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Epidemiology: End-Stage Renal Disease
Epidemiology: End-Stage Renal Disease
The major sources of the glucose that circulates in the blood are through the absorption of ingested food in the gastrointestinal
tract and formation of glucose by the liver from food substances.
Diabetes mellitus is a group of metabolic diseases that occurs with increased levels of glucose in the blood.
Diabetes mellitus most often results in defects in insulin secretion, insulin action, or even both.
Classification
The classification system of diabetes mellitus is unique because research findings suggest many differences among individuals
within each category, and patients can even move from one category to another, except for patients with type 1 diabetes.
Diabetes has major classifications that include type 1 diabetes, type 2 diabetes, gestational diabetes, and diabetes mellitus
associated with other conditions.
The two types of diabetes mellitus are differentiated based on their causative factors, clinical course, and management.
Pathophysiology
Diabetes Mellitus has different courses of pathophysiology because of it has several types.
Insulin is secreted by beta cells in the pancreas and it is an anabolic hormone.
When we consume food, insulin moves glucose from blood to muscle, liver, and fat cells as insulin level increases.
The functions of insulin include the transport and metabolism of glucose for energy, stimulation of storage of glucose in the
liver and muscle, serves as the signal of the liver to stop releasing glucose, enhancement of the storage of dietary fat in adipose
tissue, and acceleration of the transport of amino acid into cells.
Insulin and glucagon maintain a constant level of glucose in the blood by stimulating the release of glucose from the liver.
Type 1 Diabetes Mellitus
With gestational diabetes mellitus (GDM), the pregnant woman experiences any degree of glucose intolerance with the onset
of pregnancy.
The secretion of placental hormones causes insulin resistance, leading to hyperglycemia.
After delivery, blood glucose levels in women with GDM usually return to normal or later on develop type 2 diabetes.
Epidemiology
Diabetes mellitus is now one of the most common disease all over the world. Here are some
quick facts and numbers on diabetes mellitus.
More than 23 million people in the United States have diabetes, yet almost one-
third are undiagnosed.
By 2030, the number of cases is expected to increase more than 30 million.
Diabetes is especially prevalent in the elderly; 50% of people older than 65 years
old have some degree of glucose intolerance.
People who are 65 years and older account for 40% of people with diabetes.
African-Americans and members of other racial and ethnic groups are more likely
to develop diabetes.
In the United States, diabetes is the leading cause of non-traumatic amputations,
blindness in working-age adults, and end-stage renal disease.
Diabetes is the third leading cause of death from disease.
Costs related to diabetes are estimated to be almost $174 billion annually.
Causes
The exact cause of diabetes mellitus is actually unknown, yet there are factors that
contribute to the development of the disease.
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Genetics. Genetics may have played a role in the destruction of the beta cells in
type 1 DM.
Environmental factors. Exposure to some environmental factors like viruses
can cause the destruction of the beta cells.
Weight. Excessive weight or obesity is one of the factors that contribute to type
2 DM because it causes insulin resistance.
Inactivity. Lack of exercise and a sedentary lifestyle can also cause insulin
resistance and impaired insulin secretion.
Weight. If you are overweight before pregnancy and added extra weight, it
makes it hard for the body to use insulin.
Genetics. If you have a parent or a sibling who has type 2 DM, you are most
likely predisposed to GDM.
Clinical Manifestations
Clinical manifestations depend on the level of the patients hyperglycemia.
Prevention
Appropriate management of lifestyle can effectively prevent the development of diabetes
mellitus.
Complications
If diabetes mellitus is left untreated, several complications may arise from the disease.
Hypoglycemia. Hypoglycemia occurs when the blood glucose falls to less than
50 to 60 mg/dL because of too much insulin or oral hypoglycemic agents, too
little food, or excessive physical activity.
Diabetic Ketoacidosis. DKA is caused by an absence or markedly inadequate
amounts of insulin and has three major features of
hyperglycemia, dehydration and electrolyte loss, and acidosis.
Hyperglycemic Hyperosmolar Nonketotic Syndrome. HHNS is a serious
condition in which hyperosmolarity and hyperglycemia predominate with
alteration in the sense of awareness.
Medical Management
Here are some medical interventions that are performed to manage diabetes mellitus.
Nutritional Management
The foundations. Nutrition, meal planning, and weight control are the
foundations of diabetes management.
Consult a professional. A registered dietitian who understands diabetes
management has the major responsibility for designing and teaching this aspect
of the therapeutic plan.
Healthcare team should have the knowledge. Nurses and other health care
members of the team must be knowledgeable about nutritional therapy and
supportive of patients who need to implement nutritional and lifestyle changes.
Weight loss. This is the key treatment for obese patients with type 2 diabetes.
How much weight to lose? A weight loss of as small as 5% to 10% of the total
body weight may significantly improve blood glucose levels.
Other options for diabetes management. Diet education, behavioral therapy,
group support, and ongoing nutritional counselling should be encouraged.
Meal Planning
Criteria in meal planning. The meal plan must consider the patients food
preferences, lifestyle, usual eating times, and ethnic and cultural background.
Managing hypoglycemia through meals. To help prevent hypoglycemic
reactions and maintain overall blood glucose control, there should be consistency
in the approximate time intervals between meals with the addition of snacks as
needed.
Assessment is still necessary. The patients diet history should be thoroughly
reviewed to identify his or her eating habits and lifestyle.
Educate the patient. Health education should include the importance of
consistent eating habits, the relationship of food and insulin, and the provision of
an individualized meal plan.
The nurses role. The nurse plays an important role in communicating pertinent
information to the dietitian and reinforcing the patients for better
understanding.
Pharmacologic Therapy
Nursing Management
Nurses should provide accurate and up-to-date information about the patients condition so
that the healthcare team can come up with appropriate interventions and management.
Nursing Assessment
The nurse should assess the following for patients with Diabetes Mellitus:
Diagnoses
The following are diagnoses observed from a patient with diabetes mellitus.
Risk for unstable blood glucose level related to insulin resistance, impaired
insulin secretion, and destruction of beta cells.
Risk for infection related to delayed healing of open wounds.
Deficient knowledge related to unfamiliarity with information, lack of recall, or
misinterpretation.
Risk for disturbed sensory perception related to endogenous chemical
alterations.
Impaired skin integrity related to delayed wound healing.
Ineffective peripheral tissue perfusion related to too much glucose in the
bloodstream
Nursing Priorities
Nursing Interventions
The healthcare team must establish cooperation in implementing the following
interventions.
normally clear, and monitoring proper storage and preparation because these
affect insulin absorbability.
Review type of insulin used. Note the type of insulin to be administered
together with the method of delivery and time of administration. This affects
timing of effects and provides clues to potential timing of glucose instability.
Check injection sites periodically. Insulin absorption can vary day to day in
healthy sites and is less absorbable in lipohypertrophic tissues.
Evaluation
To check if the regimen or the interventions are effective, evaluation must be done
afterward.
Documentation Guidelines
The following should be documented for patients with diabetes mellitus.