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Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies. When our food is digested the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin makes it possible for our cells to take in the glucose. Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, and lowers the blood sugar level. A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.
(World Health Organization) Diabetes Types 1 and 2 are chronic medical conditions - this means that they are persistent and perpetual. Gestational Diabetes usually resolves itself after the birth of the child.
Symptoms of Diabetes
People can often have diabetes and be completely unaware. The main reason for this is that the symptoms, when seen on their own, seem harmless. However, the earlier diabetes is diagnosed the greater the chances are that serious complications, which can result from having diabetes, can be avoided. Here is a list of the most common diabetes symptoms:
Frequent urination Have you been going to the bathroom to urinate more often recently? Do you notice that you spend most of the day going to the toilet? When there is too much glucose (sugar) in your blood you will urinate more often. If your insulin is ineffective, or not there at all, your kidneys cannot filter the glucose back into the blood. The kidneys will take water from your blood in order to dilute the glucose - which in turn fills up your bladder. Disproportionate thirst If you are urinating more than usual, you will need to replace that lost liquid. You will be drinking more than usual. Have you been drinking more than usual lately? Intense hunger As the insulin in your blood is not working properly, or is not there at all, and your cells are not getting their energy, your body may react by trying to find more energy - food. You will become hungry. Weight gain This might be the result of the above symptom (intense hunger). Unusual weight loss This is more common among people with Diabetes Type 1. As your body is not making insulin it will seek out another energy source (the cells aren't getting glucose). Muscle tissue and fat will be broken down for energy. As Type 1 is of a more sudden onset and Type 2 is much more gradual, weight loss is more noticeable with Type 1. Increased fatigue If your insulin is not working properly, or is not there at all, glucose will not be entering your cells and providing them with energy. This will make you feel tired and listless. Irritability Irritability can be due to your lack of energy. Blurred vision This can be caused by tissue being pulled from your eye lenses. This affects your eyes' ability to focus. With proper treatment this can be treated. There are severe cases where blindness or prolonged vision problems can occur. Cuts and bruises don't heal properly or quickly Do you find cuts and bruises take a much longer time than usual to heal? When there is more sugar (glucose) in your body, its ability to heal can be undermined. More skin and/or yeast infections When there is more sugar in your body, its ability to recover from infections is affected. Women with diabetes find it especially difficult to recover from bladder and vaginal infections. Itchy skin A feeling of itchiness on your skin is sometimes a symptom of diabetes. Gums are red and/or swollen - Gums pull away from teeth If your gums are tender, red and/or swollen this could be a sign of diabetes. Your teeth could become loose as the gums pull away from them. Frequent gum disease/infection As well as the previous gum symptoms, you may experience more frequent gum disease and/or gum infections.
Sexual dysfunction among men If you are over 50 and experience frequent or constant sexual dysfunction (erectile dysfunction), it could be a symptom of diabetes. Numbness or tingling, especially in your feet and hands If there is too much sugar in your body your nerves could become damaged, as could the tiny blood vessels that feed those nerves. You may experience tingling and/or numbness in your hands and feet.
Diagnosis of diabetes
Diabetes can often be detected by carrying out a urine test, which finds out whether excess glucose is present. This is normally backed up by a blood test, which measures blood glucose levels and can confirm if the cause of your symptoms is diabetes. If you are worried that you may have some of the above symptoms, you are recommended to talk to your Doctor or a qualified health professional.
What is insulin?
Insulin is a hormone. It makes our body's cells absorb glucose from the blood. The glucose is stored in the liver and muscle as glycogen and stops the body from using fat as a source of energy. When there is very little insulin in the blood, or none at all, glucose is not taken up by most body cells. When this happens our body uses fat as a source of energy. Insulin is also a control signal to other body systems, such as amino acid uptake by body cells. Insulin is not identical in all animals - their levels of strength vary. Porcine insulin, insulin from a pig, is the most similar to human insulin. Humans can receive animal insulin. However, genetic engineering has allowed us to synthetically produce 'human' insulin.
Stop smoking!
As smoking might have a serious effect on the cardiovascular health the patient should stop smoking.
