How to Deal with Diabetes - Assignment Example

DIABETES- MANAGEMENT By Diabetes- Management Question Adults at the age of forty years and above are at an increased risk of contracting diabetes thus some of the areas that will be explored when assessing Jazminder are as follows. To begin with the assessment will try to study if she has demonstrated any of the obvious symptoms that would imply the presence of diabetes. Since she indicated that her sister had been recently diagnosed with the disease, it is prudent to note that Jazminder has a history of diabetes in her family. Thus, I will try to explore if she has ever experienced any form of gestational diabetes during pregnancy or has she ever given birth to a child weighing more than nine pound. Additionally, elements such as body weight will be explored to furnish the assessment with knowledge of whether she is obese or not and issues such unexplained weight loss in the past or instances of being diagnosed with high blood pressure in the past will be explored to examine the bigger picture of the patient’s health history. Similarly, the assessment will try to identify whether Jazminder has any history of cardiovascular disease, blurred vision or ever experienced sores that do not heal. The areas assessed above are important since they give the medical practitioner a hint of the history of the patient concerning the symptoms of the disease. It is from this premise that the practitioner will have ground to order for a diagnosis to determine if the patient indeed is suffering from diabetes or not (Chan, 2005). There are three primary tests that can be conducted to diagnose whether Jazminder is suffering from diabetes they include the following; Oral Glucose Tolerance Test (OGTT), Fasting Plasma Glucose (FPG), and A1C test also known as Glycohemoglobin test. The tests are designed to diagnose various aspects of diabetes, and thus the results obtained will give a better indication of the probable type of diabetes that Jazminder is likely to be suffering. Results from A1C test are generally presented in the form of a percentage. That is the higher the percentage obtained, the higher the blood glucose levels in that individual. An average person is supposed to get a glucose level of 5.7 %, results that range between 5.7-6.4% will confirm the diagnosis of prediabetes; however, the test will need to be retaken after one year. If Jazminder record a glucose level percentage that is greater than 6.4 then she is probably suffering from diabetes. Results indicating blood glucose level of below 5.7% might also put Jazminder at risk depending on the risk factors that she demonstrates. The FPG test measures blood glucose level after she has been subjected to eight hours of fasting, if the results indicate glucose level of 100-125mg/dL then Jazminder has an impaired fasting glucose alternatively referred to as prediabetes. Relatively, if a result of above 126mg/dL that is confirmed by a repeat test, then Jazminder has diabetes. Oral Glucose Tolerance Test measure the blood glucose level after eight hours of fasting and two hours after the individual has taken 75g of glucose dissolved in water. Results indicating anything between 140-199mg/dL mean Jazminder has an impaired Glucose Tolerance while glucose level of 200mg/dL or above that value means Jazminder is diabetic (“Nice Clinical Guide 87”, 2014). Question 2 Type 1 is commonly a disease of the young people with its peak incidence at age 10-12 years for female and 12-14 for the male counterparts. However, type 1 diabetes can still occur at any age but statistics indicates that a significant number of type 1 cases are reported before the age of 20 years. The disease is a cell-mediated autoimmune damage that is caused by the pancreatic beta islet cells that make them unable to produce insulin according to the demands of the body thus eventually leading to an acute insulin deficiency hence subjecting the individuals involved to a diabetic ketoacidosis (DKA) condition. Research on the autoimmune nature of type 1 diabetes has been done extensively, and the pathogenesis of the diseases can be explained by the interaction between the environment and genetics (Guthrie, 2002). Currently, there are no exact scientific causes that have been found to be responsible for causing type-1 diabetes but genetic and epidemiological studies point a strong genetic element for the development of the disease. However, approximately 90% of the people who are suffering from the illness do not have any close relative who is infected with diabetes but history of the ailment in the family has been a significant factor in predicting the occurrence of diabetes. Some of the clinical presentation that are frequently experienced by patients suffering from this type of diabetes