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Write about Diabetes.
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ABSTRACT
In this, there is a detailed description of the physical assessment, pathophysiology, pharmacology, health promotion and levels of prevention of Diabetes Type 1. Type I Diabetes is genetic in nature. It runs among the close relatives in the family. There are few ways which we will identify here in which its onset is delayed or may be deviated. Type I Diabetes has a very early onset because of which it is also called juvenile diabetes. It is necessary to prevent it so that the patient can lead a better life. Physical assessment of the diabetic patient is very important as it helps in early detection of complications. There are many drugs available in the market which can stop the progress of the disease. The disease is autoimmune in nature. Using immune suppressive medication may help in many cases. There are many health promotion measures which can be taken to control the onset and further progress of diabetes. There are various levels of prevention which can be utilised depending on the stage of diabetes. Also, there are various nursing models which will help in preventing further progress of the disease.
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DIABETES TYPE I
There are many types of diabetes. It is a group of metabolic disorders. In this, there are high levels of blood sugar for a prolonged duration. There are many symptoms associated with it such as frequent urination, increased thirst and increased hunger.
Diabetes cannot be left untreated as it can result in diabetic ketoacidosis, hyperosmolar coma or even death. It is important to treat diabetes right from the start as a later diagnosis could lead to severe health effects if left untreated. It has severe cardiovascular implications.
Three Types of Diabetes
Type I Diabetes - This is a failure of the pancreas to produce insulin. The cause is unknown. But in this, the onset is in early life. As the pancreas don’t produce any insulin. Diabetes sets in at a very early age.
Type II Diabetes - This is a condition when the cells become resistant to insulin. They do not recognise insulin and as the disease progresses there is also a lack of insulin. The primary cause of this is a poor lifestyle and dietary habits. There is a gain in body weight due to a sedentary lifestyle and lack of exercise.
Gestational Diabetes - This mainly occurs during pregnancy. There is no previous history of diabetes. Generally, it goes off once the delivery takes place. In some, it may remain for a longer duration.
Pathophysiology of Type 1 Diabetes
This is due to the destruction of beta cells of the pancreas. This is due to genetic or environmental factors. This mostly is an autoimmune response of the body towards the beta cells of the pancreas. These cells produce insulin. So in absence of beta cells, no insulin production takes place.
Physical Assessment Of Patients with Type 1 Diabetes
The examination of diabetes includes assessment of the vital signs, vascular examination, funduscopic examination and foot examination.
Assessment Of Vital Signs
In this case, if the patient is having diabetes he/she will be having orthostatic hypotension. Orthostatic vital signs are useful in assessing the volume status. Measurement of the pulse is also important. There is tachycardia in autonomic neuropathy. There is often the development of orthostatic hypotension. If the respiratory pattern suggests Kussmaul respiration, DKA must be considered.
There is also a careful examination of the retina. There should be optic disc and the macula are visualised. If any haemorrhages are seen in the eyes refer to the ophthalmologist immediately. Examiners should be properly experienced about retinopathy and he should not ignore it under any circumstance. Its evaluation of retinopathy requires dilated pupils. The pulsations over dorsal pedis and posterior tibia are felt and their presence and absence are noted.
Examination of lower extremities is important for the patients with foot infections .If the blood flow in the lower extremity is low then it can delay healing. There can also be amputation in extreme cases. If peripheral neuropathy is found then appropriate steps need to be taken. Hence the personnel must be aware of foot care.
Pharmacology of Type 1 Diabetes
These patients need to be on lifelong insulin therapy. They may require two or more injections on a daily basis. The doses of insulin are adjusted as per the fluctuating glucose level. This is monitored by self-care. In this disease, there is a requirement of discipline in the day to day life.
In some patients, there can be episodes of diabetic ketoacidosis followed with a symptom-free period in which the person might require no insulin. This Insulin Free State is due to the partial return of endogenous excretion. These patients need to be taught the importance of self-care.
Diabetes type 1 requires being taken care of, as the blood glucose level decides the amount of insulin to be taken. ADA recommends that patient’s age can be one of the considerations of the amount of insulin and the glycemic goals. There is also a requirement of screening for long-term complications. In few cases, pancreatic transplantation is one of the options considered. It is one of the end-stage treatments.
Health Promotion Activity
Exercise is crucial for patients with diabetes. It has many mental and health benefits. It has been seen that most people with diabetes do not indulge in exercise. Exercise is a very crucial part to have good health in diabetes (Liese et al, 2013). Regular weight checkups along with regular blood sugar checkups are necessary .It is important to keep the risk of obesity at bay. Obesity makes diabetes worse.
It is important to make people understand the short term and long term complications of diabetes (Naughton et al, 2014). Diabetes type 1 is an early onset disease which tends to continue lifelong. So it is important to make them feel positive. Initiate positive change in them so that they can fight the disease.
Diet should be based on whole grain diet instead of starch based. The food has to be rich in fibres such as oats, beans, peas, lentils, grains, seeds and fruits. It is important to follow a low-fat diet and not consume any processed foods. Eat a healthy breakfast to avoid hypoglycaemia. Minimise the sedentary lifestyle. Effective weight loss programmes can be joined which have many types of exercises to choose from. By keeping weight in check and eating a balanced diet is very essential and it can serve as key elements to controlling diabetes. Moderate daily exercise for 30 minutes is required. Also, it is important to use the community resources such as the community hall to provide awareness to the people. It is important to address the key factor behind the increasing weight loss.