Hyperglycemia - when blood glucose is too high - can also have a bad effect on the patient. Hyperglycemia can cause:
Polyphagia - frequently hungry Polydipsia - frequently very thirsty Polyuria - frequent urination Blurred vision Extreme tiredness Weight loss Cuts and scrapes will heal slowly and badly Dry mouth Dry or itchy skin Erectile dysfunction (impotence) Recurrent infections Kussmaul hyperventilation: deep and rapid breathing Cardiac arrhythmia Stupor Coma
http://www.medicalnewstoday.com/info/diabetes
Diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Individuals with diabetes are at two to four fold increased risk of cardiovascular events compared with individuals without diabetes. Major increase in chronic disease and premature death of those with diabetes are considered to be due to the development of macro and micro vascular complications, including failure of the wound healing process Complications associated with diabetes mellitus Cardiovascular disease is responsible for between 50% and 80% of deaths in people with diabetes. Risk factors for heart disease in people with diabetes include high blood pressure, high serum cholesterol, obesity and smoking. Recognition and management of these conditions may delay or prevent heart disease in people with diabetes. Diabetic neuropathy is probably the most common complication. Studies suggest that up to 50% of people with diabetes are affected to some degree. Major risk factors of this condition are the level and duration of elevated blood glucose. Neuropathy can lead to sensory loss and damage to the limbs. It is also a major cause of impotence in diabetic men. Diabetic retinopathy is a leading cause of blindness and visual disability. Research findings suggest that, after 15 years of diabetes, approximately 2% of people become blind, while about 10% develop severe visual handicap. Diabetes is among the leading causes of kidney failure, but its frequency varies between populations and is also related to the severity and duration of the disease. Diabetic foot disease, due to changes in blood vessels and nerves, often leads to ulceration and subsequent limb amputation. Diabetes is the most common cause of non-traumatic amputation of the lower limb. Generally, the injurious effects of hyperglycemia are separated into macrovascular complications (coronary artery disease, peripheral arterial disease, and stroke) and microvascular complications (diabetic nephropathy, neuropathy, and retinopathy) Vascular complications prevalent in south Indian population with Type-2 diabetes
INTRODUCTION: Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. Symptoms include frequent urination, lethargy, excessive thirst, and hunger. The treatment includes changes in diet, oral medications, and in some cases, daily injections of insulin.
The most common form of diabetes is Type II, It is sometimes called age-onset or adult-onset diabetes, and this form of diabetes occurs most often in people who are overweight and who do not exercise. Type II is considered a milder form of diabetes because of its slow onset (sometimes developing over the course of several years) and because it usually can be controlled with diet and oral medication. The consequences of uncontrolled and untreated Type II diabetes, however, are the just as serious as those for Type I. This form is also called noninsulin-dependent diabetes, a term that is somewhat misleading. Many people with Type II diabetes can control the condition with diet and oral medications, however, insulin injections are sometimes necessary if treatment with diet and oral medication is not working. The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic factors passed on in families) and environmental factors involved. Research has shown that some people who develop diabetes have common genetic markers. In Type I diabetes, the immune system, the bodys defense system against infection, is believed to be triggered by a virus or another microorganism that destroys cells in the pancreas that produce insulin. In Type II diabetes, age, obesity, and family history of diabetes play a role. In Type II diabetes, the pancreas may produce enough insulin, however, cells have become resistant to the insulin produced and it may not work as effectively. Symptoms of Type II diabetes can begin so gradually that a person may not know that he or she has it. Early signs are lethargy, extreme thirst, and frequent urination. Other symptoms may include sudden weight loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. It is not unusual for Type II diabetes to be detected while a patient is seeing a doctor about another health concern that is actually being caused by the yet undiagnosed diabetes. Individuals who are at high risk of developing Type II diabetes mellitus include people who:
are obese (more than 20% above their ideal body weight) have a relative with diabetes mellitus belong to a high-risk ethnic population (African-American, Native American, Hispanic, or Native Hawaiian) have been diagnosed with gestational diabetes or have delivered a baby weighing more than 9 lbs (4 kg) have high blood pressure (140/90 mmHg or above) have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a triglyceride level greater than or equal to 250 mg/dL have had impaired glucose tolerance or impaired fasting glucose on previous testing
Diabetes mellitus is a common chronic disease requiring lifelong behavioral and lifestyle changes. It is best managed with a team approach to empower the client to successfully manage the disease. As part of the team the, the nurse plans, organizes, and coordinates care among the various health disciplines involved; provides care and education and promotes the clients health and well being. Diabetes is a major public health worldwide. Its complications cause many devastating health problems. ANATOMY AND PHYSIOLOGY: Every cell in the human body needs energy in order to function. The bodys primary energy source is glucose, a simple sugar resulting from the digestion of foods containing carbohydrates (sugars and starches). Glucose from the digested food circulates in the blood as a ready energy source for any cells that need it. Insulin is a hormone or chemical produced by cells in the pancreas, an organ located behind the stomach. Insulin bonds to a receptor site on the outside of cell and acts like a key to open a doorway
into the cell through which glucose can enter. Some of the glucose can be converted to concentrated energy sources like glycogen or fatty acids and saved for later use. When there is not enough insulin produced or when the doorway no longer recognizes the insulin key, glucose stays in the blood rather entering the cells.
