Report on Type 2 Diabetes Mellitus Patient - Case Study Example

1 I just gave my uncle some hard candy, the blurry vision will soon pass and he will feel better. He lost weight during the past few months; he's on some kind of low fat-high fiber diet that the doctor prescribed. After his exercise, he's going to need some rest, then lunch, before I drive him over to the Clubhouse to meet some friends. He was working in the vegetable garden when the first attack came. He said he was feeling quite tired that morning but had to get the job done. As he was about to finish weeding the tomato patch, his vision became blurred and he felt numbness creep into his hands and feet. It was a good thing that I arrived from town at that exact moment and saw him slump on the ground. I rushed him to the hospital. During his brief period of confinement, some tests were done and was diagnosed to have diabetes mellitus type II. Diabetes mellitus is a condition which results from the lack of insulin within the body's blood stream (The Family Heath Guide, page 284). Insulin is a pancreatic hormone that is secreted in the bloodstream to break down glucose (sugar), amino acids and fatty acids for better assimilation within the cells for energy and storage (Blackwell's Dictionary of Nursing, page 358). There are two major types of diabetes: 1) Type I or insulin dependent diabetes mellitus (IDDM) and 2) Type II or non insulin dependent diabetes mellitus (NIDDM). IDDM or type I usually occurs in children and young adults. The onset is usually acute, and the absence of insulin is due to the destruction of the islet cells in the isle of Langerhan. The cause of destruction is not fully known but is attributed to genetic malfunction and heredity. NIDDM on the other hand is better known as type II diabetes mellitus. This type of diabetes is the most common form of diabetes mellitus which can be controlled by means of proper diet, regular exercise and religious intake of prescribed oral medications (hypoglycimes)(The Family Health Guide, page 284). Since my uncle has been diagnose with this disease he manifested most of the following common signs and symptoms, which are (The Family Health Guide, page 285): 1) constant thirst (polydipsia); 2) frequent urine elimination (polyuria); 3) frequent hunger or strong appetite (polyphagia); 4) weight loss despite a strong appetite; 5) tiredness or weakness; 6) tingling sensation and numbing of hands and feet; 7) blurred vision; 8) recurrent skin infection and 9)itching in the private parts. Frequent thirst in diabetic people is triggered by the high level of sugar in the blood that must be excreted by the kidneys. For this to happen, the kidneys automatically produce more urine, thus requiring large amounts of water to be eliminated from the body. To avoid dehydration due to excess water excretion, the person becomes thirsty and drinks excessive amounts of water (Dictionary, Definition: Polydipsia, page 1). After having ingested large quantities of water, polyuria or frequent urination occurs because the bladder is constantly filled with liquid that must be eliminated. Long before being diagnosed with diabetes mellitus, my uncle seemed to have an insatiable appetite. A few minutes after finishing a meal, he claims he is hungry again and would go back to the dining room to eat. This behavior among diabetics is termed as polyphagia. The primary reason for this kind of behavior is due to the loss of excess glucose (sugar) which was eliminated through frequent urination (polyuria). Since the eliminated glucose (sugar) also contains carbohydrates and other rich organic molecules required for body energy and storage, the body compensates for it by triggering hunger that could be sated by eating frequently to make-up for the lost proteins, carbohydrates and fats. Weight loss normally occurs with people who have IDDM or type I diabetes mellitus, because the pancreas can no longer produce insulin to help glucose be absorbed within the body 2 cells. Hence, the body automatically flushes out unusable glucose and calories resulting to weight loss (Weight and Diabetes, page 1). So, even if the person exceeds his normal amount of food intake the likelihood to metabolize the carbohydrates and sugar to maintain normal levels of weight are nil, until meal intake is properly monitored and treated with proper diet management (Weight and Diabetes, page 1). Another intriguing fact about diabetes mellitus is it makes its victims very tired and weak. There may be other factors like lack of sleep or jet lag, why a person may feel tired or weak. However, tiredness and weakness when one has diabetes mellitus is a natural occurrence because the glucose (sugar) that is needed to penetrate the body cells to be converted to energy remains in the blood and is usually eliminated through natural processes since it is unusable (Weakness and Fatigue, WebMD, page 2). In order for the body to do a normal day's activity without immediately getting tired and weak afterwards, sufficient energy from proteins, carbohydrates and fats must be properly metabolized and stored within the cells. The tingling sensation