Diabetes Management - Report Example

Diabetes, which is a chronic metabolic disorder, is characterized by a reduced metabolism of carbohydrates, fats and proteins in the body. This is a result of a lack or inefficient functioning of the hormone insulin, which is secreted by the beta-cells of the islets of langerhans in the pancreas. A complete lack of the insulin hormone results in type 1 form of the disorder. In cases where the insulin is secreted by the cells but is not effectively utilized by the target cells due to a defect in the cell-receptor for the hormone or reduction in the secretion of the hormone by the islet cells, the type 2 form of the disorder ensues. In some pregnant women resistance to the insulin hormone can occur during the gestation period resulting in a rise of blood sugar level (Diabetes Management). The type 1 and type 2 form of the disorder are the most prevalent. They however, differ in their onset and causative factors. While the type 1 form occurs in individuals who are genetically predisposed to the disorder, inheritance of specific genetic components has also been found in case of the type 2 diabetes. Exposure of certain environmental agents such as viruses, toxins and the presence of stress has also been linked to the onset of the type 1 diabetes, while no specific environmental agents have been associated with the type 2 form of the disorder. Overt symptoms of the disease occur when there is an autoimmune destruction by the body immune cells on the beta cells in the islets that causes the death of about 80-90% of the cells. This thereby halts the normal production of the insulin hormone. However, no such autoimmune reactions have been known to cause the type 2 form of the disease, which typically result due to defects in the insulin receptors which are present in different tissues that in turn results in a reduced uptake of the hormone by the specific organ and inefficient functioning. In some cases aging can also cause the pancreatic cells to produce less amount of the insulin hormone. Another reason could be the excessive secretion of glucose by the liver cells and the corresponding reduction in the secretion of sufficient insulin (Diabetes Management). Poorly controlled diabetes in the long run may lead to macrovascular as well as microvascular complications which have been found to be a cofactor in morbidity and also the leading cause of mortality among people. The macrovascular complications are mainly associated with the heart and blood disorders with ischemic heart disease (IHD), peripheral vascular disease and stroke being the major complications. Studies have shown that compared to the normal population people with diabetes have a 2 to 8 fold increased risk for developing cardiovascular problems and its related mortality. Other major complications of the diabetes such as the risk for developing hypertension and dyslipidemia increase the risk of development of IHD. The microvascular complications of the disorder include peripheral neuropathy which could lead to limb amputations in the additional presence of a peripheral vascular disease, diabetic retinopathy which is the leading cause of blindness in diabetics, and diabetic nephropathy which when left untreated can lead to kidney diseases and finally end-stage renal disease and mortality (Home, 2003). Thus the complications associated with poorly controlled diabetes potentially decrease the life expectancy of the individual and also cause significant socioeconomic problems both for the individual and their families and the healthcare industry (Home, 2003). The medications used in the treatment of type 1 and 2 differ as the type 1 form of the disorder in which the secretion of insulin is absent or severely affected insulin is administered as the fundamental treatment modality. In type 2 diabetes, combination drugs are used depending on the metabolic condition of the individual and insulin treatment is administered in case the other medications are not effective in controlling the blood sugar levels. The insulin injections administered include fast action, intermediate action and prolonged action insulin’s and these are administered in the conventional as well as intensive therapy modes. In case of the conventional therapy one or two injections of insulin are given based on the blood glucose levels which are constantly monitored. In patients with higher levels of blood glucose levels intensive therapy is given with 3 to 4 multiple doses of insulin along with frequent monitoring of blood glucose levels. Medications are prescribed for type 2 form of the disorder in cases where control of blood sugar level is not achieved through diet and exercise. The most commonly prescribed medications are sulfonylurea’s which are first treatment choice for diabetics who are not obese and they work by stimulating the secretion of preformed insulin by the pancreatic cells through high-affinity receptors present in the beta cells. However, these are not prescribed to patients who are allergic to sulfonamides, have type 1 form of diabetes in which the pancreas are unable to produce insulin and those who have undergone pancreatectomy. Secretagogue drugs such as repaglinide and nateglinide which activates the beta cells to produce insulin in short intervals post-prandial and not during fasting. Another class of drugs, the biguanides, which have been used since the middle ages for the treatment