PATHOPHYSIOLOGY:
Image Source: www.caninsulin.com/Pathophysiology-algorithm.htm DIAGNOSTIC TEST: Several blood tests are used to measure blood glucose levels, the primary test for diagnosing diabetes. Additional tests can determine the type of diabetes and its severity.
Random blood glucose test for a random blood glucose test, blood can be drawn at any time throughout the day, regardless of when the person last ate. A random blood glucose level of 200 mg/dL (11.1 mmol/L) or higher in persons who have symptoms of high blood glucose (see Symptoms above) suggests a diagnosis of diabetes.
Fasting blood glucose test fasting blood glucose testing involves measuring blood glucose after not eating or drinking for 8 to 12 hours (usually overnight). A normal fasting blood glucose level is less than 100 mg/dL. A fasting blood glucose of 126 mg/dL (7.0 mmol/L) or higher indicates diabetes. The test is done by taking a small sample of blood from a vein or fingertip. It must be repeated on another day to confirm that it remains abnormally high (see Criteria for diagnosis below). Hemoglobin A1C test (A1C) The A1C blood test measures the average blood glucose level during the past two to three months. It is used to monitor blood glucose control in people with known diabetes, but is not normally used to diagnose diabetes. Normal values for A1C are 4 to 6 percent (show figure 3). The test is done by taking a small sample of blood from a vein or fingertip. Oral glucose tolerance test Oral glucose tolerance testing (OGTT) is the most sensitive test for diagnosing diabetes and pre-diabetes. However, the OGTT is not routinely recommended because it is inconvenient compared to a fasting blood glucose test.
The standard OGTT includes a fasting blood glucose test. The person then drinks a 75 gram liquid glucose solution (which tastes very sweet, and is usually cola or orange-flavored). Two hours later, a second blood glucose level is measured. Oral glucose tolerance testing is routinely performed at 24 to 28 weeks of pregnancy to screen for gestational diabetes; this requires drinking a 50 gram glucose solution with a blood glucose level drawn one hour later. For women who have an abnormally elevated blood glucose level, a second OGTT is performed on another day after drinking a 100 gram glucose solution. The blood glucose level is measured before, and at one, two, and three hours after drinking the solution. MEDICATIONS: When diet, exercise and maintaining a healthy weight arent enough, you may need the help of medication. Medications used to treat diabetes include insulin. Everyone with type 1 diabetes and some people with type 2 diabetes must take insulin every day to replace what their pancreas is unable to produce. Unfortunately, insulin cant be taken in pill form because enzymes in your stomach break it down so that it becomes ineffective. For that reason, many people inject themselves with insulin using a syringe or an insulin pen injector,a device that looks like a pen, except the cartridge is filled with insulin. Others may use an insulin pump, which provides a continuous supply of insulin, eliminating the need for daily shots. The most widely used form of insulin is synthetic human insulin, which is chemically identical to human insulin but manufactured in a laboratory. Unfortunately, synthetic human insulin isnt perfect. One of its chief failings is that it doesnt mimic the way natural insulin is secreted. But newer types of insulin, known as insulin analogs, more closely resemble the way natural insulin acts in your body. Among these are lispro (Humalog), insulin aspart (NovoLog) and glargine (Lantus). A number of drug options exist for treating type 2 diabetes, including: Sulfonylurea drugs. These medications stimulate your pancreas to produce and release more insulin. For them to be effective, your pancreas must produce some insulin on its own. Second-generation sulfonylureas such as glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase PresTab, Micronase) and glimepiride (Amaryl) are prescribed most often. The most common side effect of
