Case Study on Type2 Diabetes Mellitus
This paper will look at the physiology of normal blood glucose. The pathophysiology of Diabetes mellitus type 2 with a description of some of the common presenting symptoms of polyuria. polydipsia and polyphagia. Research the importance of integrating the 5 constituents of pull offing the disease and discourse why the Autochthonal population are more than 3. 4 times more likely to be affected than non-indigenous Australians ( AIHW 2006. Brown & A ; Edwards 2008 ) .
The organic structure maps at its best with a blood glucose degree of about 3 to 8 mmol/L despite a broad fluctuation in nutrient or physical activity ( Brown & A ; Edwards 2008 ) . The independent actions of both insulin and glucagon control blood glucose degrees ( Marieb & A ; Hoehn 2007 ) . Under normal fortunes insulin is the chief regulator of the metamorphosis and storage of saccharides. fats and protein. Insulin allows glucose to come in cell membranes in most tissues ( Brown & A ; Edwards 2008 ) . An increased blood glucose degree is the chief stimulation of insulin synthesis and secernment ( Brown & A ; Edwards 2008 ) . Insulin is inhibited by low glucose degrees along with glucagon. somatostatin. catecholamines and hypokalaemia ( Brown & A ; Edwards 2008 ) . A major response of insulin on glucose metamorphosis occurs in the liver. where the endocrine stimulates glucose to be integrated into animal starch and triglycerides by halting gluconeogenesis ( Brown & A ; Edwards 2008 ) . Another of import function of insulin is in the peripheral tissues where it facilitates glucose into cells. conveyance of aminic acids across musculus membranes to synthesize into protein and conveyance of trigylcerides into adipose tissue. Thus insulin is a storage or anabolic endocrine ( Brown & A ; Edwards 2008 ) .
After alterations in blood glucose degrees are stimulated such as after eating a repast. insulin is responsible for the storage of foods ( constructive metabolism ) and in the fasting province where glucose is non readily available endocrines such as catecholamines. hydrocortisone and glucagon break down stored complex fuels ( katabolism ) for usage as simple glucose ( Brown & A ; Edwards 2008 ) .
In type 2 diabetes the organic structure does non utilise insulin decently or the production of insulin does non run into the demands of the organic structure ( Brown & A ; Edwards 2008 ) . Three major metabolic abnormalcies are seen to lend to play a function in Diabetes mellitus. Firstly insulin opposition which can be seen as the organic structures tissues do non react to the action of insulin ( Brown & A ; Edwards 2008 ) . This opposition harmonizing to ( Capriotti 2005 ) encourages the pancreas to release increasing sums of insulin as a regulative response to command glycaemic degrees. Second the inability of the pancreas to release adequate insulin due to Beta cells going fatigued from the overrun created by the opposition of the cells to uptake insulin ( Brown & A ; Edwards 2008 ) . Last the liver can non modulate appropriate degrees of glucose to fit blood glucose degrees making an flood into the blood stream as insulin opposition continues and hyperglycemia develops ( Capriotti 2005 ) .
There are many marks and symptoms. many of which go unnoticed until the disease is in the late phases ( Funnell. Koutoukidis & A ; Lawrence 2005 ) . Authoritative combinations of symptoms are seen as the 3 Ps. polydipsia. polyuria and polyphagia all of which are associated to the high degrees of glucose in the blood. Hyperosmolarity and depletion of intracellular H2O are a consequence which triggers detectors in the encephalon to construe this as thirst ( polydipsia ) ( Hill 2009 ) . An addition in hungriness ( polyphagia ) is stimulated due to insulin lack triping katabolism of proteins and fats increasing appetency ( Hill 2009 ) and polyuria ( frequent micturition ) is due to extra glucose making an osmotic diuresis in the kidneys ( Hill 2009 ) pulling big sums of H2O with it. The freshly diagnosed patient should be informed of the importance of these symptoms which if left unnoticed or ignored can take to hyperosmotic non-ketotic province ( Hill 2009 ) . The patient would hold a high glycaemic measuring of 30mmol/l or greater and in despairing demand of rehydration to forestall the oncoming of a diabetic coma ( Hill 2009 ) .
Long term uncontrolled diabetes mellitus leads to chronic wellness issues. disablement. a hapless quality of life and premature decease in Australia s worldwide ( Thomson 2003 ) . In Australia. Aboriginal people are more likely to develop Type 2 diabetes than non Aboriginal Australians ( NATSIHS 2006 ) . A survey by the National Aboriginal and Torres Strait Islander Health study ( 2006 ) found that autochthonal Australians were more than 10 times more likely to decease from diabetes than the remainder of the Australian population.
