DIABETES MELLITUS TYPE II

Diabetes mellitus, a metabolic disorder of the pancreas, affects carbohydrate, fat and protein metabolism. Some believe that diabetes in adults is a consequence of metabolic syndrome which includes obesity especially in the abdominal area, high blood pressure, elevated triglyceride, low density lipoprotein and a low-density lipoprotein and increased blood glucose levels. Although no age group is exempt from diabetes, the American Diabetes association (2002) indicates that 90% to 95% of affected persons acquire the disease as adults. Incidence is increased among African Americans, Latinos, Native Americans and Asian Americans (including Pacific islanders). The World Health Organization predicts that, as a result of longer life expectancies, Diabetes will affect 366 million people worldwide by 2030 (WHO2004). The chronic nature of diabetes causes affected persons many debilitating and life-threatening complications before death. Research is providing exciting discoveries; however that may not eventually cure the disease. Type II non-insulin dependent DM is characterized by insulin resistance or insufficient insulin production. Although NIDDM is more common in aging adults (half of the affected clients are older than 55 years), it is also being detected in obese children. The National Health Institute of Diabetes Digestive and Kidney Disease (2004) have developed criteria that identify people with pre-diabetes, which can lead to Type II DM, heart disease and stroke. People with pre-diabetes may have either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), or both. A person with IFG has a blood glucose level of 100 to 125 mg/dL after an overnight fast. In IGT, clients have a blood glucose level of 140 to 190 mg/dL after a glucose tolerance test lasting 2 hours. A significant number of those pre-diabetes will develop the disease; however, many can delay or prevent Type II DM with weight loss and increased physical activity. The three classic symptoms of both DM are polyuria, polyphagia and polydipsia. Additional symptoms include weight loss, weakness, thirst, fatigue and dehydration. These signs and symptoms have an abrupt onset with Type I diabetes. Clients with Type II diabetes have a gradual onset of symptoms. Some develop urinary tract and vaginal infections, possibly because the elevated level of blood glucose supports bacterial growth. There may be changes in visual acuity manifested by blurred vision because of the hypertonicity of blood fluid affects the cells in the lens. MEDICAL MANAGEMENT Treatment depends on many factors, such as type of diabetes and the ability of the pancreas to manufacture insulin, and involves combinations of the following: *Diet and weight loss -Diet is the major component of treatment for every person with diabetes. Formulation of a diabetic diet depends on the clients sex, age, height and weight, activity level, occupation state of health, former dietary habits, and cultural background. When dietary allowances (calories, percentages of carbohydrates, fats and proteins) are prescribed, the client is given a diet prescription and a list of substitutions and exchanges to vary the diet. Dietary modifications alone can control type 2 diabetes. Those who are overweight is placed on a weight-reduction diet because it is less easily controlled in the presence of obesity. Even a moderate weight loss improves the bodys use of insulin. *Exercise -Exercise helps metabolize carbohydrates and control blood glucose levels because glucose-transporting receptors within skeletal muscles to take in glucose from the blood independent of insulin. This provides energy during exercise and lowers blood sugar. It can therefore reduce the need of insulin because glucose can be lowered without it, an advantage for those with diabetes. It also explains why hypoglycemia can accompany exercise.

Exercise also improves circulation of blood, which is compromised in the client with the disease. It also lowers cholesterol and triglyceride levels and improves muscle tone. The program of exercise is tailored according to the clients need and lifestyle. Most importantly, client needs to exercise consistently each day. Sporadic period of exercise are discouraged because wide fluctuations in blood glucose levels can occur. It is necessary to regulate food and insulin requirements during times of increased activities. *Insulin -Client with Type II DM eventually may become dependent on insulin therapy when the beta cells cease to function and anti-diabetic agents are no longer effective. *Oral antidiabetic agents -Oral antidiabetic drugs are prescribed for clients with Type II DM who meet the following criteria: + Fasting blood glucose level less than 200 mg/dL +insulin requirement of less than 40 units/day No ketoacidocis No renal or hepatic disease Before 1995, only one category of drugs, the sulfonylureas was used to lower the blood glucose level. Since then, many new drugs have been developed that help control DM and these are: biguanides, alpha-glucosidase inhibitor, thiazolidinediones and meglitides. NURSING MANAGEMENT Monitoring of blood glucose level before meals and at bed time Follow up result for urinalysis (to detect ketones) Administer medications as prescribed Watch out for hypoglycemia Provide and reinforce health education Signs and symptoms of hypoglycemia and hyperglycemia Methods of terminating hypoglycemia such as grape or orange juice, prolycen (commercial product containing glucose), 2 or 3 spoon of honey, hard candy and glucose tablets. Administer insulin as prescribed Weigh client daily