Diabetes mellitus (DM) refers to metabolic diseases, during which a person experiences high level of sugar in blood. It results from lack of the insulin in the pancreas, or due to failure of cells to respond to the produced insulin. High level of sugar in the blood results in classical symptoms of polyphagia, polydipsia, and polyuria. There are three types of diabetes mellitus. First type of DM results from failure of the body to produce insulin; it requires injection of insulin for the patient. The second type of DM is as a result of resistance to insulin. Cells fail to use the insulin properly and sometimes, there is absolute deficiency of insulin. This type is also referred to as non-insulin-dependent diabetes mellitus (NIDDM). The third type is gestational diabetes that occurs when pregnant women develop high level of glucose in blood; it may turn into the second type of diabetes mellitus. Other types of diabetes mellitus include the congenital diabetes that results from genetic defects in cystic secretion of insulin; the cystic fibrosis-related diabetes; and steroid diabetes that results from induced high glucocorticoids doses (Hollander et al, 2007).
Untreated diabetes may result in several complications such as nonketotic hyperosmolar and ketoacidosis coma. The long-term complications include diabetic retinopathy, chronic renal failure, and cardiovascular disease. Proper treatment of diabetes and blood pressure control are crucial. After the discovery of insulin in 1921, all diabetes types became treatable. The second type of diabetes can be controlled through medication. Some oral medications and insulin may cause hyperglycemia. The first and second of DM are chronic and cannot be cured. There have been trials of pancreas transplants with limited success. The gastric bypass surgery has been successful so far. The gestational diabetes recurs after delivery (Brancati et al, 2000).
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Classification of Diabetes Mellitus
There are four broad categories of diabetes mellitus. The term diabetes refers to the diabetes mellitus without quantification. Diabetes insipidus is the rare type with similar symptoms as in diabetes mellitus, but it does not cause disturbances in metabolism of sugar. The term type 1 diabetes replaced other terms such as childhood onset diabetes, insulin dependent diabetes, and juvenile diabetes. Similarly, the term type 2 diabetes replaced the previous terms such as obesity and non-insulin-dependent diabetes. Other types do not have agreed nomenclature (Campbell & Harold, 2001).
Diabetes Mellitus Type 1
This type results from loss of insulin-producing beta cells in Langerhans islet of the pancreas, which leads to insulin deficiency. Type 1 diabetes is immune-mediated. It affects both children and adults. The preventive measures of type 1 diabetes are not yet established. This type may be accompanied by unpredictable and irregular hyperglycemia including the impairment of counter-regulatory response to hypoglycemia (De Souza & Yugar-Toledo, 2007).
Diabetes Mellitus Type 2
This type results from resistance to insulin in combination with relatively low levels of secretion of insulin. Defective responsiveness of the tissues in the body to insulin involves the insulin receptor. Type 2 diabetes is the most common. The early stages involve predominant reduction in insulin sensitivity (Hauner et al, 2006).
This type resembles type 2 diabetes mellitus, with a combination of insufficient secretion and responsiveness to insulin. It mostly occurs among the pregnant women. The disorder is fully treatable, although, it requires a careful medical supervision of the pregnancy period (De Souza & Yugar-Toledo, 2007).
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Other types of diabetes mellitus result from failure of the body receptors to respond to insulin. The genetic mutations may lead to defects in the functioning of beta cells. In some cases, the abnormal insulin action may be determined genetically. Diseases causing damage to pancreas are likely to cause diabetes. The examples include cystic fibrosis and pancreatitis. Also, diseases causing excessive insulin secretion may lead to the development of diabetes (Jolly & Thomas, 2003).
Insulin hormone is the principal regulator of the glucose uptake from the blood into the cells. Insulin deficiency or insensitivity influences the receptors. Human beings can easily digest carbohydrates, which undergo conversion into simple sugars which provide the energy. Beta cells release glucose into the blood. Then, insulin absorbs glucose from the blood and passes it to the cells. Also, insulin controls the signals during conversion of glucose into glycogen. Storage of glycogen takes place internally in the muscle and liver cells. Glucagon hormone controls the whole process. Hence, glucose produced from internal cells re-enters the blood stream in instances of low insulin level. High level of insulin results in increased anabolic processes such as protein synthesis. Also, low insulin level triggers leaving or entering ketosis (Friberg & Scherman, 2005).
Increased glucose level beyond the renal threshold increases the osmotic pressure of urine, which inhibits the re-absorption of water by kidneys. It increases the production of urine and loss of body fluid. The water held in body cells osmotically replaces the lost volume of the blood causing thirst and dehydration (Hajjar & Kotchen, 2003).
