Diabetes Mellitus: Explanation of Reflective Work Based Practice - Coursework Example

Diabetes Mellitus: Explanation of Reflective Work Based Practice Introduction to Diabetes Mellitus Diabetes mellitus a is disease characterized by high blood pressure due to the failure of the pancreas to produce enough insulin or the failure of the cells responsible for the sugar levels to respond to the insulin produced. It is basically a disease caused by the failure or the diminished efficiency and effectiveness of the endogenous insulin. It is a disease that can be inherited or acquired in one’s life due the failure of one of the body parts responsible for the regulation of the sugar levels in the body. The causes are a combination of genetic and lifestyle factors the patients are predisposed to. The lifestyle causes include the type of diet taken by the individual and obesity or overall weight gain. A lack of sleep has also been associated with the acquisition of this health defect. In pregnant women, the disease may occur due to the methylation of DNA and the general health of the mother (Barnett, 2006, p. 23). On the other hand, there are factors that are without the patient’s control among them one’s gender, genetics and ageing. Diabetes is characterized by several symptoms in the patients that suffer from it. The most common symptoms include polyphagia which is a case of increased hunger and polyuria which is the increased frequency of urination. Other symptoms include polydipsia (increased thirst), neuropathic symptoms like tingling in feet or hands and numbness in limbs, the loss of weight, reduced vision, skin damage in some cases, diabetic foot ulcers, itchiness, recurrent vaginal infections and fatigue. There are also cases of nausea and vomiting in patients that have not been treated of the same disease (CIBA Foundation Symposium., 2009, p. 45). Infections of the skin and the bladder are also common occurrences and, in the worst of cases, diabetes can lead to lethargy and an eventual coma. Other studies in this area have shown that there are cases where diabetes causes yeast infections in men, dryness in the mouth and slow-healing sores or cuts. There are several types of diabetes mellitus that manifest in different patients. Each is diagnosed from the type of symptoms associated with it and the causes of the disease. The known most common types of diabetes mellitus are Type 1 and Type 2 (initially known as noninsulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes) diabetes mellitus. The third main type of diabetes mellitus is gestational diabetes which occurs in pregnant women who do not have a previous history of having diabetes develop a high level of glucose in their blood. This type of diabetes usually precedes type 2 diabetes mellitus. Another less common type of diabetes is secondary diabetes. This usually refers to increased blood sugar levels due to the prevalence of another medical condition. This type of diabetes may develop due to the destroyal of the pancreatic tissue responsible for insulin production by diseases such as chronic pancreatitis, trauma or, due to other cause, the surgical removal of a patient’s pancreas. Diabetes may also result from the disturbance of a patient’s hormonal balance due to a condition like acromegaly (excessive growth hormone production) and in some cases Cushing’s syndrome (Bergenstal and Powers, 2011, p. 32). The risk factors for Type 2 diabetes have been found to be several as far as the differences that exist in people are concerned. Those who have obesity, especially of the truncal type, have a higher chance of contracting the disease compared to those of average weight. Overall weight gain due to lack of exercise, a characteristic of sedentary lifestyles, also puts the individual at a high risk of contracting the disease (Tripathy and Chandalia, 2012, p. 98). One’s ethnicity is another factor that has been found to be a risk factor in contracting the disease. South Asians, Africans, African-Caribbean, American-Indian, Middle-Eastern and Polynesians are at a higher risk of getting Type 2 diabetes compared to the white people. A history of gestational diabetes also puts individuals, especially expectant mothers, at a higher risk of getting the disease. Cases of impaired glucose tolerance and impaired fasting glucose also pose a great danger of getting the disease. Having a low-fibre, high-glycaemic index diet is a cause of concern to the individuals. Metabolic syndromes are also predisposing factors that may expose an individual to Type 2 diabetes. Another syndrome is the polycystic ovarian syndrome which exposes the individual to the type 2 diabetes disease. Of great concern is the family history which places an individual at a 2.4-fold increased risk of acquiring Type 2 diabetes compared to other factors. Besides the symptoms outlined above, diabetes is clinically diagnosed by several methods. Many of these methods focus on the levels of blood sugar in the blood of the patient. There are cases where the patient may not exhibit the symptoms stated above. Such a case is in