Diabetes Mellitus Type 2
Diabetes Mellitus (DM) Type 2
An endocrine disorder is a medical condition that causes a hormonal imbalance. When an endocrine gland functions abnormally, producing either too much of a specific hormone (hyperfunction) or too little (hypofunction), the hormonal imbalance can cause various complications in the body. The major glands of the endocrine system are the pituitary, thyroid, parathyroid, adrenal, and pancreas. One of the common endocrine disorders is diabetes. According to the article, classification of diabetes mellitus, (2013, September 12) there are two types of diabetes, insulin-dependent diabetes mellitus (IDDM) 1 or “juvenile diabetes” which is common in small children between the ages of 10 to 14 years of and there is also diabetes mellitus (DM) 2 which is common in middle age people. Diabetes mellitus and other pancreatic gland disorders disrupt the production of several hormones, including insulin, that regulate metabolism and digestion. Insulin is essential to the absorption of glucose from the bloodstream into body cells for conversion into cellular energy. This essay will explain casual factors, clinical features, prognosis, therapeutic treatments and nursing care of patient with diabetes mellitus. The article, ‘ prevention and management of diabetes’ (2013, September) elaborate that diabetes mellitus is a complex disorder of carbohydrate and protein metabolism that is primarily a result of a deficiency or complete lack of insulin secretion by the beta cells of the pancreas or resistance to insulin.
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It is characterized by hyperglycaemia and present with characteristics symptoms such as thirst, polyuria, glycosuria, blurring of vision and weight loss. In its most severe forms, ketoacidosis or a non-ketotic hyperosmolar state can develop and lead to stupor, coma, and in the absence of effective treatment, death. The diagnosis of confirmed by fasting plasma glucose and history. In addition, Diabetes mellitus (DM) 2 or type 2 diabetes is more common than diabetes mellitus type 1 and is prevalent in people over 40 years old. The condition and its symptoms develop slowly over a period from weeks to months. In DM type 2, the patient’s body still makes insulin but the amount is not enough for the body’s needs. This condition is called insulin resistance where the body cells become resistant to normal levels of insulin or if there is inadequate production of insulin. With DM type 2, the patient needs more insulin to keep the blood glucose level down. The obese and those who have type 1 diabetes are at risk developing type 2 diabetes (Lustman, 1984). Many people have no visible signs or symptoms of diabetes. Symptoms can also be so mild that the patient cannot notice them. Early symptoms may be nothing more than chronic fatigue; generalised weakness and malaise (feeling of unease), excessive urine production, excessive thirst and increased fluid intake blurred vision (typically from lens shape alterations, due to osmotic effects, e.g., high blood glucose levels), unexplained weight loss, lethargy and itching of external genitalia (Osteen, 1978).
The symptoms of diabetes mellitus type 2 often come on gradually and can be quite vague at first. The article, ‘prevention and management of diabetes’ (2013, September) elaborates that many people have diabetes for a long period of time before their diagnosis is made. There are four common symptoms which the patient will experience before being diagnosed as diabetes mellitus type 2. Being thirsty a lot of the time; passing large amounts of urine, tiredness and weight loss. The reason why passing a lot of urine and become thirsty is because glucose leaks into urine, which pulls out extra water through the kidneys. In addition, as the symptoms may develop gradually, the patient can become used to being thirsty and tired and may not recognise that he is ill for some time. Some people also develop blurred vision and frequent infections, such as recurring thrush (Brown, 1980). However, some people with type 2 diabetes do not have any symptoms if the blood sugar (glucose) level is not too high. But, even if they do not have symptoms, they should still have treatment to reduce the risk of developing complications.
The article, ‘treatment and management of diabetes (2013, September 10), emphasized that complications of the diabetes mellitus are severe and can be life threatening if not treated early. Kidney failure is one of the most common causes of death in people with diabetes type 2 (DM). It has a high chance of developing ketoacidosis. It then resolves to breakdown of fats to supply energy to cells. One of the products is ketones (highly acidic than normal body tissues). Normally, ketones are removed from the blood by the kidneys in the form of urine. Accumulation of ketones overload the kidneys and when not treated results in ketoacidosis. In addition, hypoglycaemia or insulin shock is another side-effect of any medication for lowering BSL (Osteen, 1978). For a diabetic patient, the goal is to lower BSL levels to within normal range (6-12g/mmol). Insulin reaction occurs if too much insulin or too large dose is taken, miss or delay a meal, eat too little food, increase in activity etc. These results in: dizziness, hunger, sweating, fatigue, shakiness, blurred vision and drowsiness etc. If blood glucose level is higher than normal over a long period of time, it can gradually damage blood vessels.
