Adult Onset Diabetes Mellitus: Kolb's Learning Method - Essay Example

Running Head: ADULT ONSET DIABETES MELLITUS Adult Onset Diabetes Mellitus: Kolbs Learning Model of the Under the guidance of APA format Adult Onset Diabetes Mellitus: Kolbs Learning Method Introduction Reflective learning is essential to clinical nursing practice because it provides a retrospective view of the current practice and questions the reasons for doing so. Researchers have considered reflective learning as a good way of learning and that it enables the nurse to assess, understand, assimilate and learn through their experiences (Burns and Grove, 1997). The experiences may be in clinical practice or in ones life. There are several models and frameworks of learning which help nurses in the process of understanding of the subject andreflection. In this self-direct essay, I will be using Kolbs Model of learning, also known as Experiential Learning Model to understand Adult-Onset Diabetes Mellitus. I have chosen diabetes as the topic because of the growing problem of this disease globally and also for the fact that both my parents are suffering from it and I would like to gain insight into the disease process, prevention and management. I have chosen Kolbs Model because enables clear description of concepts, experiences, observation and reflection and testing and application (Kolb, 1984). Learning Adult Onset Diabetes Mellitus based on Kolbs Model According to Kolb (1984), there are four stages of learning, they are concrete experience, reflection, abstract conceptualization and active experience. 1. Concrete experience Both my parents are suffering from Adult-Onset Diabetes Mellitus. The disease was detected in their adulthood. Although initially they were started on pills to control the sugar levels, after a few years, the mode of treatment had to be shifted to insulin. With both my parents being patients of diabetes, I can see what a distressing condition the disease is. They cannot eat sweets, they have to stick to strict food regimens and they have to eat in a timely manner. They also have to take insulin injections everyday and check their sugar levels frequently. They meet the physician frequently to review their condition and to monitor for any complications that may arise from the disease. It is for these reasons that I have developed an interest in knowing about the disease, especially to prevent myself from developing it. As such, I am an overweight person with lifestyle and eating habits similar to that of my parents. 2. Reflective observation My parents suffered from diabetes because they were overweight and did not lead an appropriate lifestyle. Diabetes is group of clinical syndromes characterized by hyperglycemia arising as a result of absolute or relative insulin deficiency. There are mainly 2 types of diabetes and they are type-1 and type-2 (Kumar, Abbas and Fasto, 2007). Type-1 diabetes mellitus occurs commonly in younger people with no hereditary factors and is due to absolute insulin deficiency resulting from pancreatic beta-cell destruction. Type-2 diabetes mellitus is the most common type of diabetes and occurs in older people with hereditary factors or predisposing factors like obesity and sedentary lifestyle (Votey, 2007). It occurs due to a combination of peripheral resistance to insulin action and an inadequate secretory response by the beta cells. My parents suffer from type-2. The main metabolic defect in type-2 diabetes, also known as Adult Onset Diabetes Mellitus is decreased ability of the peripheral tissues to respond to insulin and inadequate secretion of insulin by beta cells of pancreas. The factors which probably lead to insulin resistance are inflammatory cytokines, increased non-esterified fatty acids, mitochondrial dysfunction and adipokines (Stumvoll, Goldstein, van Haeften, 2005). It is important to note that the only source of insulin production in the body are the beta cells in the pancreas. When these cells fail to adapt themselves to the long-term demands of peripheral insulin resistance and also to the increased needinsulin secretion, impaired insulin secretion ensues (Kumar et al, 2007). This occurs due to lipotoxicity, glucotoxicity and amyloid formation for beta-cell dysfunction (Stumvoll et al, 2005). The dysfunction is both quantitative and qualitative. The normal pulsatile, oscillating pattern of insulin secretion is lost and there is attenuation of the rapid first phase of insulin secretion which is a normal response to elevated plasma glucose. There is also decrease in beta cell mass, islet degeneration and deposition of islet amyloid (Kumar et al, 2007). Lipotoxicity is an acquired cause of the progressive decline in beta cell function as individuals progress from impaired glucose tolerance to overt type 2 diabetes mellitus. This is because there is an inverse correlation between fasting plasma free fatty acids (FFAs) and insulin sensitivity. There