Traditional Aborigines lived as huntsmans and gatherers but with the exposure of westernised life styles the autochthonal people have changed their affinity with the land ( Thomson 2003 ) . This exposure to nutrients high in fat and sugars. intoxicant and nicotine usage along with a sedentary life style have placed them in a high hazard class of developing diabetes and at an earlier age than not autochthonal people ( Thomson 2003 ) . Aboriginal people had the familial make-up to last when nutrient was scarce but now this one time efficient metamorphosis. exposed to a western influence is now working against them ( Thomson 2003 ) . As Mr Daley is a freshly diagnosed patient. there is a existent demand to concentrate on instruction. Education has been identified as a important factor in the effectual control of blood glucose degrees. ( Jerreat 2009 ) Pull offing diabetes can be disputing and support is needed if the person is to hold a close to normal life ( AIHW 2006 ) .
First instruction is of import to underscore to the patient the importance of close monitoring and direction as diabetes can go a chronic disease with multiple wellness issues and a hapless quality of life ( AIHW 2006 ) . Brown & A ; Edwards ( 2008 P. 1352 ) points out that patient learning enables them to take control and to go confident in take parting in their ain attention ; this besides provides the footing for a successful intervention program. Mr Daley should be educated on diabetes and provided with booklets to take place. The nurse could besides inquire him to go to a clinic daily for more instruction and supervising with blood glucose monitoring and she could besides reply any inquiries he may hold ( AIWW 2006 ) .
The freshly diagnosed patient will necessitate to cognize the importance of doing alterations to their life style in respects to nutrition. diet and weight control ( Farrell 2005 ) . Obesity is a major lending factor to the likeliness of developing diabetes mellitus type 2 as fat cells in peculiar are immune to insulin action therefore these people can develop the disease. For this ground weight loss can dramatically better blood glucose degrees ( Farrell 2005 ) . Aboriginal people are advised to follow their traditional shrub nutrient eating. Bush nutrients are found to be low in fat and sugars and the attempt of ‘hunting and gathering’ besides promotes exercising ( Thomson 2003 ) . In Mr Daley’s instance if the rural country is distant plenty he should be encouraged to scrounge for traditional nutrient and may seek counsel from seniors. The nurse could supply information on low GI nutrients and the benefits of devouring these in relation to keeping blood glucose degrees for longer periods ( Capaldi 2007 ) . Educate the patient to eat regular repasts. nutrients high in fiber and at least 5 parts of fruit and veggies each twenty-four hours. Reduce sugar – incorporating nutrients and imbibe intoxicant in moderateness and with nutrient ( Capaldi 2007 ) . Alcohol ingestion greatly reduces the diabetic individual from being able to command blood glucose as the physiological procedures are changed ( Farrell 2005 ) . The patient affected by intoxicant may non recognize the symptoms of hypoglycemia and topographic point themselves in danger ( Farrell 2005 ) .
Exercise has been found to be an effectual tool in commanding blood glucose degrees in people with diabetes type2 ( Thomas et al. 2006. AIHW 2006 ) . Exercise lowers the degree of glucose in the blood as musculuss use up glucose when they are working ( Farrell 2005 ) . It besides helps cut down weight as it increases the resting metabolic rate ( Farrell 2005 ) . Farrell ( 2005 p. 1164 ) besides points out that exercising besides contributes to the lowering of blood lipoid degrees diminishing the hazard of CVD. The nurse can urge that Mr Daley exercising at least for 30 proceedingss of moderate to intense impact at least 5 times a hebdomad ( Diabetes Australia 2009 ) . Careful supervising peculiarly of people on insulin or unwritten hyperglycaemic lowering medicines are needed as hypoglycemia can happen after exercising ( AIHW 2006 ) . A 15g saccharide bite with some protein before exerting can assist diminish the opportunity of hypoglycemia ( Farrell 2005 ) .
When exercising and diet can non command diabetes sufficiently on their ain the following direction procedure is medicine. Oral hypoglycemic agents will be trialled foremost ; the nurse can assist find the most suited ( Brown & A ; Edwards 2008 ) . Factors such as mental position. eating wonts. place environment and entree to resources are considered ( Brown & A ; Edwards 2008 ) . The patient should be educated that along with medicine diet and exercising still have a topographic point in direction of diabetes. If the patient experiences unwellness or utmost emphasis. they can still endure from hyperglycemia while taking their medicines ( Brown & A ; Edwards 2008 ) . Oral hypoglycemic medicines do non really lower blood glucose degrees they alter liver map or increase the effectivity of insulin ( Bullock. Manias & A ; Galbraith 2007 ) . Some of the nursing actions required are reding on the side effects. some of which are hypoglycemia. skin reaction. GI disturbances. hydrops. anemia and hepatic perturbations. Monitoring how effectual the medicine is at keeping blood glucose degrees and conveying when best to take it and what to make if a dosage is missed or if blood glucose degrees are low ( Bullock. Manias & A ; Galbraith 2007 ) .
