Diabetes Essay Advanced PDF

Preview

Summary

Diabetes mellitus essay/patho ...

Description

1

Diabetes Mellitus

November 30, 2020

2 Diabetes Mellitus Diabetes mellitus is a metabolic disease that affects the secretion of insulin and causes an increased level of glucose in the blood. Insulin, the hormone secreted by beta cells, is responsible for many functions necessary for the body to function. The hormone’s principal actions are to metabolize and transport glucose that is used for energy, store glucose in the muscle and liver, communicate with the liver to end the release of glucose, and to initiate the breakdown of stored glucose, protein, and fat. Diabetes mellitus type 1 occurs when the body is unable to produce insulin, whereas type 2 diabetes occurs when there is a resistance to insulin (Hinkle and Cheever, 2018). Etiology Diabetes mellitus type 1 and 2 have many causative factors, many that can be managed or adjusted. A factor leading to increased risk is central obesity with a waist circumference greater than 100 cm in males and 88 cm in females (Holman et al., 2019). Diabetes research has found that specific groups, such as Asian Americans, Hispanic Americans, African Americans, Native Americans, and Pacific Islanders are all at an increased risk compared to others, along with adults 45 years old and older (Hinkle and Cheever, 2018). It is also noted that diabetes mellitus is more prevalent in males than females (Holman et al., 2019). Type 2 diabetes requires a patient to overcome insulin resistance and prevent the buildup of glucose in the bloodstream. In order to have the insulin resistance to be treated, the increased insulin levels must be secreted to acquire a glucose level within an acceptable range. Type 2 diabetes can be managed by increased exercise, a change in diet, and a medication regimen that is followed (Hinkle and Cheever, 2018). Clinical Manifestations

3 While the level of glucose is the chief factor for clinical manifestations, the typical manifestations found include polydipsia, polyuria, and polyphagia. Increased urination, polyuria, and increased thirst, polydipsia, can result in a surplus of fluid loss associated with osmotic diuresis. An increased appetite, or polyphagia, is associated with the catabolic state where insulin is unable to breakdown the appropriate fats and proteins. Other common symptoms include fatigue, weakness, vision changes, decreased peripheral sensation, wounds, and infections (Hinkle and Cheever, 2018). Laboratory Tests and Diagnostic Procedures Laboratory tests for determining if a patient had diabetes mellitus include fasting blood glucose, glycosylated hemoglobin, urine ketones, and a lipid profile. The fasting glucose test will be completed after 8 hours of no intake of food, drink other than water, and antidiabetic medication. An oral glucose tolerance test is a series of blood glucose tests that are obtained every 30 minutes for 2 hours. Glycosylated hemoglobin (HbA1c) is a test to evaluate the effectiveness and compliance of treatment for diabetes. The expected range of HbA1c is 4% to 6% for patients without diabetes and 6.5% to 8% for those with diabetes. Urine ketone tests for ketones that have accumulated in the blood from the breakdown of fatty acids. This occurs when insulin is not available and causes the breakdown of fatty acids. When levels are greater than 300 mg/dL, it is a medical emergency that indicates hyperglycemia. To diagnose diabetes, the abovementioned tests are used and evaluated on the basics of criteria. On two separate days, if one of the following findings are in abnormal ranges a client may be diagnosed with diabetes: a manifestation of diabetes with a blood glucose test greater than 200 mg/dL, a fasting blood glucose greater than 126 mg/dL, 2-hour glucose greater than 200 mg/dL, and a glycosylated hemoglobin greater than 6.5% (Holman et al., 2019).

