DIABETES MELLITUS IN ENGLISH

                                            

                                 DIABETES MELLITUS IN ENGLISH

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DIABETES MELLITUS-

Ø Diabetes mellitus is a metabolic diseases characterized by increased levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both

CLASSIFICATION OF DM-

Ø The major types of diabetes are-

Ø Type 1 diabetes and

Ø Type 2 diabetes,

TYPE 1 DM-

Ø Type 1 diabetes is much less prevalent than type 2. it affects only 5 to 10 % of people suffering from DM. Type 1 diabetes has an acute onset, usually before 30 years of age. It is also known as juvenile diabetes or insulin dependent diabetes mellitus (IDDM). DKA is typically associated with type 1 diabetes.

Ø Causative factors-

           Type 1 diabetes is  caused by destruction of the pancreatic beta cells. Destruction of beta cells of ilets of Langerhans of pancreas gland may be associated of Genetic, immunologic, and possibly environmental factors. Regardless of the specific cause, the destruction of the beta cells results in decreased insulin production.

TYPE 2 DM-

           Type 2 diabetes is much more prevalent than type1. It affects  90 to 95 % of people suffering from DM. Type 2 diabetes can affect any age group but it is more common among people older than 30 years of age. It is chronic and slow progressive DM. Normally DKA is not associated with this type of diabetes.

Ø Causative factors-

           Type 2 diabetes is  caused by insulin resistance and impaired insulin secretion. Insulin resistance refers to a decreased tissue sensitivity to insulin. In type 2 diabetes, the intracellular reactions are diminished, making insulin less effective at stimulating glucose uptake by the tissues and at regulating glucose release by the liver.

CLINICAL MANIFESTATIONS-

Ø Clinical manifestations diabetes mellitus depend on the patient’s level of hyperglycemia.

Ø Typical sign and symptoms of all type of DM include-

Ø Polydipsia (increased thirst)

Ø Polyuria (increased urination)

Ø polyphagia (increased appetite)

Ø Other symptoms include-

Ø Fatigue and weakness,

Ø Sudden vision changes,

Ø Tingling or numbness in hands or feet,

Ø Dry skin,

Ø Skin lesions or wounds that are slow to heal, and

Ø Recurrent infections.

DIAGNOSTIC INVESTIGATIONS-

Ø History taking and Physical examination.

Ø An abnormally high blood glucose level is the basic criterion for the diagnosis of diabetes.

Ø Fasting plasma glucose

Ø Random plasma glucose, and

Ø glucose level 2 hours after food.

TREATMENT-

Ø The main goal of diabetes treatment is to normalize  blood glucose levels to reduce chances of the development of vascular and neuropathic complications.

Ø Diabetes management has five components: pharmacological therapy, monitoring, nutritional therapy, exercise and education.

Ø pharmacological therapy-

In type 1 diabetes,  insulin injection must be administered for life because the body loses the ability to produce insulin.

In type 2 diabetes, Oral hypoglycemic agents (medicines) are sufficient to control glucose levels but some times they may need insulin injections for some period of time 

Ø Monitoring-

Blood glucose monitoring is very important in diabetes management. Using frequent SMBG and learning how to respond to the results enable people with diabetes to adjust their treatment regimen to obtain optimal blood glucose control.

Ø Nutrition therapy-

           The main goal of nutritional management of diabetes are control of total caloric intake to attain or maintain a reasonable body weight, control of blood glucose levels, and normalization of lipids and blood pressure to prevent heart disease. The patient should strictly follow diet chart prescribed by physician or dietician.

Ø Exercise-

           Exercise lowers blood glucose levels by increasing the uptake of glucose by body muscles and by improving insulin utilization. Resistance  training, such as weight lifting, can increase muscle mass, thereby increasing the resting metabolic rate. Ideally, a person with diabetes should exercise at the same time  and in the same amount each day.

Ø Health Education-

           Diabetes mellitus is a chronic illness that requires a lifetime of special self-management behaviors. Patient needs knowledge regarding basic details about diabetes, self monitoring of glucose, self administration of insulin, effect diet and menu planning, exercise schedule, Recognition, treatment, and prevention of Complications etc.

COMPLICATIONS OF DM-

Ø Acute complications-

Ø There are three major acute complications of diabetes mellitus-

Ø Hypoglycemia,

Ø DKA (Diabetic keto-acidosis), and

Ø HHNS (hyperglycemic hyperosmolar nonketotic syndrome)

Ø Hypoglycemia-

Ø  Hypoglycemia is a condition in which blood glucose falls to less than 50 to 60 mg/dL because of too much insulin or oral hypoglycemic agents, too little food, or excessive physical activity.

Ø Clinical manifestations of mild hypoglycemia include sweating, tremor, tachycardia, palpitation, nervousness, and hunger.

Ø Clinical manifestations of moderate hypoglycemia include inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of the lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behavior, double vision, and drowsiness.

Ø Clinical manifestations of severe hypoglycemia include disoriented behavior, seizures, difficulty arousing from sleep, or loss of consciousness.