of diabetes have become a more popular form of medication that are administered. These drugs, which include metformin, work by reducing the glucose produced by the liver through glyconeogenesis and glycogenolysis and also increase the uptake of glucose by the muscle. In addition to reducing the release of excess sugar into the bloodstream they have also shown to reduce the triglyceride levels, improve the flow of blood and fibrinolytic activity. The Thiazolidinediones which are prescribed only in combination therapy due to its potential in causing hepatotoxicity works by stimulating the genes responsible for the increase in both number and affinity of receptors to insulin in peripheral tissues such as muscle and adipose tissues. Hence as these reduce the resistance of insulin to uptake by various tissues their action requires the presence of an insulin reserve. The final class of drugs, the alpha-glycosidase inhibitors inhibits the intestinal glycosidase enzyme thereby reducing the absorption of post prandial carbohydrates (Simo & Hernandez, 2002). The main goals of diabetic nutritional management should be to maintain an ideal blood glucose level corresponding to the age, height and weight and lifestyle of the individual and also normal levels of blood pressure and lipid levels as a preventive measure for development of complications associated with diabetes. The carbohydrate component of the diet should comprise about 45% of the total calories and should include high-fiber cereals, breads, grains, legumes, vegetables and fruits and low-fat dairy products. Small quantities of added sugar in the form of sucrose or fructose can be incorporated into the diet. About 25-50g of dietary fiber which may include both insoluble as well as soluble dietary fibers should be included in the diet that would help to slowdown gastric emptying thereby reducing hunger pangs. A 15-20% intake of dietary protein in the form of vegetable protein is recommended. A fat intake of less than 35% comprising majorly of monounsaturated, polyunsaturated and lesser quantity of trans fat can be taken in the diet. Fish fat that is rich in omega fatty acids and plant sterols that lower LDL cholesterol should also be included in the diet. Vitamins and minerals should also be included in the diet by including colored fruits and vegetables (De Melo, n.d). Studies have revealed that exercise increase the oxygen consumption throughout the body by nearly 20-fold with larger increases occurring in the muscle tissues. for the additional energy requirement the body utilizes the stored glycogen in muscle tissues as well as triglycerides and free fatty acids which are obtained from the adipose tissue. And in case of diabetic patients it is widely believed that exercise improves their sensitivity to insulin and helps maintain the blood glucose levels at a normal range. Apart from glycemic control exercise has also shown to decrease the risk of cardiovascular problems, hyperlipidemia, hypertension, and obesity. In case of patients with type 1 form of the disease the hypoglycemia that could result either during or after exercise can be alleviated through the appropriate use of insulin therapy and those individuals who are free from any other complications due to the disorder can engage in regular exercise activities (Diabetes Mellitus and Exercise). Teaching plan for diabetes mellitus type 1 Insulin administration: a person who is newly diagnosed with diabetes type 1 can be subjected to conventional insulin therapy which may include one or two injections of insulin along with regular checking of blood sugar levels. The dosage of insulin can be altered based on blood sugar measurements. Diet: in addition to the regular diet as mentioned above for diabetic patients, replacing high-glycemic foods by low-glycemic foods will help in slower absorption of glucose from the intestine and thus help to achieve glycemic control in people with type 1 form of the disease. Such foods will also help reduce the A1C levels and the occurrence of hypoglycemia. Exercise: people with type 1 diabetes can engage in routine exercises, leisure activities and recreational and professional sports provided they do not suffer from any complications associated with the disorder. The insulin regimen can be altered based on the activities performed by them. References 1. Diabetes Management in the School Setting. (2009). Retrieved 4 August, 2011, from http://health.mo.gov/living/healthcondiseases/chronic/diabetes/pdf/DMOverview.pdf 2. Home, P. (2003). The challenge of poorly controlled diabetes mellitus. Diabetes Metabolism, 29: 101-109. Retrieved 4 August, 2011, from http://www.alfediam.org/media/pdf/Home_dm2.pdf 3. Simo, R., & Hernandez, C. (2002). Treatment of Diabetes Mellitus: General Goals and Clinical Practice Management. Rev.Esp.Cardiol, 55(8): 845-860. Retrieved 4 August, 2011, from http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13037902&pident_usuario=0&pcontactid=&pident_revista=255&ty=7&accion=L&origen=elsevier&web=www.revespcardiol.org&lan=en&fichero=255v55n08a13037902pdf001.pdf 4. De Melo, M. (n.d). Nutritional Management of Diabetes Mellitus. Retrieved 4 August, 2011, from http://www.bbdc.org/diabetesmanagement/chapter3.html#Ch3-S1 5. Diabetes Mellitus and Exercise. (2002). Diabetes Care, 25(1): s64. Retrieved 4 August, 2011, from http://care.diabetesjournals.org/content/25/suppl_1/s64.full.pdf+html Read More