Diabetes Management in Older People - Article Example

Diabetes management in older people Diabetes is a disease related to the metabolism of the human body. It has to be understood with regards to our food intake and the way in which our body processes digested food in order to provide growth and energy. Mostly, our daily food intake is broken down into glucose which exists in our blood in the form of sugar. When food is digested in our body glucose passes through the blood from where it is used by the relevant organs to provide energy. In order to break the glucose down, however, the body requires a certain amount of a substance called insulin which is in essence a hormone produced by the pancreas. In people afflicted with diabetes however the problem is that there is little or no insulin produced because of which there is a buildup of excess glucose in the blood, which then overflows into the urine and passes out of the body through the channel of urine itself. The body therefore loses its main source of energy despite the blood containing large amounts of glucose. The three main types of diabetes are, type 1 diabetes, type 2 diabetes and gestational diabetes Type 1 diabetes is an autoimmune disease which results when the body’s system for fighting infection (the immune system) turns against a part of the body. A person who has type 1diabetes must take insulin daily to live. The most common form of the disease however is type 2 diabetes. This is mostly found in associations with old age, obesity, a chronological family history of the ailment, physical inactivity, and certain ethnicities. About 80 per cent of people with type 2 diabetes are overweight. The third type of diabetes is gestational diabetes which is found in pregnant women. The following assignment will focus largely on type2 diabetes, the basic issues regarding self management of the disease in old age and the methodologies that should ideally be used in research seeking to put forward a solution the issues identified. The first problem that can be identified with regards to diabetes regulation in old people is with regards to diet and exercise. A number of factors that ultimately result in a diabetic condition that can include low income, poor vision, poor appetite due to decreased taste and smell, arthritis or tremor, making preparation of food difficult, poor teeth or dry mouth and depression which affects the appetite. A related issue is the usage of exercise as a cure to diabetes. Many are of the opinion that exercise can be a controlling factor where diabetes is concerned. The second issues that assume major relevance with regard to diabetes management in older people is that of eyesight, urinary and sexual issues. The first and arguably the most important issue with regards to the problem is the fact that these people are highly susceptible to issues like cataracts, macular degeneration, and open-angle glaucoma in addition to diabetic retinopathy. The problem can seem a personal one but is hardly so because it affects not just the patients but also people who are related to the patient especially a spouse. The issue therefore is the impact of the ramifications of the family and the ways to deal with it. A related problem in s much as that it affects the patient at a physiological level is that of the urinary and sexual problems that arise in diabetic people, which are common. The third and probably but without doubt an important third angle of this triangle is that of the psychological aspect. It has been found that diabetic management in older people perhaps is hindered the most by the mental issues that these people have to undergo on a day to day basis. It is a prerequisite of diabetic care that a careful diet is followed, the patient exercises regularly, there are regular checkups for blood sugar levels, and there is in place a system to ensure that diabetes medicines as prescribed. There is however a belief that in people suffering from both depression and diabetes, depression can interfere with diabetes care. The problems in question therefore can be identified as, Role of exercise and diet control Impact of the disease on the spouse and family Mental aspects and how best to go about ensuring that they don not major adverse affects on patients. If one has to look at the various approached that are available in order to provide an insight into solving the problems or ‘research questions’ that have been outlined with regards to management of diabetes in older people, there are three clear cut approaches that appear to become available to a researcher. Before going into the intricacies of the approaches one can broadly say that the qualitative approach would be ideally suited to this kind of a problem, this is true because the approach can be an important tool in understanding the emotions and perceptions of people undergoing a medical condition. It is person centered; hence researchers can consider participants as whole human beings and not a collection of mere physical parts. Qualitative research methodology has been defined by Strauss and Corbin (1990) as “a way to gain insights through discovering meanings by improving our comprehension of the whole. Qualitative research explores the richness, depth, and complexity of phenomena.  Qualitative research, broadly defined, means "any kind of research that produces findings not arrived at by means of statistical procedures or other means of quantification". The various branches in the broad category of qualitative research include case studies, grounded theory, phenomenology, ethnography and historical research. The first problem can be researched using a combination of the models of case studies and the Grounded theory. Case studies would mean going back to research already available with regards to the issue along with the identification of a restricted number of cases, which can be then studies and conclusions can be drawn on a case by case analysis. Although time consuming and long, the method has proven to be very effective. This cannot however be done in isolation and the researcher has to make use of the grounded theory here. The phrase "grounded theory" refers to theory that is developed inductively from a corpus of data. (Glaser and Strauss, 1967). The first step according to this method would be the collection of data, rather than the formation of a hypothesis. The basic points of conclusion as drawn from the data collected are then marked with codes. The codes with similar aspects are grouped together to form categories which serve as the basis for the creation of the theory. In this regard, the variables to be observed will be the patients themselves. The idea is infact simple. The ones who make exercise as part of their daily routine can be part of the first category and the ones who don’t will form the second one. Levels of diabetes and the kinds of exercise coupled with the frequency are the demarcating codes. Ideally the research will throw open answers to a number of questions. The second issue is ideally suited to the interpretative phenomenological analysis (IPA) method of qualitative research. The method seeks to express mathematically the conclusions drawn from observed phenomena without any attention to subjective detailing. Interpretative Phenomenological Analysis (IPA) is a relatively recent qualitative approach developed specifically within psychology. It is now being used widely by researchers in health, clinical and social psychology. IPA makes use lived experiences of participants, and is concerned with the meaning that the experience holds for the participant in question. It aims to explore the individual’s personal perception or account of an event. It does not try to project an objective record of the event itself. A research based on this method would be ideal in dealing with the problem as identified because it would take into account the nuances of the human mind and the response in similar kinds of aggrieved situations. The method is scientific yet philosophical. The third issue is best researched sing the ethnographic method of qualitative analysis. Ethnography is a form of research focusing on the sociology of meaning through close field observation of sociocultural phenomena. Typically, the ethnographer focuses on a community (not necessarily geographic, considering also work, leisure, and other communities), selecting informants who are known to have an overview of the activities of the community. The community in question here is diabetic patients. Informants can be asked to identify others with similar problems and a hypothesis can be drawn from their experiences. What this will achieve is simple. The analysis will surely give a few clear answers about whether or not diet control and exercising can be effective in diabetes regulation. Focus on a community of say an age group, will prove how best to deal with the physical aspects of the ailment, what medicines and measures work and which ones do not. It will also shed light on the inter linking of diabetes to depression. The psychological analysis will be needed in order to provide data in order to fill up the gaps in research. The methods used have to include interactive interviewing, written descriptions and observations. References: Management of Diabetes in the Elderly, Wallace, I. 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