This can occur even if the glucose level is not very high above the normal level. This may lead to some of the following complications often years after patient first develops diabetes; furring or hardening of the arteries (atheroma) which can cause problems such as angina, heart attacks, stroke and poor circulation, kidney damage often develops into kidney failure (Nephropathy), damage to the small arteries in the retina can cause eye problems (Retinopathy), nerve damage, foot problems and impotence due to poor circulation and nerve damage. The type and severity of long-term complications vary from case to case (Brown, 1980). In addition, (Evan, Wang and Morris, 1986) points out that cardiovascular disease are the major cause of mortality and morbidity in people with Type 2 diabetes. Indeed some studies have suggested a risk similar to that of people without diabetes but with declared CVD. While others ‘merely’ show markedly increased risk, some cohorts with particular risk factors have shown extreme risk. Assessment, but more particularly aggressive management, of CV risk factors in Type 2 diabetes is then seen as a core part of care. Some of the risk relates to blood pressure control and blood glucose control and is addressed elsewhere in this guideline, as are the lifestyle interventions which generally benefit the whole spectrum of CV risk factors.
The article ‘prevention and management of diabetes’ (2013, September) emphasized on management of diabetes typically involves a considerable element of self-care, and advice should, therefore, be aligned with the perceived needs and preferences of people with diabetes, and carers. People with type 2 diabetes should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If patients do not have the capacity to make decisions, healthcare professionals should help them. Good communication between healthcare professionals and patients is essential. It should be supported by evidence-based written information tailored to the patient’s needs (Evan 1985 et al). Treatment and care, and the information patients are given about it, should be culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. If the patient agrees, families and carers should have the opportunity to be involved in decisions about treatment and care. In addition, the nurses should offer care to all people with diabetes, with sensitivity to cultural wishes and desires. They should encourage a collaborative relationship, by actively involving the person with diabetes in the consultation, and creating opportunities for them to ask questions and express concerns (Lustman, 1984).
Ensure that issues important to the person with diabetes are addressed in a systematic order. The nurse should ensure that education is accessible to all people with diabetes, taking account of culture, ethnicity, psychosocial, and disability issues when delivering health education in the community or at a local diabetes centre, and in different languages. The nurses should who provide care should communicate with a person with diabetes, adopt a whole-person approach and respect that person’s central role in their care and communicate non-judgementally and independently of attitudes and beliefs. Lustman (1984) emphasized that psychological well-being is itself an important goal of medical care, and psychosocial factors are relevant to nearly all aspects of diabetes management. Being diagnosed with diabetes imposes a life-long psychological burden on the person and his or her family. Moreover, diabetes can be seen as an additional risk factor for developing psychological problems, and the prevalence of mental health problems in individuals with diabetes is therefore likely to exceed that found in the general population.
Furthermore, poor psychological functioning causes suffering, can seriously interfere with daily diabetes self-management, and is associated with poor medical outcomes and high costs. More serious psychological disorders need to be identified, and assist them accordingly (Von, Korff and Rutter (1985). Nurses as care givers should consider all aspects of life while caring for the patient with diabetes and make sure the patient is in good health to receive the treatment. For example when a patient has amputated his or her foot, they will experience a loss which will affect the patient psychologically and physically. The nurses should provide holistic care to the patient so that he or she will adapt to new life and accept the loss as a life-saving approach and concentrate on treatment or other measures to help cure the illness. The first-line treatment for type 2 diabetes is diet, weight control and physical activity. If blood sugar (glucose) level remains high despite a trial of these lifestyle measures then tablets to reduce the blood glucose level are usually advised. Insulin injections are needed in some cases if the blood glucose level remains too high despite taking tablets (Von et al, 1985). Treatments for other related problems may also be advice. In addition, there are various medicines that can reduce the blood glucose level. Different ones suit different people. It is fairly common to need a combination of medicines to control blood glucose level. Some medicines work by helping insulin to work better on the body’s cells.
Others work by boosting the amount of insulin made by the pancreas. Another type works by slowing down the absorption of glucose from the gut. There is also a type which suppresses a hormone called glucagon, which is released into the bloodstream by the pancreas and stops insulin from working (Griffin and Kinmonth, 1980). Management of type 2 diabetes should begin with lifestyle modifications (e.g., weight control, proper nutrition, and adequate exercise). According to the article ‘treatment option’ (2013, September 12) Metformin is recommended as the first drug for most patients with type 2 diabetes when glycaemic control cannot be adequately achieved by lifestyle interventions alone. Start metformin treatment in a person who is overweight or obese and whose blood glucose is inadequately controlled by lifestyle interventions (nutrition and exercise) alone. Consider metformin as an option for first-line glucose-lowering therapy for a person who is not overweight or obese.