is enough research supporting the association between obesity and insulin resistance. Central obesity is more associated with diabetes. Intracellular triglycerides are markedly increased in muscle and liver tissues in obese individuals because the increased circulating FFAs are deposited in these organs (Kumar et al, 2007). Raised FFAs and intracellular triglycerides are potent inhibitors of insulin signalling. There is also dysregulation of adipokine secretion which further contributes to the insulin resistance (Kumar et al, 2007). Both insulin resistance and decreased insulin secretion must be present for the development of hyperglycemia. In most cases, insulin resistance develops prior to inadequate secretion of insulin. As a result of insulin resistance, coupled with decreased insulin production, there is decreased uptake of glucose in muscle and adipose tissues. Most of the obese patients have insulin resistance, but only those with an inability to increase beta-cell production of insulin develop diabetes (Votey, 2007). From this information, it is clear that adult onset diabetes mellitus occurs because of obesity and sedentary lifestyle. Another important factor which has been incriminated in the development of diabetes mellitus type-2 is the hereditary factor (Votey, 2007), which adds to my concern. It is very important to control diabetes because of the overwhelming complications it is associated with. Diabetes causes decreased intracellular glucose levels which in turn lead to decreased wound healing and recurrent infections. Decreased intracellular glucose levels also leads to lipolysis for deriving energy to the cells (Votey, 2007). Lipolysis leads to increase in fatty acids in the blood. These are taken up by the liver and metabolism in the liver yields ketone bodies, acetoacetic acid and hydroxybutyric acid (Votey, 2007). The ketone bodies are utilized for energy but when the rate of production increases, hyperketonemia results causing metabolic acidosis and dehydration. In the long-term, diabetes leads to 3 main conditions, disease of the eyes (retinopathy), nerves (neuropathy), and kidneys (nephropathy) (Votey, 2007). These effects are due to the damaging effect of hyperglycemia on the blood vessels in these tissues. 3. Concepts and generalization Adult onset diabetes mellitus mainly occurs because of hereditary predisposition, obesity and sedentary lifestyle. Central obesity is associated with diabetes more than peripheral obesity. It is very important to prevent and manage diabetes appropriately because of the dangerous consequences it is associated with like nephropathy, neurpathy and retinopathy. Appropriate measures to control weight gain, regular exercise and physical activity can decrease the chances of development of diabetes in those who are already predisposed to the disease by hereditary means. 4. Active experimentation (Testing and application) As the awareness of the pathophysiology of diabetes mellitus type-2 dawned upon me, I began make several amendments in my lifestyle and eating habits. I have started to get up early to buy time for regular exercise. I now spend at least half an hour in the morning exercising. The main physical activities I undertake are jogging, running, brisk walking, swimming and cycling. I take regular, frequent, small meals and avoid sweets, sugary juices and fatty food. I eat lots of fresh fruits and vegetables. I dont smoke or consume alcohol. I take the stairs to my classroom and avoid using lifts. Whenever possible, I walk and avoid using car. I am losing weight constantly. I feel energetic and confident. I have also checked my glucose levels recently. They are normal. I continue to lead a healthy lifestyle and have advised other friends and relatives about the benefits of active and healthy lifestyle. Conclusion Through Kolbs learning method, the concrete experience of parents suffering from diabetes mellitus type-2 has led to reflective learning of the pathophysiology of diabetes. Thus conceptualization of the fact that obesity, sedentary lifestyle and hereditary are important predisposing factors for the development of the disease occured. Through this understanding, lifestyle modification and dietary modification was done as a part of active experimentation. References Burns, N., Grove, S. K.(1997). The Practice of Nursing Research: Conduct, Critique and Utilisation, 3rd ed.. Philadelphia: W. B. Saunders Co. Kolb, D.A. (1984). Experiential Learning. Englewood Cliffs, NJ: Prentice-Hall Kumar, V., Abbas, A. and Fausto, N. (2007). Robbins and Cotran Pathologic Basis of Disease. 7th ed. Philadelphia: Saunders Publishers. Stumvoll, M., Goldstein, B.J., van Haeften, T.W. (2005). Type 2 diabetes: principles of pathogenesis and therapy. Lancet, 365(9467), 1333-46 Votey, S.R. (2007). Diabetes Mellitus, Type 2 - A Review. Retrieved on 15th Feb, 2010 from http://www.emedicine.com/emerg/topic134.htm> Read More