Portfolio I: Objective 1 Type 2 Diabetes: An Overview of Nursing Care According to the Center for Disease Control & Prevention (2011), diabetes is the sixth most common cause of death in adults in the United States, 25.8 million people in the United States have diabetes, and 90 to 95% of adults with diabetes suffer from Type 2 Diabetes. Diabetes is a major cause of heart disease, stroke, and complications such as hypertension, blindness, kidney disease, non-traumatic amputations, and nervous system damage (CDC, 2011). Total estimated medical care costs for diabetes in the US are astronomical, and the number is only expected to rise, to as much as $192 billion by 2020 (CDC, 2011). Rising healthcare costs, an aging population, and other prevalent risk factors like obesity are predictors of the continued rise in diabetes (Smeltzer, Bare, Hinkle, & Cheever, 2008). People with diabetes pay, on average, twice that of non-diabetics in medical expenses. According to Smeltzer et al. (2008), half of all people with diabetes undergo hospitalization every year. Research shows that Type 2 Diabetes can be prevented largely by lifestyle modifications such as weight loss and exercise (Smeltzer et al., 2008). Educational intervention by nurses plays a vital role in the care for this population.Pathophysiology Diabetes is a chronic metabolic disease characterized by high levels of glucose in the blood, termed hyperglycemia. Glucose is needed by human cells for energy. Insulin is an endocrine hormone produced by the beta cells of the pancreas. Insulin transports glucose into muscle, liver, and fat cells to use for energy, stimulates storage of glycogen in the liver and muscles, inhibits the breakdown of stored glucose, protein, and fat, and signals the liver to stop the release of glucose (Smeltzer et al., 2008). Insulin is responsible for the management of blood sugar. If the glucose in the blood stream cannot be taken into cells, it remains in the blood (hyperglycemia) and causes many complications and health risks. Furthermore, if the body cells do not have enough glucose to use for fuel, they may begin to use muscle and fat, producing ketones bodies - acids that can cause Diabetic Ketoacidosis, a life threatening emergency. This is less common in Type 2 Diabetics than in those with Type 1, as there is usually enough insulin circulating to prevent fat breakdown (Urden, Stacy, & Lough, 2010).Type 2 Diabetes, formerly called “non insulin-dependent diabetes,” involves a defect in the way one’s body makes or uses insulin. In this form of diabetes, people may still able to make and secrete some insulin, unlike those with Type 1 Diabetes who have absolute insulin deficiency because of destroyed beta cells in the pancreas (Urden et al., 2010). Urden et al. (2010, p. 900) explain the problem lies in a “progressive insulin secretory defect in addition to insulin resistance.” Insulin resistance occurs when the body’s organ and tissue cells do not allow glucose and insulin to enter, leaving high levels of insulin (that cannot do its purpose) and glucose in the blood circulating. The patient may be producing adequate, or even an overproduction of, insulin in the beta cells, yet it cannot be used. Insulin resistance has been shown to increase with obesity. In others with Type 2 Diabetes, there is what is called inadequate insulin response in that the beta cells may not be functioning efficiently or declining in productivity and an inadequate amount of insulin is produced (Urden et al., 2010). The effect is too much glucose in the bloodstream. If allowed to continue for years, the toxic effects of glucose derivatives on body tissue are the primary cause of late complications of diabetes (Solnica, 2006). Chronic complications of diabetes are: high blood pressure and heart problems leading to heart attacks and heart failure; difficulty in vision and retinal damage leading to blindness; compromised renal perfusion, leading to kidney failure; nerve damage primarily leading to problems of the lower extremities but also other parts of the body (Kapur & Kelkar, 2012). Symptoms and Risk Factors Type 2 Diabetes is associated with insidious symptoms that may take years to become noticeable. Increased urination and thirst are classical signs of Type 2 Diabetes. Mild fatigue, polyuria, polydipsia, poor wound healing, blurred vision, and vaginal infections may also be other symptoms (Smeltzer et al., 2008). A fasting plasma glucose greater or equal to 126 mg/dL, confirmed with two tests, OR symptoms of diabetes and a random plasma glucose equal or greater than 200 mg/dL is criteria for diagnosis (Smeltzer et al., 2008). Risk factors for developing type 2 diabetes include family history, obesity (increases insulin resistance), older age >45 years (age-related changes in carbohydrate metabolism), history of hypertension, previous gestational diabetes, and low HDL cholesterol level (Smeltzer et al., 2008). Treatment Treatment is largely aimed at maintaining blood glucose levels in the normal range. According to Smeltzer et al. (2008), the five components of diabetes management are: Nutrition Therapy, Education, Monitoring, Exercise, and Pharmacologic Therapy. The first step for those diagnosed with Type 2 Diabetes is usually diet modification and weight loss (Smeltzer et al., 2008). Exercise is useful in maintaining blood glucose by promoting the effect of insulin (Smeltzer et al., 2008). If hyperglycemia persists with these interventions, oral anti-diabetic agents can be used. There are many different antidiabetic oral drugs and often a combination of more than one is used (Urden et al., 2010). During times of illness or lack of success with oral antidiabetics, subcutaneous insulin injections may be necessary due to the physiologic stress or unstable blood glucose levels (Smeltzer et al., 2008). |
