Diabetes Mellitus

Question: Discuss about theDiabetes Mellitus. Answer: Introduction: Mrs. Elizabeth is a 65-year-old lady living with her two 26-year-old twin daughters. She has type 2 diabetes mellitus which she was diagnosed with ten years ago. She reports that she attends a local diabetic patient group meeting composed of 17 individuals where they regularly share their experiences with the condition and receive education from a community healthy provider. She has been using oral hyperglycemic agents as well as injectable insulin therapy in the management of her condition. She started to use insulin therapy exclusively due to the ineffectiveness of the oral hyperglycemic agent-metformin that failed to improve her condition due to lack of adherence to the prescribed daily intake. She reports to be forgetful and hates taking any oral drugs but prefers injectable medication. She was hospitalised 12 years ago after sustaining a fracture of her left lower limb femur after falling while she was jogging as a part of her thrice a week morning exercises. On hospitalisation, she was further diagnosed with a secondary diagnosis of hypertension which she has also been managing with an intake of oral hypertensive medication such as hydralazine combined with hydrochlorothiazide. Initially, before she retired at the age of 50 years, she used to involve herself in community activities and excesses since she is a fan of athletics. On the other hand, she used to smoke and drink alcohol a habit she developed since she was in college in her twenties. At the moment, she takes alcoholic beverages and occasionally smokes regardless of being advised against it after being diagnosed with diabetes and hypertension. She trained as a banker in college, and she has been working as one until she retired. After retiring, she started managing her supermarket business investments where she is driven to and picked from each morning and evening respectively. Her favourite food is beef which she takes at least five times a week. In addition, she consumes a variety of snacks daily accompanied with coffee. After retiring, she never involved herself in her routine jogging exercises but reports that she felt too old and exhausted to perform them regularly as she used to before. In ad dition, she states having developed poor eyesight of late years, a factor that she attributes to her falling after tripping and sustaining a fracture of the femur while she was jogging. Furthermore, she currently has a foot ulcer that she developed about six months ago. She receives a check-up four times a week from a home-based healthcare provider who is also a podiatrist besides her foot being dressed daily to prevent infection and deterioration of her condition but promote healing (Zochodne Malik, 2014). She has a height of 1.65 meters, a weight of 102 kilograms and a body mass index (BMI) of 37.47 kg/m2. She is, therefore, obese, one of the risk factors for both type 2 diabetes mellitus and hypertension besides other cardiovascular diseases (Watson Dokken, 2014) Some of the non-pharmacological interventions that have been recommended and used in the management of her diabetic condition include development of a strict diet plan, exercises, health education to create awareness of the risk factors, complications, and self-management, losing weight. Moreover, health care providers have utilized cognitive behaviour therapy, motivational interviews, and assessment of eating disorders in the effort to manage her diabetic condition non-pharmacologically. However, due to lack of adherence to treatment strategies by Mrs. Elizabeth and other diabetic individuals, there is a need for the community health care management team to utilize the diabetic model of care in order to provide quality ser vice delivery and consequently improve their clients conditions (Dunning, 2014). Most of the individuals affected by type 2 diabetes mellitus in this locality and most other communities are those aged above 60 years. However, other age group individuals are also affected but at a significantly lower rate. Type two diabetes mellitus is a metabolic disease that develops over time, and it is characterised by resistance to insulin, and consequently high blood glucose levels and in some cases, there can be reduced insulin production (Daniels, 2012). It is closely associated with some risk factors that are most prevalent in the locality of my current clinical practice that includes lifestyle aspects such as inadequate dietary intake that leads to overweight and obesity. Obesity is the leading cause and risk factor of type two diabetes mellitus. High accumulation of fat cells throughout the body plays a significant role in the development of insulin resistance and hence there is the establishment of the condition. Secondly, most individuals engage in recreational intake of alcohol, smoking, and sedentary lifestyle. Alcohol consumption and tobacco smoking contribute to the rapid progression of type 2 diabetes mellitus, cardiovascular diseases such as hypertension and even renal diseases (Novak, Costantini, Schneider Beanlands, 2013). They may also predispose one to several other mental diseases that have an impact on the social and eating behaviours of the affected individuals. Eating disorders such as binge eating disorder as well as bulimia nervosa have far-reaching detrimental effects on the affected persons health besides markedly contributing to the development of other risk factors such as obesity (Behshid Garrusi, Mohammad Reza Baneshi Samaneh Moradi, 2013). On the other hand, the most affected population (above 60 years) mostly engage in no physical activities such as exercises due to their advanced age or other health conditions that hinder them from being able to do these activities. Thus most of these individuals lead a sedentary lifestyle that leads to obesity that is implicated in hypertension and diabetes as well as other cardiovascular and renal diseases (Daniels, 2012). Lack of adequate health education and information among the general population usually, predisposes them to lifestyle conditions like diabetes, hypertension among others due to lifestyle practises, lack of