prediabetes which most often precedes the more severe Type 2 diabetes. The clinical diagnosis of this disease is the level of fasting plasma glucose level which should be greater than or equal to 7.0 mmol/l or 126mg/dl. Another test considers the level of glucose in blood which should be greater or equal to 11.1 mmol/l or 200mg/dl a couple of hours after a load of 75g of oral glucose is used in a glucose tolerance test. A third test is any glycated hemoglobin (Hb A1C) values greater or equal to 6.5 percent (Rooney and Strom-Gottfried, 2011). The values detailed above are for asymptomatic patients who require medical attention. Explanation of Reflective Work Based Practice Reflective work, according to Moon, is “set of abilities and skills, to indicate the taking of a critical stance, an orientation to problem solving or state of mind (Moon, 1999). Reflective work should thus be focused around finding a solution or remedy to the problem at hand. Another scholar, Cowan, suggested that reflective work should be used by learners in solving problems “when they analyze or evaluate one or more personal experiences, and attempt to generalize from that thinking" (Cowan, 1999). These and other scholars define what a reflective piece of work should be concerned with. Further study by Biggs evoked the statement; “a reflection in a mirror is an exact replica of what is in front of it. Reflection in professional practice, however, gives back not what it is, but what might be, an improvement of the original” (Biggs, 1999). Therefore, besides using the available solutions, a reflective paper like the one at hand should aim at generating new ideas as to solving the problem identified. This paper therefore focuses on solving the issue of diabetes mellitus in the many ways it manifests in patients (Barnett, 2006, p. 56). The aim of this reflective paper is to identify the negative effects of diabetes to the society and to detail the options both available and suggested to solve the negative effects of this disease. So far, the symptoms of the disease have been identified and the clinical tests that are carried to confirm the existence of same disease outlined. The economic effects of the disease besides other areas that are of importance are to be addressed in the following sections of the paper. The costs of the diabetes epidemic shall be detailed before solutions are suggested (CIBA Foundation Symposium., 2009, p. 76). The costs of diabetes are heavy on the society in terms of the health costs that are incurred both by individuals, government bodies and any other bodies that have taken interest in the development of solutions to diabetes. The latter include individuals who undertake philanthropy and non-governmental organizations who have taken up the role of eliminating diabetes and its effects. It was estimated by the National Health Service in the year 2010 that diabetes costs 1.5 million pounds each hour. That amount is equivalent to 10 percent of the National Health Service for England and Wales (Bergenstal and Powers, 2011, p. 43). The amount translates to 25 thousand pounds per minute. These figures show that a very large sum of money is channeled towards the treatment of the diabetes disease. These are not even inclusive of the costs incurred by individuals in treating their sick. In total, at least 14 billion is spent in the United Kingdom to treat cases of diabetes each single year. Non-diabetes drugs made up 15.2 percent of the costs spent on diabetes care in general. Diabetes drugs made up 7.8 percent of the costs of the care provided to the patients. Another negative effect of diabetes is the costs of early retirement, absenteeism and the social benefits the diabetes patients heavily rely upon. In 2010, it was estimated that the cost of the social benefits that the diabetes patients require amounted to 0.152 billion pounds while that of absenteeism amounted to 8.4 billion pounds each single year. On the other hand, early retirement cost the United Kingdom 6.9 billion pounds in the year 2010 (Barnett, 2006, p. 88). Overall, the treatment costs rose by 40 percent for that year as far as the treatment of and care for diabetes patients is concerned. The suggested solutions to this epidemic are several since there is effort the world over that is aimed at reducing its effects on the society. There are several areas and classifications to the disease and its solutions among them research, education, clinical practice, counseling and leadership and management. These are the general classification used by the institutions and individuals whose efforts are channeled towards the development of solutions to this problem. On the part of clinical practice, governments have increased their investments towards the development of better health care facilities for patients of diabetes and other diabetes-related cases. There have been efforts to reduce the costs of medication that diabetes patients incur (Moon, 1999). These include the introduction of subsidies as far as medicines are concerned. From the above-stated figures, the United Kingdom spends a huge