Furthermore, continue with metformin if blood glucose control remains or becomes inadequate and another oral glucose-lowering medication (usually a sulfonylurea) is added. Step up metformin therapy gradually over weeks to minimise risk of gastro-intestinal (GI) side effects. Consider a trial of extended absorption metformin tablets where GI tolerability prevents continuation of metformin therapy. However, Keith, Arthur and Smith 1985) emphasized that when metformin is first started, some people feel sick or have mild diarrhoea, abdominal discomfort, nausea, vomiting, loss of appetite and metallic taste. These are less likely to occur if you start with a low dose and gradually build up to the usual dose over a few weeks. If these side-effects do occur, they tend to ease off in time. Other side-effects are uncommon. According to the article, ‘indications and side effects’ (2013, September 12) Pramlintide is an injectable medicine for adults with Type 1 and Type 2 diabetes to control blood sugar. It slows down the movement of food through the stomach. This affects how fast sugar enters blood after eating. Pramlintide is always used with insulin to help lower blood sugar during the 3 hours after meals. Even when pramlintide is carefully added to mealtime insulin therapy, blood sugar may drop too low, especially if patient have Type 1 diabetes. If this low blood sugar (severe hypoglycaemia) happens, it is generally seen within 3 hours after a pramlintide injection.
However, (Keith et al, 1985) stated that severe low blood sugar makes it hard to think clearly, drive a car, use heavy machinery or do other risky activities which will cause harm to himself or other people. Pramlintide should only be used by people with type 1 or type 2 diabetes who already use their insulin as prescribed but still need better blood sugar control. Never mix pramlintide and insulin. Always advise the patient to use different syringes for pramlintide and insulin because insulin can affect pramlintide when the two are mixed together. Treatment of type 2 Diabetes Mellitus generally requires lifestyle changes, such as increased exercise and dietary modification, and sometimes insulin in addition to other medications (Osteen, 1978). For example, the nurses should educate their patients not to eat sugary foods which contain higher percentage of glucose in order to keep their blood sugar level lower. Foods like white bread, soft drinks and white rice should be strongly discouraged from taking it. Both the nurse and the guardian should monitor the patient’s daily routine of eating and discourage patient from taking chunk foods which will increase the risk of hyperglycaemia.
Furthermore, both type 1 and type 2 DM are usually controlled, however, some children do not achieve good control of their diet for a variety of reasons; most prefer foods that satisfy their taste buds regardless of the nutritional content, availability of food and the socio-economic factors (Von 1985, et al).. Both types of DM cause hyperglycaemia, which is an abnormally high level of blood glucose that may produce acute and long-term complications. Acute complications of hyperglycaemia include diabetic ketoacidosis. Diabetic ketoacidosis is an acute; potentially life threatening complication of Diabetes Mellitus in which the chemical balance of the body becomes dangerously hyperglycaemic and acidic (Brown, 1980). It results from a severe insulin deficiency, which can occur due to missed or inadequate daily insulin therapy or in association with an acute illness. It usually requires hospital treatment to correct the acute complications of dehydration, electrolyte imbalance, and insulin deficiency. Long-term complications of chronic hyperglycaemia include many conditions affecting various body systems but are rare in children (Griffin, 1980 et al). Children with diabetes mellitus may experience episodes of hypoglycaemia, which is an abnormally low level of blood glucose. Most children age 6 and older recognize the symptoms of hypoglycaemia and reverse them by consuming substances containing glucose; however, some do not take this step because of hypoglycaemia unawareness (prevention and management of diabetes, 2013, September 12). Severe hypoglycaemia can lead to complications, including seizures or loss of consciousness.
For all other children (that is, children with DM who are age 6 or older and require daily insulin, and children of any age with DM who do not require daily insulin), the nurse should determine whether the DM is severe, alone or in combination with another impairment. The management of DM in children can be complex and variable from day to day, and all children with DM require some level of adult supervision (Brown, 1980). For example, if a child age 6 or older has a medical need for 24-hour-a day adult supervision of insulin treatment, food intake, and physical activity to ensure survival. To conclude, Diabetes is an endocrine disorder characterized by high level of blood glucose or sugar in the blood, (hyperglycaemia). Diabetes often results from a failure of the islets of the pancreas to produce sufficient insulin or from the reduced ability of the body cells to use it. In addition, the person diagnosed with Type 2 diabetes requires access to immediate and ongoing care. Who provides this care, and where and when, will depend on local circumstances, but it needs to be organized in a systematic way. General principles include: annual review of control and complications; an agreed and continually updated diabetes care plan; and involvements of the multidisciplinary team in delivering that plan, centred on the person with diabetes.
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