regular medical check-ups and lack of adherence to disease management programs that prevent further progression and deteriorations. On the other hand, there are a number of physical, socio-economic, cultural and religious determinants that are related to diabetes mellitus affecting this population. Firstly, a broad range of cultural beliefs and practises that are diverse have both positive and negative influences on the health of the people and their health seeking behaviours (Commers, 2012). For instance, it has been noted that males are generally reluctant in the search for medical services at the early onset of illness as compared to their female counterparts. In the same way, adherence to the treatment programs is higher in females than males a factor that has a negative impact on the progression of the particular diseases in men. Secondly, social, economic status is related to type 2 diabetes mellitus in that it is majorly experienced by the high social class individuals due to a sedentary lifestyle and poor dietary habits. On the other hand, it may be attributed to substandard education, low income, lack of access to specialized health care, lack of exposure to mass media, the high cost of living, poor health services and lack of insurance cover for those affected by the low social class. The discrepancy in the government policies that are concerned with the regulation of smoking, intake of alcohol and other substances also have detrimental effects on the health of the entire population. For instance, smoking in public exposes every non-smoker to tobacco effects since they are passive smokers and therefore may experience the same effects as the active smoker albeit different in intensities depending on the amount and duration of exposure. Finally, family history, age, and genetic factors are other non-modifiable determinants of health that have a broad range of impacts on the health of the population. Advanced age and those with a history of obese and diabetes have a greater risk of developing this condition as compared to the general population who have no family history of the condi tion. Furthermore, family history can be closely associated with genetic and hereditary traits that are passed on from generation to another through offspring that increase the risks of developing type 2 diabetes mellitus in some individuals than others (World Health Organization, 2013). Pharmacological interventions that are provided in the management of diabetes, as well as its complication, have different mechanisms of action hence affecting various body tissues that are affected by type 2 diabetes mellitus pathophysiology. In essence, development of these interventions, diagnosis, and prescription of medications in the treatment of these conditions is largely dependent on the understanding of their pathophysiology. Environmental and genetic factors are the initiators of type 2 diabetes mellitus initiators. It can be due to impaired insulin secretion or due to generalized insulin resistance in the body but in most instances, these factors coexist. Due to dysfunction of pancreatic beta cells, there is reduced or no release of insulin in response to increased blood glucose a common phenomenon in healthy individuals. This dysfunction is caused by reversible metabolic abnormalities such as glucotoxicity and lipotoxicity, hormonal imbalance in the body, increased apopt osis of beta cells in the pancreas (Copstead Banasik, 2013). Reduced insulin production, therefore, leads to hyperglycaemia which is termed as type 2 diabetes mellitus. This condition is progressive, and its effects are typically felt when the body is unable to adapt to the increasingly high blood glucose levels due to permanent destruction of the beta cells. On the other hand, it can develop due to increased resistance to insulin by the body cells. There is the usual production of insulin by the beta cells only that the insulin does not exert an adequate effect on the insulin receptors in the body cells especially the muscle and liver cells due to resistance. Development of the disease in this manner is linked to genetic factors that affect insulin signals in the cells more than the environmental factors. Obesity increased fatty acids and adipokines also contribute to the increase of this resistance. This leads to lack of conversion glucose to glycogen and uptake of glucose by cel ls. Therefore, pharmacological interventions such as insulin therapy are aimed at supplying the body with enough insulin in the case of reduced or no production in order for the blood glucose regulation to occur normally. It enhances the storage and metabolism of carbohydrates, proteins, and fats which occur primarily in the liver, muscles and adipose tissue where there is a large number of its receptors on the cellular plasma membrane. It is also known to affect cell membrane transport characteristics, cellular growth, enzyme activation and changes in protein and fat metabolism by promoting rapid uptake of these substances by cells. However, caution should be taken when administering injectable insulin not to result in hypoglycaemia, a condition that has detrimental effects on ones health to the extent that it can cause death. Oral hyperglycemic agents such as chlorpropamide act by mainly stimulating the release of insulin from functional beta cells of the pancreatic islet tissue. Another oral hyperglycemic agent, metformin acts by decreasing gluconeogenesis and increasing peripheral glucose metabolism and therefore controlling the high glucose levels in the blood (Bennett, Brown Sharma, 2012). High glucose levels in the blood increase the oncotic pressure within the cardiovascular system hence leading to retention of more water and causing cardiovascular overload. Since ones blood pressure is directly determined by volume and resistance, it rises with this increased water retention and therefore causing hypertension. This condition may worsen over time if not controlled by lifestyle modifications such as reduced sodium intake. It may also significantly influence the development of renal diseases, stroke, and other cardiovascular diseases. Other complications that are known to be as