4 To monitor diabetes mellitus, self-monitored blood glucose (SMBG) is used as a diagnostic test. The SMBG test is for patients to use to monitor their blood glucose levels by taking a blood sample collection with a glucose meter. It is essential that patients receive proper education for using this glucose meter. To check the accuracy of the meter strips, one can use the control solution. Hand hygiene, proper storage of strips, and the proper amount of blood needed are all educational points that should be taught to obtain proper level readings (Holman et al., 2019). Treatment Diabetes mellitus can be treated and managed by lifestyle changes and resources such as nutritional therapy, exercise, monitoring glucose levels, medication, and education. Weight loss is a major factor in the treatment of diabetes, clients are recommended to follow a strict diet that has increased protein and decreased lipids, fats, and sugars. Decreased levels of glucose in the diet have been linked to significant weight loss. Exercise is immensely effective in lowering the blood glucose level and reducing the risk of complications such as cardiovascular disease. Regularly monitoring the glucose level can prevent complications of hypoglycemia before they occur. Hypoglycemia typically occurs before and after meals. Insulin therapy is necessary for maintaining glucose levels within an acceptable range to avoid further complications. Education is required for a patient to treat the disease of diabetes type 2 and manage diabetes type 1. (Hinkle and Cheever, 2018). Complications Complications of diabetes include microvascular complications, macrovascular complications, and cardiovascular disease. Microvascular complications include the risk for kidney disease due to the loss of kidney function. Macrovascular complications include

5 peripheral artery disease and increased pain related to foot ulcers from narrowed blood vessels in the extremities. Cardiovascular disease, such as hypertension, myocardial infarction, and stroke, can occur due to severe hypoglycemia. Amputation of an extremity is another complication of diabetes which can result from ulcers caused from narrowed blood vessels or infections on the lower extremity (Banach et al., 2018). Preventative Measures Diabetes mellitus type 1 cannot be prevented due to it being an autoimmune dysfunction, whereas type 2 diabetes can be prevented easily with lifestyle changes (Holman et al., 2019). Standard lifestyle changes may be recommended for patients who are at an increased risk for developing this disease, such as increasing their exercise routines and modifying their diet. Implementation of lifestyle changes include weight loss and intensified physical activity. It is found from research that there is a decreased risk of developing type 2 diabetes if one follows the recommendations of weight loss and increased exercise (Hinkle and Cheever, 2018). Patient Teaching Patient education is necessary for the management of diabetes mellitus for the following topics: foot care, nutritional guidelines, and exercise. Patients are recommended to inspect their feet daily for any signs of infection or skin breakdown. When washing feet, use mild soap with warm water, and pat feet, including between the toes, dry to ensure there is no moisture that can cause an infection. Patients are advised to wear closed-toed shoes that fit correctly and clean, absorbent socks made of cotton or wool. Avoiding lotions, prolonged sitting or standing can decrease the risk for infection and skin breakdown in clients with diabetes mellitus (Holman et al., 2019).

6 Education on nutritional intake is an important measure in managing diabetes mellitus type 2. Patients should be advised to plan their meals according to the onset and peak of insulin. Meals should be consumed at regular intervals and should not be skipped. Patients are recommended to count their calories, carbohydrates, and saturated and trans fats of their diet to ensure they are consuming the correct amounts of each category. Consulting a dietitian can provide further education and recommendations for meal planning, weight management, and management of lipid and glucose levels (Holman et al., 2019). Before exercising, it is important for the patient to be educated to ensure safety. The patient needs to check their blood glucose level prior to exercising, and only continue if the levels are between 80 to 250 mg/dL. If it has been an hour or more since eating, a carbohydrate snack should be consumed before beginning to exercise. When exercising, it is important to always carry or wear identification information regarding diabetic status. After intense exercising, the blood glucose level needs to be checked more often for the next 24 hours (Holman et al., 2019). Conclusion Diabetes has a wide variety of effects and risk factors that can cause serious complications. While diabetes type 1 cannot be prevented or treated, it can be managed with the proper application of education provided, whereas type 2 diabetes can be prevented or treated with lifestyle modifications. It is important to be aware and recognize the risk factors, and signs and symptoms of the onset of diabetes to treat it before complications occur.

7 References Banach, M., Bekiari, E., Rizzo, M., and Edmonds, M. (2018). Complication of Diabetes. Journal of Diabetes Research. Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14th Edition. Wolters Kluwer.

Holman, H. C., Williams, D., Sommer, S., Johnson, J., Ball, B., Wheless, L. Leehy, P., and Lemon, T. (2019). RN Adult Medical Surgical Nursing 11TH edition. Assessment Technologies Institute....