, African Americans and Hispanic Americans. The pathophysiology of this type of Diabetes is defined as the pancreas not being able to produce enough insulin that is required for normal body processes. The individual’s immune system secretes substances that attack the beta cells of the pancreas, also known as the islets of Langerhans, resulting in little or no insulin being produced. Individuals with Type 1 Diabetes can expect symptoms of polyuria (increased urine), Polydipsia (increased thirst), Polyphagia (increased hunger or eating) weight loss, nausea, blurred vision, fatigue and weakness, muscle cramps, gastrointestinal symptoms and peripheral neuropathy (numbing and tingling in both hands and feet). The second type of Diabetes is Type 2 Diabetes, also known as non-insulin dependent Diabetes or adult onset diabetes. 90-95% of Diabetics have this type of diabetes, 20% of that number coming from the population over 65 years of age. 55% of individuals are obese. The pathophysiology of this type of Diabetes is simply defined as being insulin resistant. Insulin is needed to move blood sugar into the cells where it can be stored for later use. Having type 2 Diabetes makes the fat, muscle cells and liver resistant to insulin, resulting in blood sugar not getting into the cells to be stored for energy. This results in the blood glucose level becoming elevated which triggers the pancreas to produce more and more insulin but not enough for the body’s demand. Individuals with Type 2 Diabetes can expect symptoms such as; Blurred vision, fatigue, frequent or slow-healing infections, increased appetite, increased thirst, increased urination and erectile dysfunction. The third type of Diabetes is Gestational Diabetes. This type of Diabetes is only diagnosed during pregnancy. The pathophysiology of Gestational Diabetes is defined as being the body not being able to make or use all of the insulin it needs for pregnancy. It is said that the hormones released from the placenta, block the action of the mother’s insulin, resulting in elevated blood sugar. This can be extremely dangerous for mother and baby. The extra blood glucose goes through the placenta, giving the baby high blood glucose levels resulting in the baby’s pancreas to make extra insulin to get rid of the excess blood glucose received from the mother. This extra energy will result in being stored as fat, which can lead to macrosomia, or “fat baby”. The baby can also have low blood glucose levels at birth, which will in turn give them breathing problems. These babies also have a high risk for obesity. Women with gestational diabetes have very few symptoms, but those documented include; excessive weight gain, excessive hunger or thirst, excessive urination or recurrent vaginal infections.
The exact causes of Diabetes is still unknown to medical scientists but what is known is that certain factors also known as risk factors may contribute to the disease. These risk factors vary with what type of Diabetes the individual has but some of them coincide with each other. Type 1 Diabetes is is considered an autoimmune disease, which is the cause of 0.3% of type 1 cases. Other risks factors include the individual being genetically susceptible to the disease, having a poor diet or being malnourished, and the environment in which the individual lives that may give off a virus that affects the pancreas. With Type 2 Diabetes, genetics also play a big role as with Type 1 Diabetes. The offspring is more likely to develop Diabetes if the mother had diabetes, and 2 to 3% of offspring will develop diabetes from their father is diabetic. If both parents are diabetics, the risk is much greater. Other risk factors include, age-80% of all cases occur after the age of 50, poor diet, as with type 1, obesity and fat distribution-having excess body fat over 30% will result in increased insulin resistance, sedentary lifestyle, stress, certain drugs-clozapine, olanzapine, risperidone, quetiapine and ziprasidone, infection-such as strephylococci, sex-more common in women especially those with a history of multiple pregnancies and those suffering from Polycystic Ovarian Syndrome, Hypertension, and high triglycerides and cholesterol levels-which lead to high blood sugars.
There are many consequences for the individual that poorly controls their Diabetes and these consequences are generally the same for both types of Diabetes. Individuals that have had Diabetes for 10 to 15 years are at risk for eye problems such as Retinopathy-which is damage to the small blood vessels and nerve endings that are responsible for vision. Large blood glucose levels can also cause blurred vision, and difficulty in focusing. Cataracts are also more likely to occur in elderly person with Diabetes. Other consequences include kidney problems known as Nephropathy. The kidney filters waste products from our bodies and expels this waste into the urine. If blood sugar is elevated, increased glucose is filtering through the kidneys, which will in time, cause kidney damage which will require dialysis or kidney transplantation. Screening for this complication is recommended 2 years after diagnosis of diabetes in adolescents and 5 years in individuals diagnosed with diabetes after puberty. Nerve problems such as Neuropathy (nerve damage) are also cause for concern in those with Diabetes. Symptoms of this complication include; numbness or feelings of pins and needles in the extremities. It is not typically found in young people but can arise with poor control of Diabetes. If neuropathy is found in the early stages, it can be reversed with improved Diabetes control. Vascular Disease is another complication arising from poorly controlled Diabetes. This complication can be very serious because it can lead to heart attacks and strokes due to the narrowing or blockages of the large blood vessels. Those individuals with secondary diseases such as untreated high blood pressure and high cholesterol levels or those who smoke are at greater risk for this type of complication. Foot problems, due to decreased blood flow or nerve problems are also possible complications. Although children and adolescents generally do not get this complication, it is always advised that they protect their feet from injury. Plantar warts, calluses, corns and in grown toe nails will be slower to heal with the high sugar environment so proper care of these issues is important to prevent more further damage. Aside from complications that can arise from poorly controlled diabetes, there are other medical conditions that are at higher risk with the individual has diabetes and those include thyroid problems, such as hypothyroidism and hyperthyroidism, and coeliac disease-which is an autoimmune condition in which the body forms antibodies against the protein gluten, which can be found in rye, oats, barley and wheat.