Signs and Symptoms of Diabetes Mellitus
Diabetes mellitus results in loss of weight, increased urination, hunger, and thirst. Development of symptoms is usually gradual, though, it may be rapid. Prolonged high level of glucose in blood may result in absorption of glucose in the eye lens leading to problems with sight. Blurred vision is a common diagnosis for diabetes mellitus. Also, diabetic dermadromes is characterized by skin rashes. All types of diabetes result in increased long-term complications. These long-term complications include damage to blood vessels. In case of damaged capillaries and retinopathy, blood vessels in the retina are affected, which leads to problems with sight. Diabetic nephropathy results from damages to the nervous system and kidneys. Also, neuropathy results in problems with feet (Brancati et al, 2000).
Relationship of Diabetes Mellitus and HFSON Conceptual Framework
The HFSON conceptual framework comprises of environment, health, nurse and client systems. These components uniquely interact within the framework and are open to new information exchanges and learning. The evidence-based interventions promote good health and prevent illnesses. Professional nurses provide health care with the help of educators, leaders, collaborators, advocates, managers, and clinicians. According to this framework, health entails actualization of acquired and inherent human potential through incorporation of environmental, social, and cultural context. Nurturing and provision of this interaction happens within a health-protecting environment. Therefore, this framework can be integrated in the medical surgical state of diabetes mellitus, where the healthcare provider should ensure careful control of the level of sugar in the blood of the patient. The control of the level of sugar in blood enhances functioning of the body organs (Hauner et al, 2006).
The evaluation of the client by the healthcare provider includes both modifiable and non-modifiable factors relating to the management of the client’s level of sugar. The healthcare professionals should assess the potential complications of myocardial infarction, angina, and kidney diseases. It should be accompanied by the healthcare plan that entails pharmacological or non-pharmacological process targeting at controlling level of sugar in the blood. The strategies for control of the glucose levels in the blood include dietary modification and administration of insulin for type 2 diabetes. The main challenge entails client’s awareness of the prevention methods for long-term complications. The quality initiatives aim at completing the audit for healthcare records to enhance adherence to the behavior of providers and patients (Hambleton, 2009).
Nursing Practice Roles Relating to Diabetes Mellitus
The nursing practice roles of the nurse stipulate the main functions in all practice settings. These practices require skills and confidence in masterly of competences and standards of practice (Hajjar & Kotchen, 2003). The practices are listed below.
A clinician refers to a health professional expert in patient care field as opposed to research administrator. The practice of a clinician depends on treatment and direct observation of the client system. Clinicians formulate data-driven practice decisions that rely on scientific evidence. The nurse, as a clinician, should ensure that the level of sugar in blood is controlled properly. Proper control of sugar level in blood enhances tissue perfusion and organ function. The clinician should evaluate the client’s conditions and seek for the appropriate measures of improvement (Hajjar & Kotchen, 2003).
As an educator, a nurse uses the interpersonal and interactive communication skills in mentoring and providing dialogue. Nurses use the knowledge and skills of the evidence-based practices in impacting the practice issues. It promotes health through facilitation of changes in attitude, skills, and knowledge. Education and motivation are crucial in achieving the optimal healthcare outcomes. The initiation of comprehensive mortality and morbidity reforms on diabetes mellitus enhance management of diabetes in terms of reduced costs, and improve the wellbeing of an individual (Goldstein & Fred, 2001)
Legal Issues on Diabetes Mellitus
The medico-legal approach on insulin reaction in diabetes is yet to arouse deserved interest within the medical world. There is a profound sociological problem of individuals’ susceptibility to hypoglycemic changes. It has to be altered and adequately adjusted in relation to society, occupational groups, and families. The increased importance of this condition is apparent to enhance a continuous mounting of the incidence of diabetes and increased use of insulin among the diabetic patients. The acceptance of the insulin condition by physicians and patients has enhanced better control of the diabetic patients (Brancati et al, 2000).
Evidence-Based Practice on Diabetes Mellitus
The evidence-based practices should entail proper control of the level of sugar in blood to improve the performance of the body organs. Also, the healthcare professionals should evaluate the client’s condition by including modifiable and non-modifiable factors relating to the management of the level of sugar in blood. Dietary modifications and stress management are crucial in controlling the instances of the level of sugar in blood. Daily monitoring of weight and assessment of potential complication are also necessary. The inclusion of the evidence-based invention enhances efficient treatment of diabetes among patients (Friberg & Scherman, 2005).
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