Diabetes mellitus is a metabolic disorder that occurs due to chronic hyperglycemia that results due to defective insulin secretion, defective insulin action or both. Type 1 diabetes occurs when there is an autoimmune reaction to proteins of the β-cells of islets of Langerhans of the pancreas. The cause of type 2 diabetes could be a combination of impaired insulin secretion and / or insulin resistance. Obesity, lack of exercise, overeating and stress besides genetic factors are commonly cited reasons for type 2 diabetes. Advancing age can also cause diabetes in some patients, particularly if they have a family history. Alcohol consumption and smoking are also risk factors and can impair insulin secretion and increase insulin resistance in susceptible individuals (Ozougwu, Obimba, Belonwu, & Unakalamba, 2013).
Since diabetes is caused due to the decrease in insulin secretion, it is important to understand the anatomy of pancreas. The pancreas functions as an exocrine and endocrine organ. It is located in the upper abdominal cavity and lies in the C-curve of the duodenum. The pancreas is supplied with blood through several arteries. It is made up several acini that resemble the lobes of berries. There are scattered throughout the inside of the pancreas tiny groups of cells arranged like a nest and are called the islets of Langerhans. The beta cells sense the rising levels of carbohydrates in the blood and secrete insulin into the blood. The insulin helps the cells to take up the glucose so that it can be burnt to produce energy. Liver and muscle cells can turn excess glucose into glycogen. Once the blood sugar is consumed and sugar levels in the blood are low, the secretion of insulin stops. But in diabetes patients the secretion of insulin is low or the cells are unable to take in enough glucose so the high levels of sugar in the blood cause hyperglycemia (Guyton & Hall, 2006).
At the time of diagnosis Mr. X, has experienced the three classical manifestations of diabetes. Thirst was felt due to the dehydration that occurred due to loss of salts and electrolytes due to frequent urination. There was significant weight loss because calories were lost in the form of glucose in the urine. Breakdown of fat and protein is accelerated by insulin deficiency. The increased catabolism leads to weight loss. The spilling over of glucose into the urine when the blood sugar exceeds the renal threshold of 180mg/dl is called polyuria. Loss of water, salt and other electrolytes from the body causes dehydration and thirst. Other systems affected to diabetes in this patient was blurred vision, Candida infection, tiredness and fatigue (McCuloch, 2015).
The understanding of Mr. X pertaining to diabetes had been sketchy in the beginning by his own admission. He did not feel motivated to stick to the diet, exercise and motivation prescribed by the doctor. As a result of his failure to stick to the routine, he reported high blood sugar on several occasions. His symptoms of blurred vision, thirst and fatigue continued. On the recommendation of his doctor he decided to attend an education program designed specifically for diabetes patients. (García-Pérez, Álvarez, Dilla, Gil-Guillén, & Orozco-Beltrán, 2013). Following the program, his blood sugar levels showed tremendous improvement. The tips and suggestions given by the diabetes educator were not difficult to follow. As someone who liked to walk, Mr. X started walking to work and back, his diet improved and he learnt to remember the oral medication prescribed by the doctor. He noticed improvements because the symptoms of thirst, fatigue and blurred vision vanished. He got extensive support from his family and friends. His family stopped using sugar and having desserts, which helped Mr. X to resist temptation of eating sugar laden foods (Miller & DiMatteo, 2013).
Some patients find the tasks of taking medicines, watching their diet constantly, checking blood sugar levels and visiting the doctor regularly difficult to perform. The diagnosis of diabetes means that they have to change the way they live. Some patients are more likely to develop depression and anxiety because they live in fear of not being able to live a healthy life. They also fear the several health complications that can result from uncontrolled blood sugar levels. While some patients are open about the sadness they feel, others may have to be probed to find out whether they are feeling stress because of the disease or are afraid of the risks of morbidity (Chew, Shariff-Ghazali, & Fernandez, 2014).
At the physical level, some patients find it difficult to cope with the need to exercise because they are not used to much physical effort.
Diabetes management by the patient requires that the patient be empowered to manage the disease successfully and improve quality of life. Self-management of diabetes through the development of a plan of care is important in achieving the desired outcomes for patients who find it difficult to cope with the changed requirements. The process of behaviour change involves informing the patient, shared decision making, forming strategies of self care and providing assistance to facilitate change (Cárdenas-Valladolid, et al., 2012). A care plan should include the following steps:
Regular checks and adherence to the diet, exercise and medication regimen can improve the health of diabetes patients and keep them safe from the complications associated with high blood sugar. A care plan incorporates testing for all the risks that are associated with diabetes. Early detection of complications can reduce morbidity and mortality to a great extent.
Since the interviewed patient is a resident of Perth,
web address, street address, telephone contact of three diabetes-care facilities:
Perth Diabetes Care
Street address: 968B, Albany Hwy,East Victoria Park, WA 6101.
Street address: Level 3/322, Hay Street, Subiaco, 6008
Telephone: 1300 136 588
Fax: (08) 94750485
Emslies floreat pharmacy
Street address: 445, Cambridge Street, Floreat, WA 6014.
Telephone: 08 9387 1803
Fax: 08 9284 1215
Cárdenas-Valladolid, J., Salinero-Fort, M., Gómez-Campelo, P., de Burgos-Lunar, C., Abánades-Herranz, J., Arnal-Selfa, R., & López- Andrés, A. (2012). Effectiveness of Standardized Nursing Care Plans in Health Outcomes in Patients with Type 2 Diabetes Mellitus: A Two-Year Prospective Follow-Up Study. PLoS One, 7(8), e43870.
Chew, B.-H., Shariff-Ghazali, S., & Fernandez, A. (2014). Psychological aspects of diabetes care: Effecting behavioral change in patients. World Journal of Diabetes, 5(6), 796–808.
García-Pérez, L.-E., Álvarez, M., Dilla, T., Gil-Guillén, V., & Orozco-Beltrán, D. (2013). Adherence to Therapies in Patients with Type 2 Diabetes. Diabetes Therapy, 4(2), 175–194.
Guyton, A., & Hall, J. (2006). Textbook of Medical Physiology. Elselvier Saunders.
McCuloch, D. K. (2015, March 19). clinical-presentation-and-diagnosis-of-diabetes-mellitus-in-adults. Retrieved from https://www.uptodate.com: https://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-diabetes-mellitus-in-adults
Miller, T., & DiMatteo, M. R. (2013). Importance of family/social support and impact on adherence to diabetic therapy. Diabetes, Metabolic Syndrome and Obesity, 6, 421–426.
Ozougwu, J. C., Obimba, K. C., Belonwu, C. D., & Unakalamba, C. B. (2013). The pathogenesis and pathophysiology of type 1 and type 2 diabetes mellitus. Journal of Physiology and Pathophysiology, 4(4), 46-57.
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