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Diabetes Mellitus Case Study

Diabetes Mellitus Case Study

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Published by: MYJAH4EVER7910 on Jan 07, 2011
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10/04/2013

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Diabetes Mellitus Case Study 
INTRODUCTION:
Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose inthe blood cannot be absorbed into the cells of the body. Symptoms include frequent urination, lethargy, excessive thirst, and hunger. The treatment includeschanges in diet, oral medications, and in some cases, daily injections of insulin.The most common form of diabetes is Type II, It is sometimes called age-onset or adult-onset diabetes, and this form of diabetes occurs most often in people whoare overweight and who do not exercise. Type II is considered a milder form of diabetes because of its slow onset (sometimes developing over the course of several years) and because it usually can be controlled with diet and oral medication. The consequences of uncontrolled and untreated Type II diabetes, however,are the just as serious as those for Type I. This form is also called noninsulin-dependent diabetes, a term that is somewhat misleading. Many people with Type IIdiabetes can control the condition with diet and oral medications, however, insulin injections are sometimes necessary if treatment with diet and oral medication isnot working.The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic factors passed on in families) and environmental factorsinvolved. Research has shown that some people who develop diabetes have common genetic markers. In Type I diabetes, the immune system, the body’sdefense system against infection, is believed to be triggered by a virus or another microorganism that destroys cells in the pancreas that produce insulin. In Type IIdiabetes, age, obesity, and family history of diabetes play a role.In Type II diabetes, the pancreas may produce enough insulin, however, cells have become resistant to the insulin produced and it may not work aseffectively. Symptoms of Type II diabetes can begin so gradually that a person may not know that he or she has it. Early signs are lethargy, extreme thirst, andfrequent urination. Other symptoms may include sudden weight loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. It is not unusualfor Type II diabetes to be detected while a patient is seeing a doctor about another health concern that is actually being caused by the yet undiagnosed diabetes.Individuals who are at high risk of developing Type II diabetes mellitus include people who:
are obese (more than 20% above their ideal body weight)
have a relative with diabetes mellitus
belong to a high-risk ethnic population (African-American, Native American, Hispanic, or Native Hawaiian)
have been diagnosed with gestational diabetes or have delivered a baby weighing more than 9 lbs (4 kg)
have high blood pressure (140/90 mmHg or above)
have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a triglyceride level greater than or equal to 250 mg/dL
have had impaired glucose tolerance or impaired fasting glucose on previous testingDiabetes mellitus is a common chronic disease requiring lifelong behavioral and lifestyle changes. It is best managed with a team approach to empower the clientto successfully manage the disease. As part of the team the, the nurse plans, organizes, and coordinates care among the various health disciplines involved;provides care and education and promotes the client’s health and well being. Diabetes is a major public health worldwide. Its complications cause manydevastating health problems.
ANATOMY AND PHYSIOLOGY:
Every cell in the human body needs energy in order to function. The body’s primary energy source is glucose, a simple sugar resulting from the digestion of foodscontaining carbohydrates (sugars and starches). Glucose from the digested food circulates in the blood as a ready energy source for any cells that need it. Insulinis a hormone or chemical produced by cells in the pancreas, an organ located behind thestomach. Insulin bonds to a receptor site on the outside of cell and actslike a key to open a doorway into the cell through which glucose can enter. Some of the glucose can be converted to concentrated energy sources like glycogenor fatty acids and saved for later use. When there is not enough insulin produced or when the doorway no longer recognizes the insulin key, glucose stays in theblood rather entering the cells.
 
PATHOPHYSIOLOGY:
 
Image Source: 
Several blood tests are used to measure blood glucose levels, the primary test for diagnosing diabetes. Additional tests can determine the type of diabetes and itsseverity.
Random blood glucose test — for a random blood glucose test, blood can be drawn at any time throughout the day, regardless of when the personlast ate. A random blood glucose level of 200 mg/dL (11.1 mmol/L) or higher in persons who have symptoms of high blood glucose(see “Symptoms” above
 
) suggests a diagnosis of diabetes.
Fasting blood glucose test — fasting blood glucose testing involves measuring blood glucose after not eating or drinking for 8 to 12 hours (usuallyovernight). A normal fasting blood glucose level is less than 100 mg/dL. A fasting blood glucose of 126 mg/dL (7.0 mmol/L) or higher indicates diabetes. Thetest is done by taking a small sample of blood from a vein or fingertip. It must be repeated on another day to confirm that it remains abnormally high(see“Criteria for diagnosis” below
 
).
Hemoglobin A1C test (A1C) — The A1C blood test measures the average blood glucose level during the past two to three months. It is used tomonitor blood glucose control in people with known diabetes, but is not normally used to diagnose diabetes. Normal values for A1C are 4 to 6 percent (showfigure 3
 
). The test is done by taking a small sample of blood from a vein or fingertip.
Oral glucose tolerance test — Oral glucose tolerance testing (OGTT) is the most sensitive test for diagnosing diabetes and pre-diabetes. However,the OGTT is not routinely recommended because it is inconvenient compared to a fasting blood glucose test.The standard OGTT includes a fasting blood glucose test. The person then drinks a 75 gram liquid glucose solution (which tastes very sweet, and is usually cola or orange-flavored). Two hours later, a second bloodglucose level is measured.Oral glucose tolerance testing is routinely performed at 24 to 28 weeks of pregnancy to screen for gestational diabetes; this requires drinking a 50 gram glucosesolution with a blood glucose level drawn one hour later. For women who have an abnormally elevated blood glucose level, a second OGTT is performed onanother day after drinking a 100 gram glucose solution. The blood glucose level is measured before, and at one, two, and three hours after drinking the solution.
MEDICATIONS:

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