amount of money to reduce the medical costs that the diabetes patients incur. It is suggested in this reflective paper the number of facilities like dialysis machines should be increased to reduce the effects of diabetes to the economy. The costs of medication should be further reduced to allow those who have been diagnosed with the disease access to good quality health care (Holosko and Dulmus, 2012). Considering research, more efforts should be channeled towards the research into this disease. So far, the United Kingdom has invested heavily in research into this disease and its hospitals provide some of the best healthcare facilities in the world. This research paper suggests that even greater efforts should be made since the number of patients who discover they have the disease at later stages of their lives is as high as 850 thousand as stated above from the National Health Service. Education and research go hand in hand as far as the findings on diabetes mellitus are concerned. The main universities in the United Kingdom, with their excellent ratings in the world, have one of the best facilities available for the education and training of some of the best doctors in the world (Egan and Kadushin, 2012, p. 89). The doctors who have specialized in the treatment of diabetes and the various ailments that accompany it are many but when compared to the number of patients suffering from diabetes, they compare dismally. The reflective paper thus suggests that other institutions of higher learning should be set up to increase the number of health practitioners who possess the required skills to deal with the cases of diabetes mellitus in the wide United Kingdom. The last two pillars in the curbing of the disease are counseling and leadership and management. These two areas are of great importance to the solving of diabetic cases. The United Kingdom has many people involved with the handling of diabetes patients without getting involved with the treatment of the patients. Since diabetes mellitus is a type of lifestyle disease that one gets to live with, the most important thing to do is to find ways of managing it by keeping its effects on the patients low so that they get to do activities as normal people would. There are many counselors in the United Kingdom who are charged with the management of this disease but the number needs to be increased especially those whose aim is to sensitize the public on the symptoms and the need to be tested of this disease (Ekoé and Zimmet, 2008, p. 55). Diabetic Patients Patient One The patient is aged 62 years and has had Type 2 diabetes for the past 11 years. His diabetes can be traced to two different causes the first one of them being that it could be inherited since it has been proven that his grandfather had diabetes and, secondly, to the fact that he is a heavy smoker who smokes between ten to twenty cigarettes per day and a drinker taking between two to five beers per day. The main symptoms are that he is often thirsty and experiences blurred vision. His was proved by the fact that a clinical test showed a fasting blood sugar level of 16.4. Before the patient was 30 years of age, he had acid reflex (CIBA Foundation Symposium., 2009, p. 88). The patient has no physical disabilities and he is in fact an independent individual. Among the few shortcomings he has is that he is a smoker and an alcohol addict. He exercises by walking and takes a small amount of rice during his lunches to balance between the body’s need for carbohydrates while avoiding too much carbohydrates that may form excessive sugar in the body. The patient checks his blood sugar level every day before he goes to bed and at times randomly when he notices that he is shaking. It has been found out from his tests that his blood sugar level is always high in the morning. The patient is also fond of coffee and tea with milk and eats a lot of fruits especially bananas and apples for his energy requirements. The only complications noted in the patient are independent of diabetes and are oseophegal reflex and high blood pressure which he has had for a long time. The high blood pressure prompted his taking of one tablet of ramipril and another one of amlodipine before the doctor added him another tablet of tamilosin which is an alpha blocker (Egan and Kadushin, 2012, p. 140). The patient’s medical plan includes 4 tablets of metformin, 4 tablets of gliclazide, 1.8 mls of victosa injection and 20 units of glargine insulin. All these medications are administered in the morning but he still shows signs of hyperglycemia. The doctor had prescribed one tablet of gliclazide and it had been effective then he started metformin (normal) before shifting metformin (slow release) as he had stomach problems. The single tablet of gliclazide worked until the last two years when his HbA1C was high. This prompted the doctor to prescribe victosa injection then insulin glargine (Katsilambros, 2011, p. 201). From this case, it can be deduced that while the patient has taken several measures to control his blood sugar level, his blood sugar level tests show it