sulfonylureas is low blood sugar, especially during the first four months of therapy. Youre at much greater risk of low blood sugar if you have impaired liver or kidney function. Meglitinides. These medications, such as repaglinide (Prandin), have effects similar to sulfonylureas, but youre not as likely to develop low blood sugar. Meglitinides work quickly, and the results fade rapidly. Biguanides. Metformin (Glucophage, Glucophage XR) is the only drug in this class available in the United States. It works by inhibiting the production and release of glucose from your liver, which means you need less insulin to transport blood sugar into your cells. One advantage of metformin is that is tends to cause less weight gain than do other diabetes medications. Possible side effects include a metallic taste in your mouth, loss of appetite, nausea or vomiting, abdominal bloating, or pain, gas and diarrhea. These effects usually decrease over time and are less likely to occur if you take the medication with food. A rare but serious side effect is lactic acidosis, which results when lactic acid builds up in your body. Symptoms include tiredness, weakness, muscle aches, dizziness and drowsiness. Lactic acidosis is especially likely to occur if you mix this medication with alcohol or have impaired kidney function. Alpha-glucosidase inhibitors. These drugs block the action of enzymes in your digestive tract that break down carbohydrates. That means sugar is absorbed into your bloodstream more slowly, which helps prevent the rapid rise in blood sugar that usually occurs right after a meal. Drugs in this class include acarbose (Precose) and miglitol (Glyset). Although safe and effective, alpha-glucosidase inhibitors can cause abdominal bloating, gas and diarrhea. If taken in high doses, they may also cause reversible liver damage. Thiazolidinediones. These drugs make your body tissues more sensitive to insulin and keep your liver from overproducing glucose. Side effects of thiazolidinediones, such as rosiglitazone (Avandia) and pioglitazone hydrochloride (Actos), include swelling, weight gain and fatigue. A far more serious potential side effect is liver damage. The thiazolidinedione troglitzeone (Rezulin) was taken off the market in March 2000 because it caused liver failure. If your doctor prescribes these drugs, its important to have your liver checked every two months during the first year of therapy. Contact your doctor immediately if you experience any of the signs and symptoms of liver damage, such as nausea and vomiting, abdominal pain, loss of appetite, dark urine, or yellowing of your skin and the whites of your eyes (jaundice). These may not always be related to diabetes medications, but your doctor will need to investigate all possible causes. Drug combinations. By combining drugs from different classes, you may be able to control your blood sugar in several different ways. Each class of oral medication can be combined with drugs from any other class. Most doctors prescribe two drugs in combination, although sometimes three drugs may be prescribed. Newer medications, such as Glucovance, which contains both glyburide and metformin, combine different oral drugs in a single tablet. NURSING INTERVENTIONS:
Advice patient about the importance of an individualized meal plan in meeting weekly weight loss goals and assist with compliance. Assess patients for cognitive or sensory impairments, which may interfere with the ability to accurately administer insulin. Demonstrate and explain thoroughly the procedure for insulin self-injection. Help patient to achieve mastery of technique by taking step by step approach.
Review dosage and time of injections in relation to meals, activity, and bedtime based on patients individualized insulin regimen. Instruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia. Explain the importance of exercise in maintaining or reducing weight. Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack before exercising to avoid hypoglycemia. Assess feet and legs for skin temperature, sensation, soft tissues injuries, corns, calluses, dryness, hair distribution, pulses and deep tendon reflexes. Maintain skin integrity by protecting feet from breakdown. Advice patient who smokes to stop smoking or reduce if possible, to reduce vasoconstriction and enhance peripheral flow.
MGA KABABAIHAN AT DIABETES Sa U.S., mayroong 9.1 milyong kababaihan ang may diabetes at 3 milyon sa kanila ang hindi nakakaalam na mayroon sila nito. Mas malaki ang posibilidad na magkaroon ng miscarriage o sanggol na may depekto ang mga kababaihang may diabetes. Karamihan sa mga kababaihang may diabetes ay mahirap. Nagiging mas malaking problema na subaybayan ang diabetes dahil ditto. SAKIT AT ATAKE SA PUSO Mas malaki ang posibilidad na magkaroon ng maagang atake sa puso ang mga kababaihang may diabetes. Karamihan sa mga taong may diabetes ay namamatay sa atake sa puso o stroke. KAYO BA AY MAARING MAGKADIABETES? Kayo ba ay overweight? Kayo ba ay hindi gaano o walang ehersisyo? Mayroon ba kayong high blood pressure (130/80 o mas mataas) Mayroon ba kayong kapatid na may diabetes? Mayroon ba kayong magulang na may diabetes? Kayo ba ay nagkaroon ng diabetes nang kayo ay buntis O mayroon ba kayong anak na lampas sa 9 lbs. ang timbang