include; blurred vision, being excessively thirsty, feeling tired and lethargic, having unexplained weight loss, always feeling dizzy, passing out a lot of urine just to name but a few. When combinations of these symptoms are experienced, the patient needs to see a medical practitioner for diagnosis to be carried out since they imply the presence of type 1 diabetes (Winter and Signorino, 2002). Type-2 diabetes is the most prevalent of all other forms of diabetes. It accounts for approximately 90% of all cases of diabetes that are reported. Type-2 diabetes is common among the adults, and its incidences are high at the age of 45years and above. The disease is characterised by fluctuating degrees of a combination of insulin resistance and insulin deficiency. The earliest defect that characterises type-2 diabetes in its pathogenesis in insulin resistance and this is typically caused by obesity, lack of physical exotics that makes the islet cells of the pancreas to strain in the production of more insulin to meet the increased demand for the muscles and fats in the body. Hyperglycaemia takes place when there is a mismatch the insulin secreted as dictated by the islet cells and the insulin required for the body as dictated by insulin resistance. Type-2 diabetes has a strong genetic base to its development and thus in most cases it has always been perceived that it is caused by interplay between genetic factors and the environment. Conversely, there is no precise cause that has been singled out as being responsible for the cause of type-2 diabetes. The role that genetics and the environment play are mainly out of research that is based on the pathogenesis of the disease. Unlike in type-1 diabetes people suffering from type-2 diabetes will not depict any typical symptoms but the disease can only be identified by screening or if they have chronic complications such as stroke or myocardial infarction (Bantle, 2006). Question 3 Microvascular Complication of Diabetes Diabetes Retinopathy Diabetes retinopathy is the most common microvascular complication that is associated with the disease. The risk of developing diabetes retinopathy largely depends on the duration and severity of hyperglycemia. The condition leads to partial, and even permanent blindness to diabetic patients due to the as the surface cells on the retina are infected thus hampering sight. Diabetes Nephropathy It is the leading cause of renal failure in the United Kingdom. The condition is characterised by proteinuria that is 500mg/24 hours in the setting of a diabetic patient that is preceded by lower instances of microalbuminuria or rather albuminuria secretion of between 30-299mg/24 hours. In situations where medical intervention is not sought patients with microalbuminuria will progressively move from into proteinuria and finally diabetic nephropathy within a short period. Screening of microalbuminuria or rather diabetic nephropathy can be conducted by either using a 24-hour urine collection or alternatively performing a spot urine test to measure the micro albuminuria-to-creatinine ratio in order to determine the extent of concentration of dilution of the individual’s urine (Dunning, 2007). Diabetes Neuropathy Diabetes neuropathy is characterised by the presence of signs and symptoms of peripheral nerve dysfunction in diabetic individuals after the exclusion of all other possible causes. Just like another microvascular complication diabetes neuropathy develops as a result of the magnitude and duration of hyperglycemia. Peripheral neuropathy in diabetes manifests itself in various forms such as focal, sensory and autonomic neuropathy. A significant number of amputations that are done to diabetic patients are as a result of peripheral neuropathy (“Nice Clinical Guide 87”, 2014). Macrovascular Complications of Diabetes Arteriosclerosis The complication is characterised by the narrowing of the artery walls throughout the body. Majorly it is attributed to an injury or chronic inflammation to the artery walls in the coronary vascular system and at times in the periphery. The condition causes less blood to flow in those vessels and thus straining the heart and it often results in heart attacks or heart failures that are fatal in most instances. Cardiovascular Disease (CVD) Cardiovascular disease is a common macrovascular condition that is often associated with diabetes however the mechanism through which diabetes increases the probability of the condition has not yet been extensively explained but still the relationship between the two conditions is still profound based on the prevalence among diabetic individuals. Conversely, cardiovascular disease is a typical cause of death for patients suffering either type-1 or type-2 diabetes (Scotland, 2010) Question 4 It is evident that despite