is still above the level required for safety. What the patient should do is reduce on his consumption of alcohol and smoking. Alcohol is a source of sugar and therefore, even without the other sources of sugar, his blood sugar level would still be above the normal one (Misra, 2012, p. 75). On the other hand, smoking is detrimental to his health since it weakens several organs in his body making him less resistant to opportunistic ailments that could affect his health severely. Smoking has adverse effects on his lungs which are vital for oxygen supply to the body and, being a patient, his body would perform better with better lungs which shall only be obtained by his quitting of smoking. The patient should thus be discouraged from smoking and drinking as much as possible since these two will always pose danger to his health and make his management of diabetes hard to manage. Since an addiction takes time to deal with, he should be enrolled in a program that shall ensure that he completely quits drinking and smoking for better management of his diabetes. Patient Two The second patient is aged 36 and has been diabetic for the last 8 years. His diabetic is not inherited since his family tree has no traces of diabetes. It can evidently be traced to a hormonal imbalance resulting from Cushing’s syndrome where the adrenal glands produce Cortisol in excessive amounts (Hoffmann and Bennett, 2009, p. 98). Cortisol is a stress hormone released for proper glucose metabolism, regulation of blood glucose, immune functions, inflammatory response and blood sugar maintenance. The patient suffers from Type 2 diabetes. His disease was discovered by symptoms that included hunger more times than necessary, ease of irritability, frequent urination, itchiness on the skin and a blurry vision. Further tests showed that he had a fasting plasma glucose level of 8.2 mmol/l, a plasma glucose level of 13.1 mmol/l and a glycated hemoglobin level of 7 percent (Llorente and Feil, 2007, p. 90). Before he developed diabetes, the patient did not have any other complications and the hormonal imbalance is attributed to a car accident he had when he was 20 years of age. The patient, being allergic to citric acid, does not take fruits since they have large amounts of the acid. The patient thus relies on injections for his energy requirements. He exercises twice a day in the morning and late evening in his house where he has a gymnasium with all the required facilities. He is fond of sugarless chewing gum that he chews at all times. The doctor changed his initial choice of chewing gum to one that had energy compounds to take care of any risks that may come about in the case he has no access to his energy injections (Bergenstal and Powers, 2011, p. 89). The doctor prescribed that he takes 2 tablets of gliclazide, 3 tablets of metformin, 2 mls of victosa injection and 18 units glargine insulin in the mornings (Kramer, 2007, p. 67). He is to take his blood sugar level twice a day to determine the levels he is experiencing and report to the doctor thereafter. This patient has no other complications since he is an independent patient by all means. His type of diabetes requires constant care since the hormonal imbalance cannot be solved in any way. If a medical procedure for replacing the adrenal glands, it could be healed since it is the source of his diabetes. The patient has done well as far as the management of the disease is concerned (Hanas, 2007, p. 67). The medical care he receives is of high quality and does not need to be changed in any way. With the current procedure, the patient is poised to live to an old age without many complications. It is also recommended that the patient increases his intake of energy foods that do not put him at the risk of having too much blood sugar. Another option he should consider is that of increase the intake of insulin and energy through injections. Patient Three The third patient is a 12 year old girl born with Type 1 diabetes. Her parents are both diabetic and so are most of her relatives. Her case is not severe since she has learnt to live with the disease from a young age. The symptoms she experiences include frequent thirst and low weight in general. She also experiences blurry vision and uses prescribed glasses in her daily activities. She is fond of grapes and exercises by walking to and from her school which is 500 meters from her home. Her plasma glucose level has been maintained around 12.8 mmol/l for the last three years while her fasting plasma glucose levels fluctuates within a narrow range whose average value for the past three years is 8.0 mmol/l (Barnett, 2006, p. 98). her glycated hemoglobin level is an average of 7 percent. She takes the blood sugar levels every morning before going to school and a few hours before retiring for the night. This patient, due to her age and the family’s experience with both types of diabetes, takes less strong medicines as the father, a medical doctor who specializes in diabetes, takes care of the family himself included. He prescribed for her daughter 1 tablet of metformin and 1 ml of