Diabetes is a chronic disorder caused by a deficiency of insulin or the body’s resistance to using insulin appropriately. Without insulin, the body cannot process the energy it needs which results in elevated blood sugar, or glucose. The increase in glucose can impact nerves, vessels, and muscles as well as increase the likelihood of heart attack, stroke, blindness, and renal disease.
The endocrine system is made up of glands. These glands secrete hormones that impact the rest of the body. The most common endocrine disorder is diabetes which involves the pancreas.
Insulin is used by the body to move glucose, or sugar, into cells for energy. If the pancreas cannot produce enough insulin or the body cannot use insulin properly, the glucose builds up in the bloodstream. It is the only hormone that has a direct effect on lowering glucose levels. Normal glucose levels stay between 70 mg/dl and 100 mg/dl After a meal, blood glucose rises and insulin is secreted in response. Approximately two-thirds of glucose that is ingested is removed from the bloodstream and is used or stored as glycogen for the body’s energy needs.
There are different types of diabetes. The first is insulin dependent diabetes or IDDM. The second is non-insulin-dependent diabetes or NIDDM. There is also gestational diabetes seen in pregnancy and prediabetes, which is a term used for people who are at risk for developing diabetes.
Insulin-dependent diabetes (IDDM) or sometimes called Type 1 diabetes, accounts for approximately 10% of all cases. It tends to run in families and is more common in children and young adults. Initial symptoms may mimic flu in young children. Typical signs are polyuria (excessive urination), polydipsia (excessive thirst), polyphagia (excessive hunger), glycosuria. A person with Type 1 insulin dependent diabetes needs to take insulin injections daily and check their blood sugar level several times throughout the day. In type 1 diabetes, the beta cells in the pancreas are usually destroyed causing a lack of insulin and elevation of blood glucose. There can be a breakdown of body fat and protein which can cause ketoacidosis and dehydration along with other complications
Non-insulin-dependent diabetes (NIDDM) or sometimes called type Il diabetes, is considered a metabolic disorder and occurs when the body cannot make enough insulin or does not properly use insulin. This accounts for approximately 90% of all diabetic cases and typically occurs over the age of 20. Typically, the patient is unaware that they have type Il diabetes until complications develop. Common signs are fatigue, skin infections, slow healing, itching and burning on urination, vision changes, obesity, and sudden weight loss. In the elderly, there may only be one or two symptoms that appear and they may complain of constant fatigue, skin lesions that take longer to heal, and vision changes. Gestational diabetes occurs in pregnancy. Glucose that is too high can be dangerous for the unborn baby as well as the mother. Babies born to mothers with uncontrolled diabetes can be overly large at birth, have respiratory problems, have yellow skin and eyes, or be stillborn. These children are more likely to be obese and develop type II diabetes later in life. The mother may also have problems with kidneys, heart, nerves, go into early labor, have high blood pressure, preeclampsia, or miscarriage.
Prediabetes is high glucose levels but not high enough to be diagnosed with diabetes. It is estimated that one out of three adults have prediabetes and of those 15 to 30% will develop type Il diabetes within five years. Additionally, prediabetes can lead to heart disease, stroke, and type Il diabetes. Often with lifestyle changes, this can be reversed. Risk factors for prediabetes include being overweight, over 45 years of age, having a parent or sibling with type Il diabetes, exercising less than three times per week, or having a history of gestational diabetes. To prevent or delay type Il diabetes the CDC suggests losing 5 to 7% of your body weight and getting at least 150 minutes of exercise each week.
Signs and Symptoms
Typical signs of diabetes include excessive thirst, frequent urination, feeling of being hungry all the time, and fatigue. Additionally, unintentional weight loss, slow healing of wounds, dry, itchy skin, tingling or loss of feeling in the feet, and blurred vision can also be seen.
Complications such as hypoglycemia and hyperglycemia can occur if diabetes is not controlled. Low blood sugar or hypoglycemia can be caused by skipping meals, stress, vomiting, diarrhea, drug interactions, or too much insulin. Signs of hypoglycemia include weakness, dizziness, shakiness, cool, moist skin, rapid shallow breathing, nervousness rapid pulse, or a low blood sugar test result. Treatments can include giving orange juice, milk, or a carbohydrate such as hard candy. Hyperglycemia or high blood sugar typically occurs because there is insufficient insulin for the body’s needs. Hyperglyceniia can be brought on by stress, illness, dehydration, injury, forgetting to take medication, or too much food intake. This may be seen as confusion, drowsiness, or high blood sugar test results. Additional signs and symptoms include a headache, drowsiness, confusion, sweet fruity odor to breath, deep or labored breathing, a full bounding pulse, nausea, vomiting, weakness, sugar in the urine, or unconsciousness. Treatments include administration of insulin fluid and electrolytes. Additional complications that can occur with diabetes are blindness, renal failure, nerve damage, damage to gum and teeth, as well as hypertension and circulatory problems that can lead to stroke, heart attack, and slow. Also, ulcers in the lower extremities are very common as well as infections and gangrene which can lead to amputations.
You will need to become familiar with complications to be able to recognize and respond to dangerous situations such as hypoglycemia or hyperglycemia. To prevent hypoglycemia, make sure the client eats and exercises at the same time each day, has snacks between meals and check their blood sugar regularly throughout the day. To prevent hyperglycemia, observe for signs of illness, infection, or stress. The client may be on a special diet and eating foods they don’t particularly like. Be supportive and empathetic. Explain the importance of food choices to help the client understand why they are on this diet. Keeping a record of all the food consumed along with glucose levels is a way to track their health and prevent dangerous situations as well.
Observe the client closely for any cuts, source, or red areas, especially on lower extremities. Daily foot care is a necessity. Report any unusual cuts, bruises or wounds that won’t heal. Observe the clients’ feet especially between the toes for infection and make sure the area between the toes is dry. Check the clients’ shoes to make sure they fit well and do not rub causing blisters. The client should always wear socks and nothing should be tight around the foot or calf that could disrupt circulation. Discourage the client from going barefoot as injuries that can lead to infection could occur. If their toenails need to be clipped this is only done by a podiatrist.
Caring for the diabetic client also means being empathetic and supportive as their lifestyle has to change to prevent complications and to control the disease. Listening to their concerns and helping them understand how to care themselves is important in maintaining a productive life.