undergoing treatment plans a significant number of type-2 diabetes spends a considerable portion of their lives after diagnosis with inadequate controlled blood glucose levels. Glycaemic control for patients with type-2 diabetes is useful to delay the onset of macrovascular complications such as a coronary artery, periphery artery disease, and stroke. Similarly, it has demonstrated a beneficial effect on microvascular complications such as neuropathy, retinopathy, and renal failure when it is achieved and maintained at earlier stages of the disease. Type-2 diabetes is a progressive disease that requires a combination of efforts to treat and manage it. For useful results to be obtained the condition needs medication, lifestyle measures as well as proper monitoring to ensure longevity of the patients’ lives, as well as the quality of life after diagnosis. Assessment of glycaemic control for type-2 diabetes involves adequate oversight of the targets that have been earlier implemented utilising the individualistic plans that each patient adopts. Typically, the goals are set after a discussion has been made and compromise reached between the clinician and the affected person. The care plans need to be reviewed periodically whenever the set target have not been achieved by engaging the patient in discussion to avoid instances of barriers to change to ensure monitoring of the disease is not hampered (Zazworsky, Bolin, & Gaubeca, 2006). Frequently, the HbA1c targets are set by the patients in partnership with the medical practitioner to come up with an individualistic goal that can be attained by the person involved in order to avoid incident whereby the patient might think he/she is being subjected to undue treatment process. During assessment whenever the set targets are not achieved it is prudent that they ought to be reviewed so as a more practical target can be configured to ensure that there is some progress to encourage the patient as well as control the blood glucose level (Unger and Schwartz, 2013). Typically, the standard HbA1c target that is recommended is 50-55mmol/mol. When it is evident that the target that had been set in glycaemic control has not been achieved, there are a number of pharmacological strategies that can be implemented to facilitate the process. The administration of metformin is the initial pharmacological intervention that will be applied. The drug is meant to decrease the glucose formation in the liver while it enhances peripheral utilization of glucose It is effective in overweight patients. Additionally, sulfonylurea can incorporated to metformin if the patient has not achieved the glycaemic control target after 90 days. The drug is effective as it increases the rate of insulin secretion in cases where the patient has pancreatic beta-cells that are functional. All these efforts are meant to ensure that relevant measures are implemented with the primary goal of ensuring the patient achieves the target set in glycaemic control since it is crucial to the progression of the disease. It is prudent that if the blood glucose level is not monitored keenly the patient will remain susceptible to macro and microvascular complications (Bandello et al., 2014). References Bandello, F., Zarbin, M. A., Lattanzio, R., & Zucchiatti, I., 2014. Clinical strategies in the management of diabetic retinopathy: a step-by-step guide for ophthalmologists. Bantle, J. P., 2006. Nutritional management of diabetes mellitus and dysmetabolic syndrome: [11th Nestlé Nutrition Workshop ... Hangzhou, China, October 30 - November 3, 2005]. Basel [u.a.], Karger. Chan, J. C. N., 2005. A manual for management of diabetes mellitus: a Hong Kong Chinese perspective. Hong Kong, Chinese University Press. Dunning, P. T., 2007. Complementary Therapies and the Management of Diabetes and Vascular Disease a Matter of Balance. Chichester, John Wiley & Sons. Retrieved from Guthrie, D. W., Guthrie, R. A., & Guthrie, D. W., 2002. Nursing management of diabetes mellitus: a guide to the pattern approach. New York, Springer. Nice Clinical Guide 87.2014. Type 2 Diabetes, The Management Of Type 2 Diabetes. Available at: //www.nice.org.uk/guidance/cg87 [Accessed on 14 May. 2015] Scotland, 2010. Management of diabetes, a national clinical guideline. Available at: http://www.sign.ac.uk/guidelines/fulltext/116/ [Accessed on 14 May. 2015] Unger, J., & Schwartz, Z., 2013. Diabetes management in primary care. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins. Winter, W. E., & Signorino, M. R., 2002. Diabetes mellitus: pathophysiology, etiologies, complications, management, and laboratory evaluation: special topics in diagnostic testing. Washington, DC, AACC Press. Zazworsky, D., Bolin, J., & Gaubeca, V. B., 2006. Handbook of diabetes management. New York, Springer. Read More