and numbness of the hands and feet are regular complaints I hear from my uncle since he cannot do manual work like before. The tingling sensation and numbness which generally occurs with the feet are traced back to diabetic neuropathy. Diabetic neuropathy or nerve damage impairs the nerve's ability to transmit signals and likewise damages the oxygenated blood cells that carry oxygen and nutrients to the cells for nourishment. The damage is essentially contributed by the high blood sugar content of the blood and genetic factors that causes chemical changes preventing the nerves to function normally (WebMD, Diabetes Health Center, page 1-2). Blurred vision is another effect of having diabetes mellitus. The high sugar content within the blood causes the eye lens to swell changing one's ability to see. To eliminate the blurry vision, the blood sugar must be controlled and brought within the range of 80-140 mg/dL before meals and 100-160 mg/dL before midnight snack is given (WebMD, Diabetes and Blurred Vision, page 1). Aside from affecting the eyes' ability to see normally, recurrent skin infection and itching within the private parts are attributed to bacteria and fungi because diabetics are highly susceptible to infection. Phagocytosis ( is the activity wherein harmful elements within the cells or tissue are destroyed by phagocytes) (Blackwell's Dictionary of Nursing, page 511) is inhibited due to inadequate intracellular glucose activity, hence it prevents the normal mechanism of the body to eliminate harmful agents that could cause complications like high blood pressure, heart disease, stroke and kidney damage The etiology or cause of diabetes is not actually known. However, research shows that it probably occurs due to 1) heredity; 2) auto-immune disorder; 3) viral infection and 4) environment. Like some other disease, diabetes is inherited. So if one has a family history of diabetes and is over forty years of age have blood sugar check two hours after a good meal. This should be done continuously because many people have diabetes for years without feeling any symptom whatsoever. Auto-immune disorder pertains to the destruction of certain cells that produces hormones for the body's normal function. So if the blood has a high content of sugar (glucose) that cannot be metabolized or used and is needed by the body, abnormal chemical changes occur triggering the body's defense system to attack the cells in the pancreas that produces the insulin. If this happens, said cells will be unable to manufacture insulin. Another cause of diabetes is environment which encompasses lifestyle and diet. An individual who has vices and unchecked diet is more prone to having diabetes. Vices like smoking and drinking are factors that magnify the complications of diabetes because they contribute carcinogens that affect 3 the internal organs like the kidney and the blood cells. Likewise, a diet that is always high in sodium and fats increases the chances of acquiring diabetes and having complications therein. Having diabetes means a lifelong treatment that includes the following home care management ( The Family Health Guide, page 285): 1) sticking to low fat and a high fiber diet; 2) if overweight – lose weight; 3) control sugar intake; 4) exercise regularly; 5) regularly inspect the body, especially the feet, for wounds or infections; 6) shave carefully; 7) practice good hygiene; 8) maintain good dental health; 9) take prescribed medicine religiously; 10) constantly monitor blood or urine sugar. Maintaining a low fat and a high fiber diet decreases the chance of acquiring diabetes or preventing complications associated with the disease. A high fiber diet consisting of fruits and vegetables is preferred for diabetics because fiber, when ingested is easily broken down and easily eliminated as well. Losing weight and regular exercise controls the high sugar content of the blood because exercising helps the body burn fats and carbohydrates thus, helping keep the glucose within normal levels. Exercise also decreases the risk of heart disease. Moreover, sugar intake must be controlled at all times because high sugar content in the body fluids makes it susceptible for the development of bacteria due to the body's impaired auto immune system. It is best to regularly monitor blood and urine sugar to ward off any complications that may arise. This being so, a regular inspection of the body, especially the feet must be done everyday to detect wounds or infection. A good hygiene must be practiced at all times to prevent bacteria and fungal growth. Shaving and cutting of finger nails and toe nails must be done with great care to avoid wounds, because wounds do not heal fast in diabetics due to the blood's sugar content making coagulation hard to achieve. Like with other diseases, it is best to take prescribed medicines religiously and not to stop medication without consulting the doctor or physician. Most people with diabetes mellitus are always advised by physicians and other health workers to implement proper foot care. Since diabetes impairs a person's sense of touch due to nerve damage (Diabetic Foot Disease, Infection