victosa injection every morning. For her insulin requirements, she receives 10 units of insulin of the glargine type. She takes unrefined cereals in her breakfast for her energy requirements and supplements that with energy supplements she takes through an injection every third day. Her health is well-managed and she has no medical complications besides her allergic reactions to pollen. Every other factor in her life is okay and she intends to live to a ripe old age (Ford, 2006, p. 100). The patient is well managed with services she receives in comparison to the average patient. The fact that the father is a medical doctor augers well for the patient since any medical complications can be easily dealt with without difficulty. The patient, having from a young age gotten familiar with the disease, will have less difficulty handling herself compared to those who get the ailment in their old age. Since she knows how to manage her health in terms of avoiding conditions that pose a danger to her health, this patient is quite safe (Egan and Kadushin, 2012, p. 160). It is advised that the patient seeks further options in the managing of her disease beyond what she is offered by her father to take care any eventualities that may come about due to he absence of her father. Conclusion It is in the interest of this reflective paper that the effects of diabetes should be reduced through the correct sensitization of the public on the effects of this disease and administration of the correct drugs to the patients. Governments should take initiative to use tax money in saving the lives of these citizens. Individuals should then take up the initiative of educate themselves and go for medical checks to determine the next steps to take if diagnosed with the ailment. With the correct medicine and information in the hands of the patients and those who take care of them, deaths due to diabetes mellitus are poised to greatly reduce (Bergenstal and Powers, 2011, p. 105). According to the United Kingdom statistics department, there were 2.9 million diabetic people in the United Kingdom. It also estimates that by the year 2025, there shall be at least 5 million people with diabetes in the United Kingdom (Hanas, 2007, p. 91). Those in the United Kingdom who are estimated to have diabetes but have not have it diagnosed are 850 thousand individuals. The average prevalence of diabetes in the United Kingdom is 4.45 percent but there are variations between regions and countries that make up the kingdom. It has also been found that the number of people with diabetes increases with their age with a majority of the patients being the elderly. In general, the prevalence of diabetes is increasing in all age groups in the United Kingdom with Type 1 diabetes increasing in children especially below the age of five as Type 2 increases in black and the ethnic groups that are considered the minority. More efforts are required especially on the sensitization of the public to increase awareness on the effects of diabetes. Thereafter, other efforts shall be needed to ensure the sick are well cared for to enable them have a good life in general (Barnett, 2006, p. 100). Another solution to the prevalence of diabetes is the increase in the government funding into the research into this disease. This would enable deeper research into the treatment of the disease and the eventual treatment of the same. References Barnett, A., 2006. Diabetes: Best Practice and Research Compendium. New York: Elsevier Health Sciences. Bergenstal, R. and Powers, M., 2011. Staged Diabetes Management. Chicago: John Wiley & Sons. CIBA Foundation Symposium., 2009. Aetiology of Diabetes Mellitus and its Complications: Volume 15: Colloquia on Endocrinology. New York: John Wiley & Sons. Egan, M. and Kadushin, G., 2012. Social Work Practice in Community-Based Health Care. Chicago: Routledge. Ekoé, J. and Zimmet, P., 2008. The Epidemiology of Diabetes Mellitus. New York: John Wiley & Sons. Ford, A., 2006. Focus On Diabetes Mellitus Research. Chicago: Nova Publishers. Hanas, R., 2007. Type 1 Diabetes in Children, Adolescents and Young Adults: How to Become an Expert on Your Own Diabetes. Chicago: Class Publishing Ltd. Hoffmann, T. and Bennett, S., 2009. Evidence-based Practice Across the Health Professions. Chicago: Elsevier Australia. Holosko, M. and Dulmus, C., 2012. Social Work Practice with Individuals and Families: Evidence-Informed Assessments and Interventions. New York: John Wiley & Sons. Katsilambros, N., 2011. Clinical Nutrition in Practice. New York: John Wiley & Sons. Kramer, M., 2007. Diabetes Prevention and Cardiovascular Risk Reduction in Primary Care Practice. New York: ProQuest. Llorente, M. and Feil, D., 2007. Psychiatric Disorders and Diabetes Mellitus. Chicago: CRC Press. Misra, A., 2012. Dietary Considerations in Diabetes – ECAB. New York: Elsevier Health Sciences. Rooney, R. and Strom-Gottfried, K., 2011. Direct Social Work Practice: Theory and Skills. New York: Cengage Learning. Tripathy, B. and Chandalia, B., 2012. Rssdi: Textbook of Diabetes Mellitus. New York: JP Medical Ltd. Read More