Ø Management of hypoglycemia include immediate oral administration of 15 g of a fast acting concentrated source of carbohydrate such as glucose tablets or candies or juice.

Ø In emergency situations, for adults who are unconscious and cannot swallow, an injection of glucagon 1 mg can be administered either subcutaneously or intramuscularly.

Ø Hypoglycemia is prevented by a consistent pattern of eating, administering insulin, and exercising. It is important that patients with diabetes, especially those receiving insulin, learn to carry some form of simple sugar with them at all times

Ø Diabetic keto acidosis

Ø  DKA is caused by chronic inadequate or missed dose of insulin, illness or infection, and undiagnosed or untreated Diabetes. The three main clinical features of DKA are

Ø • Hyperglycemia

Ø • Dehydration and electrolyte loss

Ø • Acidosis

Ø Management of DKA includes correcting dehydration, electrolyte loss, and acidosis in addition to correcting blood glucose level. IV fluids are prescribed to correct dehydration. Ketone bodies (acids) accumulate as a result of fat breakdown. The acidosis that occurs in DKA is reversed with Insulin.

Ø HHNS (hyperglycemic hyperosmolar non-ketotic syndrome)

Ø  (HHNS) is a serious condition in which hyper osmolarity and hyperglycemia predominate, with alterations of the sensorium and without ketoacidosis. Persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes.  

Ø The clinical manifestations of HHNS include hypotension, signs of profound dehydration such as dry mucous membranes, poor skin turgor, tachycardia, and variable neurologic signs such as alteration of sensorium, seizures, hemiparesis.

Ø the management of HHNS is similar to that of DKA such as fluid replacement, correction of electrolyte imbalances, and insulin administration

Ø Chronic complications-

Ø There are three major categories of long-term diabetic complications-

Ø Macrovascular disease,

Ø Microvascular disease, and

Ø Neuropathy.

 

Ø Macrovascular complications- Diabetic macrovascular complications occur in the medium to large blood vessels. Blood vessel walls thicken and become occluded by plaque that adheres to the vessel walls. Coronary artery disease, cerebrovascular disease, and peripheral vascular disease are the three main types of macrovascular complications that occur frequently in patients with DM.

Ø Microvascular complications- Diabetic microvascular complications occur in the capillaries. There is thickening of the basement membrane of capillaries. The eye problem is known as  diabetic retinopathy is caused by changes in the capillaries of the retina. Diabetic nephropathy, or renal disease secondary to diabetic microvascular changes in the kidney, is a common microvascular complication of diabetes

Ø Diabetic Neuropathies-  Diabetic neuropathy refers to a group of diseases that affect all types of nerves. The two most common types of diabetic neuropathy are sensorimotor polyneuropathy and autonomic neuropathy. Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections.

            

FOOT-SKIN PROBLEMS AND MANAGEMENT

Ø Between 50% and 75% of lower extremity amputations are performed on people with diabetes. It is also included in long term complications of DM. The typical sequence of events in the development of a diabetic foot ulcer begins with a soft tissue injury of the foot, formation of a fissure between the toes or in an area of dry skin, or formation of a callus.

Ø Patients with an insensitive foot due to diabetic neuropathies do not feel pain at injuries, which may occur from using heating pads, walking barefoot on hot concrete, testing bath water with the foot or traumatic such as injuring skin while cutting nails, walking with an undetected foreign object in the shoe, or wearing ill-fitting shoes and socks.

             

           FOOT AND SKIN CARE IN DM-

 

Ø Teaching proper foot care is a nursing intervention that can prevent diabetic foot ulcer complications.

Ø Daily foot skin assessment should be done to detect skin problems as early as possible.

Ø Feet should be examined for any redness, blisters, fissures, calluses, ulcerations, changes in skin temperature, or development of foot deformities

Ø Patient should be encouraged to inspect all surfaces of feet daily using mirror or a family member may help in feet examination.

Ø All patients should be assessed for neuropathy and undergo evaluation of neurologic status by an experienced Examiner during each visit to diabetic clinic or hospital.

Ø Patient and his family members should be taught about all aspects of preventive foot care such as Properly bathing, drying, and lubricating the feet with demonstration and return demonstration.

Ø Patient and family members should be explained to take special   precaution not to allow moisture (water or lotion) to accumulate between the toes as it may lead to infection.

Ø Patient should Wear closed-toed shoes that fit well and shoes can be padded to remove pressure from pressure points on the foot.

Ø Patient should be explained about avoiding high risk behaviors such as   walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet in  water  and shaving calluses.

Ø Nails should be cut short and corners should be carefully filed.

Ø Patient should wear the shoes and socks all the time to prevent trauma.

Ø The patient is encouraged to Feel inside of the shoes before putting them on each time to make sure the lining is smooth and there are no objects inside.

Ø To improve blood circulation the patient should keep the feet up while sitting.

Ø Patient should Wiggle the toes and move your ankles up and down for 5 minutes, 2 or 3 times a day.

Ø The patient is encouraged not to cross the legs for long periods of time, it may hinder blood circulation.