page 1), cuts, lesions, blisters, sores, scratches, discoloration and ingrown toenails should be reported immediately to the physician so proper medical care could be administered. Individuals with diabetes are more susceptible to infection because their system lacks the proper defense mechanism of defending itself from harmful elements. Due to the high sugar content within their bloodstream, peripheral vascular disease or blocked arteries occurs on the legs (Diabetic Foot Disease, General page 1) are common complications of diabetes. To avoid foot infection or ulceration, my uncle religiously follow the home treatment care plan his physician described which are (Family Health Guide, page 65): 1) drying the feet well especially in between the toes to prevent any fungal growth; 2) changing socks daily and uses cotton ones because synthetic socks makes feet perspire and that might lead to infection; 3) checks the inside of his shoes to make sure that there are no pins or pebbles inside which might cause wounds or any roughness that might irritate his skin; 4)wearing shoes that fit well and does not walk barefoot inside or outside the house; 5) washing feet with lukewarm water and mild soap; after which he applies lanolin, except between the toes and dusts his feet with foot powder or baby powder. By doing his foot care religiously, so far he has not contracted any foot infection or complications. Metabolism is a very interesting part of Physiology and Anatomy because it provides in-depth understanding on why a disease such as diabetes could cause severe abnormal physiological conditions that may lead to complications or death. Metabolism is very important because it requires the balance of proper chemical reactions within the body. Meaning the energy 4 or nutrients within the body must be able to support the required energy that is to be burned when doing a certain activity. Taking the preceding statement into consideration, body weight is dependent on the amount of food that is ingested and converted to nutrients or energy. Thus, eating more than the required energy to perform one's normal daily activities will result to being overweight or obese, whereas eating less than the required energy to do a strenuous activity for a period of time results to weight decrease. Observing my uncle following the home care treatments his physician recommended made me aware that there must be a proper balance in everything we do. Further, balance is also required by nature and the human body to function normally. 5 The following images are related to my study of diabetes, it is important for diabetics to know the significance of insulin absorption (Family Health Guide, page 64) and the appropriate injection sites (Diabetes Self management, page 1-2): Insulin Injection Sites Self-administered insulin is injected or infused into the fatty tissue just under the skin. The body areas used most commonly for insulin injections are the abdomen, buttocks, and thighs. The backs of the upper arms may be used as well. To avoid skin problems, inject at least a finger’s width away from your last injection. To avoid absorption problems, don’t inject near moles, scars, or your navel. 6 References Blackwell's Dictionary of Nursing. Osney Mead, Oxford: Blackwell Science Ltd.; 1994 Diabetes Self-Management. (n.d.) Retrieved on March 19, 2008 from http://www.diabetesselfmanagement.com/pdfs/pdf_2184.pdf Dictionary. Definition. Polydipsia. (n.d.) Retrieved on March 18, 2008 from http://www.kidshealth.org/parent/diabetes_basics/dictionary/polydipsia.html Dictionary. Definition. Polypghagia. (n.d.) Retrieved on March 18, 2008 from http://www.kidshealth.org/teen/diabetes_basics/dictionary/polyphagia.html Family Health Guide. Diabetes. MediMedia; 2003 Sorensen, L., Wu, T., Constantino, M., D.K. Diabetic Foot Disease. An Interactive Guide. General. (n.d.) from http://www.diabetes.usyd.edu.au/foot.geninfo.html Sorensen, L., Wu, T., Constantino, M., D.K. Diabetic Foot Disease. An Interactive Guide. General. (n.d.) from http://www.diabetes.usyd.edu.au/foot/Infect.html WebMD. The Nerve Damage of Diabetes. Diabetes health Center. (n.d.) Retrieved on March 18, 2008 from http://diabetes.webmd.com/nervedamage.diabetes WebMD. Diabetes Health Center. What is Diabetes? Blurred Vision. (n.d.) Retrieved on March 18, 2008 from http://diabetes.webmd.com/diabets-blurred-vision WebMD. Weakness and Fatigue. Topic Overview. Better information. Better health.(n.d.) Retrieved on March 18, 2005 from http://www.webmd.com/a-to-z-guide/weakness-and-fatigue-topic-overview?page=2 Weight and Diabetes. Teens Health. Nemours Foundation, April 2007. Retrieved on March 18, 2008 from http://kidshealth.org/teen/diabetes_basics/what/weight_diabetes.html Wilson, Kathleen J.W., Waugh, Anne. Ross and Wilson Anatomy and Physiology in Health and Illness. New York, N.Y.: Churchill Livingstone, Inc.; 1996 Diabetes Self Management http://www.diabetesselfmanagement.com/pdfs/pdf_2184.pdf Injection sites for insulin: (Family Health Guide, page 64) Abdomen – fast absorption Arm – intermediate absorption Thigh – slow absorption Buttock – slow absorption Read More