a result of diabetes are foot ulcers and peripheral neuropathy. In order to control hypertension and prevent further complications, one is offered antihypertensive therapy such a s hydralazine and hydrochlorothiazide (Randall, Kendall Alexander, 2012). The best outcome for this population is improved knowledge of the risk factors, causative factors, and self- management strategies. According to (Dunning, 2014), improved health information delivery through health information dissemination channels, medical education and social media promote acceptance of lifestyle changes that lead to reduced risk for development of the disease. Most people develop an insight on which diet they are supposed to take in order to prevent the inception of the condition. Health seeking behaviours also significantly change when individuals receive adequate information on the complications associated with late seeking medical attention. Secondly, self-management is the patients behaviour that is aimed at monitoring their condition and avoiding further progression and complications by self-administering prescribed medication or seeking advanced treatment. Self-management comes as a result of understanding the essence of primary care and by having self-motiv ation. It is both easy and cost effective since it requires no specific procedures. Daily monitoring of blood sugars will let the patient know about the progress of their conditions and take earlier actions that have positive effects on their health. In Mrs Elizabeths management and other diabetic patients in her locality, there is need to utilize the diabetic model of care as well which is composed of eight priorities which include; enhancing community and targeted promotion of healthy environment and lifestyle to curb diabetes, improved and coordinated activities of diabetes management services, involving specialists in the management and prevention, ensuring access to management and guidelines for the affected population, developing supplemental useful information and technology systems and training more multi-professional experts (Ricci-Cabello et al. 2013). However, there are several limitations and hindrances to meeting these outcomes. Firstly, it requires that one invests in purchasing the glucose monitoring glucometer that may be a challenge among those from a low social class. Some individuals may be too old and having no social support, and therefore adherence may be poor. As well, other health factors such as mental and neurological illnesses such as neuropathy, disability, and dementia may hinder one from performing these self-management procedures independently (Peu, 2012). Due to substandard education and illiteracy as well as the language barrier, information dissemination, and comprehension by the targeted population may be jeopardized, and thus the careful choice of the media for health literacy should be made for any particular group. In conclusion, Elizabeths condition, as well as those of her locality suffering from type 2 diabetes mellitus, can be managed with the utilization of various strategies. These strategies reduce the chances of developing complications and therefore improving their health. Besides managing the initial condition, other associated underlying conditions such as hypertension should also be managed and treated. The various approaches that are available for management include pharmacological and non-pharmacological interventions. The most common pharmacological interventions employed are exercises, diet modification, low sodium intake, cessation of alcohol intake and smoking. However, the choice of which non-pharmacological intervention depends on the general health condition of the affected individual. For instance, Mrs. Elizabeth can only use all of these interventions except exercises due to the leg ulcer that she has as well as a poor vision which can result in more injury and deteriorat ion of her general health. The pharmacological interventions that are essential in the management of the primary condition are insulin therapy and oral hyperglycemic agents. The choice of the drugs depends on the level of progression of the disease, allergies, response to the drugs and other underlying conditions. Strict adherence to these interventions will significantly improve the health status of not only Mrs. Elizabeth but also the other diabetic conditions. References Bennett, P, N, Brown, M Sharma, P 2012,Clinical pharmacology, Edinburgh: Elsevier. Commers, M 2012, Determinants of health: Theory, understanding, portrayal, policy, Dordrecht: Kluwer Academic Publishers. Copstead, L, E Banasik, J, L 2013,Pathophysiology, St. Louis, Mo: Elsevier. Daniels, R 2012,Contemporary medical, surgical nursing, Clifton Park, NY: Delmar, Cengage Learning. Dunning, T 2014,Care of people with diabetes: A manual of nursing practice. Chichester, West Sussex: John Wiley Sons. Novak, M., Costantini, L, Schneider, S, Beanlands, H 2013, Approaches to Self-Management in Chronic Illness,Seminars in Dialysis,26,2, 188-194. Peu, D, 2012,Community nursing, Cape Town: Oxford University Press. Randall, M, D, Kendall, D Alexander, S, P, H 2012,Pharmacology, London: Pharmaceutical Press. Ricci-Cabello, I, Olry, L, A, BoliÃÅ' var-MunÃÅ'Æ’oz, J, Pastor-Moreno, G, Bermudez-Tamayo, C, Behshid Garrusi, Mohammad Reza Baneshi, Samaneh Moradi, 2013, Psychosocial contributing factors that affect mental wellbeing in diabetic patients, Russian Open Medical Journal,2,1, 106. Ruiz-PeÃÅ' rez, I, Quesada-JimeÃÅ' nez, F, LoÃÅ' pez-De, H, J, A 2013, Effectiveness of two interventions based on improving patient-practitioner communication on diabetes self-management in patients with low educational level: study protocol of a clustered randomized trial in primary care,Bmc Health Services Research,13. Watson, R, R Dokken, B 2014,Glucose intake and utilization in pre-diabetes and diabetes: Implications for cardiovascular disease, Amsterdam: Academic Press. World Health Organization, 2013, The economics of social determinants of health and health inequalities: A resource book, Geneva: World Health Organization Zochodne, D, W Malik, R, A. 2014,Diabetes and the nervous system, Amsterdam: Elsevier Ltd.