nang ipanganak? Kayo bay African American, Native American, Hispanic, o Asian American/Pacific Islander? Kung oo ang inyong sagot sa anuman sa mga tanong na ito, magtanong sa inyong doktor, nars o pharmacist kung nangangailangan kayo ng diabetes test. MGA SENYALES NG DIABETES Madalas na pagpunta sa banyo Pakiramdam na laging gutom o uhaw Malabong paningin Pagbawas ng timbang kahit hindi sinasadya Mga sugat/galos na matagal maghilom Laging pagod na pakiramdam Pamimitig/pangingilig ng mga kamay o paa Karamihan sa mga taong may diabetes ay walang napapansin na anumang mga senyales. Ang dokumentong ito ay ginawa ng FDAs Office of Womens Health (OWH), ng National Association of Chain Drug Stores (NACDS), at ng American Diabetes Association. Nagpapasalamat ang OWH, NACDS, at ang ADA sa lahat ng mga kasaling organisasyon na tumulong sa reproduksyon at distribusyon nito. Bigyang Panahon ang Pangangalaga Tungkol sa Diabetes Para sa dagdag na impormasyon: 1-800-DIABETES (1-800-342-2383)
www.fda.gov/womens www.diabetes.org www.nacds.org DIABETES (Taglish) Kalusugang Pangkababaihan Bigyang Panahon ang Pangangalaga Sa iyong sarilisa mga nangangailangan sa iyo ANO ANG DIABETES? Binabago ng diabetes ang paraan ng paggamit ng katawan sa pagkain. Ang pagkain ay nagiging asukal sa loob ng katawan. Dinadala ng dugo ang asukal na ito sa buong katawan. Ang insulin ay tumutulong na kunin ang asukal sa dugo para maging enerhiya ng katawan. Kapag ang inyong katawan ay nagkukulang sa enerhiya, ang inyong blood sugar ay nananatiling mataas. Ang mataas na blood sugar ay maaaring maging sanhi ng komplikasyon sa puso at kidney, pagkabulag, atake sa puso o amputasyon ng paa o hita o maari ring maging sanhi ng kamatayan. ________________________ ANG MAGANDANG BALITA KAYA MONG
KONTROLIN ANG DIABETES Bantayan ang iyong pagkain, mag-ehersisyo, tamang paggamit ng mga gamot at i-check ang iyong blood sugar. ________________________ MGA TIPO NG DIABETES Type 1 Ang katawan ay hindi nakagagawa ng insulin. Ang mga taong may Type 1 na diabetes ay nangangailangan ng insulin arawaraw upang mabuhay. Type 2 Ang katawan ay hindi nakagagawa ng sapat na insulin o hindi nakakagamit ng insulin nang maayos. Karamihan sa mga taong may diabetes ay may Type 2. Ang ibang kababaihan ay nagkakaroon ng diabetes sa kanilang pagbubuntis. BANTAYAN ANG PAGKAIN AT MAGEHERSISYO Walang iisang dieta para sa mga taong may diabetes. Makipagugnayan sa inyong health team upang makagawa ng plano para sa inyo. Maaari pa ring kumain ng mga paboritong pagkain bastat bantayan lamang ang dami ng kakainin. Ang carbohydrates ang pinakagrabeng magpataas ng blood sugar. Nakakatulong din ang Nutrition Facts label sa mga pagkain.
Maraming mga packaged foods ay sobra sa isang serving. Ang mga pagkain natin ay mayroong: Carbohydrates (prutas, gulay, tinapay, juices, gatas, cereals at desserts) Fats Protina Fiber (prutas, gulay, beans, tinapay at cereals) Maging aktibo ng mga kalahating oras bawat araw sa buong linggo. Ang ehersisyo ay nakakatulong sa paggana ng insulin ng katawan. Nakakababa rin ito ng blood sugar, blood pressure at cholesterol. TAMANG PAGGAMIT NG MGA GAMOT Kung minsan, kailangang uminom ng gamot o mag-ineksyon ng insulin ang mga taong may diabetes. Siguraduhing sundin ang direksyon sa paggamit ng gamot. Tanungin ang inyong doktor, nars o pharmacist kung anong nagagawa ng mga gamot, kung kailan gagamitin at kung mayroon itong anumang side effects. ______________________________ Sabihan ang inyong doktor, pharmacist o nars na ireport ang anumang grabeng problema sa gamot o kagamitang medikal sa FDA sa 1-800-FDA-1088.
______________________________ SUBAYBAYAN ANG INYONG BLOOD SUGAR AT ALAMIN ANG IMPORMASYON SA DIABETES Maiiwasan ang sakit at atake sa puso sa pagsubaybay sa inyong blood sugar, blood pressure at cholesterol. Makipag-ugnayan sa inyong doktor, nars o pharmacist. Subaybayan ang inyong blood sugar sa pamamagitan ng metro (home testing kit). Ito ang magsasabi kung gaano kataas ang inyong blood sugar upang kayo ay makapagdesisyon ng maigi. Humingi sa doktor ng A-1-C test. Ito ay nagsusukat ng blood sugar levels sa loob ng 2-3 buwan. Makipag-usap sa inyong health team tungkol sa inyong ABCs: A1C Blood pressure Cholesterol http://www.fda.gov/downloads/ForConsu mers/ByAudience/ForWomen/FreePublica tions/UCM135416.pdf