Many medications are used for the treatment of Diabetes I and II. Everyone with Type 1 Diabetes and some with Type 2 Diabetes must take Insulin to control their diabetes if diet and exercise is not effective. Insulin cannot be taken in a pill form because the stomach enzymes break it down, so most people inject it or use an insulin pump. The most commonly used form of insulin is the synthetic human insulin, which is chemically identical to human insulin. The only problem with this type of insulin is that it doesn’t mimic the way natural insulin is secreted, but there are newer types of insulin called insulin analogs that more closely resembles the way natural insulin acts in the body. The medications used for the management of type 2 diabetes include; Sulfonylurea drugs-which stimulate the pancreas to produce and release more insulin, Meglitinides- which work like the Sulfonylurea’s, but the patient is less likely to develop low blood sugar and they work quickly and results fade rapidly, Biguanides-which inhibits the production and release of glucose from the liver, which means you need less insulin to transport blood sugar into your cells, Alpha-Glucosidase inhibitors-which block the action of enzymes in your digestive tract that break down carbohydrates. This means blood is absorbed into your bloodstream more slowly, which helps prevent the rapid rise in blood sugar that usually occurs right after a meal. Thiazolidinediones- This drug makes your body tissues more sensitive to insulin and keep your liver from overproducing glucose. Drug Combinations- Which is a combination of these drugs which will control the individual’s blood sugar in several different ways.
Nutrition plays a big part of Diabetes and may even cure Type 2 diabetes. Any food you eat will raise your blood sugar with its highest peak 1 to 2 hours after you eat, and how much you eat, and the time of day can have an impact on how high it is. Many people think that is order to control diabetes, you have to follow the “diabetes diet” which includes boring and bland foods but that is only a myth. In order to control diabetes, fruits (because fruits contain sugar fructose, which does not need insulin for its metabolism and well tolerated for diabetics), vegetables (raw vegetables should be taken liberally because they stimulate and increase insulin production), whole grains, foods that are high in nutrition and low in fat and calories, fewer animal products (increases the toxemic condition underlying the diabetic state and reduce the sugar tolerance) and fewer sweets is what needs to be implemented. It is also important to eat 4 to 5 small meals a day instead of 3 to keep your blood sugar balanced so it’s not low at some points and sky rocketing others. It is also suggested that caffeine products such as coffee, cocoa, and tea be avoided because of their adverse influence on the digestive tract. Other foods that should be avoided are white flour products, sugar, tinned fruits, sweets, chocolates, pastries, pies, puddings, refined cereals and alcoholic drinks. Finally, the “do-good” foods that every diabetic should be eating include; celery, cucumbers, beans, onion, and garlic. Eating a nutritious diet is the first step in controlling your diabetes.
Exercise is good for everyone but it is especially important for diabetics to partake in some form of exercise most days. Exercise improves your body’s use of insulin, burns excess body fat, helping to decrease and control weight-(improved insulin sensitivity), improves muscle strength, increases bone density and strength, lowers blood pressure lowers LDL’s and increases HDL’s, improves circulation, increases energy level and reduces stress. It is important to see a doctor before you start an exercise regimen but once an individual gets the free and clear, 30 minutes of aerobic exercise such as walking, hiking, jogging, biking, tennis, cross-country skiing and swimming or good choices. When exercising the body needs extra energy in the form of glucose for exercising the muscles so with exercise, the liver can release stored glucose, and the muscles can take up glucose at almost 20 times the normal rate, which lowers blood sugar levels. It is important for the individual to not overdo it though because strenuous exercise can actually have the opposite affect and increase blood sugar levels because the body recognizes intense exercise as stress and releases stress hormones that tell your body to increase available sugar to fuel your muscle. If this happens, insulin will be needed after the workout. As long as the individual follows a safe exercise routine, diabetes can be controlled and with along with a correct diet, may even be cured.
A discharge teaching plan for diabetes mellitus includes; advising the patient on the importance of an individualized meal plan by reducing carbohydrates and stressing that fad diets are not recommended and can make the condition worse, discuss the goals of dietary therapy for the patient, and if the patient is obese, setting a goal of 10% of patient’s body weight over several months to reduce blood sugar. Explain the importance of exercise in maintaining and reducing body weight and lowering blood sugar, demonstrate and thoroughly explain the procedure for insulin self-injection and ask them to re-demonstrate it to you to show understanding and review dosage and time of injections in relation to meals, activity, and bedtime based on insulin regimen. Teach patient how important it is to test blood sugar before meals to avoid hypoglycemia and after meals to avoid hyperglycemia and teach them how to correctly monitor blood sugar and ask them to re-demonstrate it to you to insure accuracy. Explain the symptoms to look for when possible complications of the disease arise. Encourage patient to wear an identification bracelet in the case that the patient is unable to speak and needs medical treatment. Teach the family or caregiver the same information to ensure competency. Provide emotional support for the patient and the family.
Diabetes is a rapidly growing disease that everyone needs to be aware so everyone can work together to bring it to an end. Although some cases will never be eliminated, education, diligence and hard work will reduce the amount of people that have it or are diagnosed with it and the complications will be decreased. Without that, the numbers will continue to increase.
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