The diseases associated with diabetes need to be checked. The factors causing aggravation of symptoms or progress of the disease has to be taken care of. The patients need to understand various education and health services which will help to detect the early onset of diabetes. Educating people for the early detection of the sign of diabetes is important (Giordano et al, 2014).
Levels of Prevention of Diabetes
The prevention is divided into 3 levels - Primary, Secondary and Tertiary levels.
Primary Prevention - This is for the individuals where there are no signs of autoimmune or metabolic impairment and there is uncertainty that diabetes will actually develop or not.
In this, all the dietary interventions are involved which may cause an environment for the trigger of Diabetes type 1. There is no specific dietary modification. There have been many observations such as Gluten involvement in the diet. It has been seen that if gluten is restricted in the diet then the autoimmune development of type 1 diabetes can be checked as there is less of consumption of carbohydrates and sugar.
Secondary Prevention - Nicotinamide is a water-soluble vitamin. It has shown that it has shown increased insulin synthesis. It is given in prior to avoid the onset of diabetes. It prevents the spontaneous increase of diabetes in non-obese patients.
Anti specific therapy-In this there is the appropriate administration of an autoantigen. It has the potential of controlling the autoimmune response of the body to cause the destruction of pancreatic cells. It directs the immune system for protective rather that destructive function.
Insulin- It is the most specific B-cell antigen (Brazeau et al, 2013).
Proinsulin peptide- There can be the intradermal administration of proinsulin peptide.
Glutamic Acid gecarboxylase-This is also injected and delayed diabetes type 1 inception has been seen.
Immunomodulation- In this, there is immune suppression with low dose cyclosporine in the first degree relatives of patients.
Tertiary Prevention - It is after the inception of diabetes. In this, there is dietary control and maintain a good diet. In this, the motive is to control further worsening of the disease. There is a regular exercise for weight loss. Diabetes comes with many complications. It is important to prevent the complications.
Trials with ciclosporin A – This drug has demonstrated better beta cells survival. Also, immune suppressive therapies are administered. There are extensive trials going on these areas where immunosuppressives are given so that the destruction of the autoimmune system to the pancreatic cells can be checked.
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Place Your OrderHealth Promotion Model (HPM) by Nola J Pender
Nola J Pender is the former professor of nursing at the University of Michigan. Her model has mainly three areas of focus. Firstly individual characteristics and their experiences. Secondly the behaviour specific cognition and its effect and thirdly the behavioural outcomes.
In this, there are background factors that influence health and behaviour. The patients are expected to engage in activity which will get us the desired result. In this, there are changes in behaviour adapted to achieve a healthy lifestyle. In the case of diabetes type 1, there is a requirement of eating healthy and exercise regularly. All these changes will help in achieving better diabetic control. The individual experiences of the patient have to be considered while giving medication and deciding on their diet. If proper diet and exercise pattern are followed then the onset of complication in Diabetes Type 1 can be delayed.
Nursing Ethics
This guides the nurses every day to make correct use of their knowledge and skills for the care and healing of the patient. In this, the nurses must ensure that the diabetic patient should understand the meaning of self-care. He should be able to follow a balanced diet. There is a requirement to be sensitive about the regular glucose checks. Also, patients must understand the importance of exercise. The patient should be aware of the complications of diabetes and he must know that if he is not taking care of himself it can have serious implication on health.
Self-care by an alteration in behaviour can help to achieve proper control over diabetes type 1 as it has an early onset and it continues lifelong. The patient is required to develop a proper routine and healthy diet and exercise should be a part of his lifestyle. It is good to avoid the complications of diabetes for as long as possible. Hence patient should develop a good lifestyle. Early onset of complication can shorten the life expectancy. Hence it is the duty of the nurse to encourage proper behavioural changes in the patient.
References
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Liese, A. D., Ma, X., Maahs, D. M., & Trilk, J. L. (2013). Physical activity, sedentary behaviors, physical fitness, and their relation to health outcomes in youth with type 1 and type 2 diabetes: A review of the epidemiologic literature. Journal of Sport and Health Science, 2(1), 21-38.
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Naughton, M. J., Joyce, P., Morgan, T. M., Seid, M., Lawrence, J. M., Klingensmith, G. J., ... & SEARCH for Diabetes in Youth Study Group. (2014). Longitudinal associations between sex, diabetes self-care, and health-related quality of life among youth with type 1 or type 2 diabetes mellitus. The Journal of pediatrics, 164(6), 1376-1383.
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Brazeau, A. S., Mircescu, H., Desjardins, K., Leroux, C., Strychar, I., Ekoe, J. M., & Rabasa-Lhoret, R. (2013). Carbohydrate counting accuracy and blood glucose variability in adults with type 1 diabetes. Diabetes research and clinical practice, 99(1), 19-23.
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Giordano, S., Martocchia, A., Toussan, L., Stefanelli, M., Pastore, F., Devito, A., ... & Falaschi, P. (2014). Diagnosis of hepatic glycogenosis in poorly controlled type 1 diabetes mellitus. World journal of diabetes, 5(6), 882.
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