Insulin therapy may necessitate to be added to the regimen or replace the unwritten hypoglycemic agents if farther intercession is needed ( Brown & A ; Edwards 2008 ) . Giving insulin allows the individual to treat saccharides. fats and proteins. to hive away animal starch in the liver. and to change over glucose to flesh out ( Capaldi 2005 ) . There are several types of insulin and they all differ in relation to their oncoming. peak clip and continuance. Timing is of import in respects to administrating insulin. by and large 30 – 45 proceedingss before a repast to let for action of insulin to co-occur with meal soaking up ( Brown & A ; Edwards 2008 ) . The nurse demands to educate the patient on the type of insulin so the patient has an apprehension of the action of the insulin for illustration long playing or rapid oncoming. The manner it is needed to be stored and the usage by day of the month noted ( Wallymahmed 2006 ) . Correct injecting of insulin or usage of pens. Rotation of injection site ( Farrell 2005 ) and the fact that blood glucose degree should be checked before insulin is injected as the inauspicious consequence of insulin is hypoglycaemia ( Bullock. Manias & A ; Galbraith 2007 ) .
Blood glucose monitoring is of import in commanding blood glucose degrees ( Brown & A ; Edwards 2008 ) . Self monitoring of blood glucose is a utile adjutant in steering the person in diet. exercising and medicine determinations ( Brown & A ; Edwards 2008 ) . It promotes autonomy and encourages the individual to take a self involvement in pull offing their ain disease ( Farrell 2005 ) . Mr Daley is of autochthonal beginnings and lives in a rural part of Australia. entree to resources such as a glucometers and other critical equipment may be limited. In that instance it may be practical to hold him see a clinic daily to entree these services until his blood glucose degrees stable. Once a modus operandi is under manner the visits can be reduced. The nurse can besides utilize this clip to supervise. Teach and reply inquiries the patient may hold.
Ultimately for Mr Daley to battle his diabetes mellitus type 2. he will necessitate entree to a figure of of import resources. Education on diet and exercising along with changeless monitoring will organize the bases of his demands. Advice and support from his wellness attention squad will play an of import function in keeping blood glucose degrees as good. The fact that Mr Daley is autochthonal and life in a distant country besides draws concern for his ability to be able to predominate and optimize the best wellness attention available. In hapless socioeconomic countries the usage of a community based attack can assist get the better of these short approachs. Education and unfastened conversation are the most of import tools a health care supplier can utilize.
Australian Institute of Health and Welfare 2008. Diabetes: Australian facts 2008. viewed 16 March 2010. hypertext transfer protocol: //www. aihw. gov. gold
Brown. D & A ; Edwards. H 2008. Lewis’s medical-surgical nursing—assessment and direction of clinical jobs. 2nd edn. Mosby. Sydney. Australia.
Bullock. S. Manias. E & A ; Galbraith. A 2007. Fundamentalss of pharmacological medicine. 5th edn. Peasrson Education Australia. Frenchs Forests
Capaldi. B 2007. ‘Optimising glycaemic control for patients get downing insulin therapy’ . Nursing Standard. vol. 21. no. 44. pp 49-53
Capriotti. Thymine 2005. ‘Type 2 diabetes epidemic additions usage of unwritten anti-diabetic agents’ . MedSurg Nursing. vol. 14. no. 5. pp. 341-347
Diabetess Australia 2009. Healthy exercising for pull offing diabetes. viewed 21 March 2010. hypertext transfer protocol: //www. diabetesaustralia. com. au/For-Health-Professionals/Diabetes-Nationa
Farrell. M ( ed. ) . 2005. Smeltzer & A ; Bare’s text edition of medical-surgical nursing. 1st Australia & A ; New Zealand edn. Lippincott. Williams and Wilkins. Broadway. NSW
Funnell. R. Koitoukidis. G. Lawrence. K 2005. Tabbner’s nursing attention: theory and pattern. 4th edition. Elsevier. Marrickville. Australia
Hill. J 2009. ‘Reducing the hazard of complications associated with diabetes’ . Nursing Standard. vol. 23. no. 25. pp. 49-55
Jerreat. L 2009. ‘Treatment of hyperglycemia in patients with type 2 diabetes’ . Nursing Standard. vol. 24. no. 1. pp. 50-58