Dealing With Type 1 Diabetes Juvenile - Research Paper Example

Type 1 Diabetes Juvenile 1. Pathological problem, definition and cause There are two types of diabetes, namely (1) noninsulin dependent and (2) insulin dependent. When human body does not produce pancreatic insulin, the person’s diabetes is classified as “insulin-dependent diabetes mellitus (IDDM)”. When human body does not produce adequate pancreatic production or its inability to utilize insulin properly, the person’s diabetes is classified as “noninsulin-dependent diabetes mellitus (NIDDM)” (Hernandez, 1989). Type 1 diabetes is called insulin dependent diabetes mellitus (IDDM). In the past, it was also known as childhood diabetes or juvenile diabetes. People living with the type I diabetes or IDDM, their bodies produce no insulin or little insulin because the beta cells have been destroyed. When the insulin is destroyed, there increases three major processes—(1) increased blood glucose, (2) breakdown of lipids for energy, and (3) a depletion of protein (Guyton & Hall, 2006; Turkoski, 2006). When the unused glucose increases in the blood, more glucose filters into the renal tubules than can be reabsorbed; this "spills" into the urine, hence "sweet water." Elevated blood glucose levels cause an osmotic imbalance that results in decreased re-absorption of water in the kidneys, resulting in excess water excretion causing serious dehydration that also leads to increased thirst (Turkoski, 2006). First, when human body has excessive blood glucose over long periods of time, it causes increasingly serious damages to bodily tissues. It results in decreased blood supply to vital organs leading to increased risks associated with heart attacks, kidney failure, stroke, and blindness. When the blood supply decreases, there are dangers of impaired wound healing, infections, and gangrene increase. The disease known as diabetic neuropathy is caused by the damage that uncontrolled long-term elevated blood glucose does to other tissues (Turkoski, 2006). Second, when the transporting of glucose into the cells is not facilitated with the insulin in, the source of energy for metabolism is shifted from carbohydrate to lipid. When the metabolism is based on lipid energy, then there is an increase in “ketoacids”. Normal cellular processes of utilizing the acids resulted in metabolic acidosis occurrence. This ketoacidosis only occurs in extreme cases of uncontrolled diabetes. If this is not treated, it can result in coma and causes death (Turkoski, 2006). Third, when glucose is unavailable for utilization in the body, and the source of metabolism is based on lipid or fats, proteins are broken down for another source of energy. The storage of proteins are damaged, symptoms such as muscle wasting, constant weakness, and weight loss occur. This type 1 diabetes accounts for about 10% of all diagnosed diabetes cases. This diabetes type 1 is called juvenile diabetes which is commonly found in young persons (Turkoski, 2006). The current theories of type 1 diabetes focus on two areas. The first is an autoimmune cause, which is a combination of genetic disposition and environmental factors (e.g., an inherited gene complex that increases the risk of developing type 1 diabetes when persons are exposed to an as-yet-unidentified trigger). The second cause of type 1 diabetes is an inherited disease that occurs without trigger. Treatment of type 1 diabetes always requires insulin, although oral hypoglycemic can be added to increase a constant blood glucose concentration throughout the day (Porth, 2006; Turkoski, 2006). Type 1 diabetes is a condition in which pancreatic β-cell destruction usually leads to absolute insulin deficiency. Two forms are identified: type 1A results from a cell-mediated autoimmune attack on β-cells, whereas type 1B is far less frequent, has no known cause, and occurs mostly in individuals of Asian or African descent, who have varying degrees of insulin deficiency between sporadic episodes of ketoacidosis. 2. Complications (additional clinical manifestations and/or side effects) Poorly controlled NIDDM on a daily basis can result in chronic fatigue, irritability, blurred vision, excessive thirst and urination, and persistent infections. On a long term basis, NIDDM is associated with (1) nucrovascular, (2) macrovascular, and (3) neurological diseases (Hoops, 1990; Schteingart, 1992). First, microvascular complications that are seen in NIDDM include retinopathy and nephropathy. In individuals with insulin dependent diabetes these two conditions generally occur together. In some ethnic minorities with NIDDM, however, nephropathy with end stage renal disease is more common (U. S. Department of Health and Human Services, 1990). Second, macrovascular complications of NIDDM generally take the form of atherosclerosis which may lead to cerebral vascular occlusion, myocardial infarction and arteriosclerosis that may result in impotence, aneurysms, and lower extremity amputations. Asians and Afiican Americans have a higher incidence of cerebral vascular accidents than other non whites (U. S. Department of Health and Human Services, 1991). Third, neuropathy is a complication that occurs in 50% of all individuals with NIDDM over age 50. It can take the form of autonomic neuropathy which can lead to gastroparesis, diarrhea, postural hypotension and silent myocardial infarctions. Peripheral neuropathy can result in serious injuries to insensitive extremities and has also been associated with increased rates of lower extrenuty amputation (Broadstone, Cyrus, Pfeifer & Greene, 1987). 3. Treatment (drug regime, surgery, life-style change, etc) Type 1 diabetes accounts for only about 5–10% of all cases of diabetes. However, it is expected that the figure will continue to increase. The disorder has a strong genetic component, inherited mainly through the HLA complex. Other factors that trigger onset of clinical disease remain largely unknown. Management of type 1 diabetes is best undertaken in the context of a multidisciplinary health team. There is no "cure" for diabetes mellitus (type 1 or type 2). It is found that “diet and exercise” cannot reverse or prevent type 1 diabetes. “Sensitivity and responsiveness to insulin” are usually normal, especially in the early stages (Turkoski, 2006). There are, however, an increasing number of medications that help control hyperglycemia and help maintain a consistent serum glucose level. Selected agents used to treat diabetes follow. Examples of adverse effects and drug interactions for these drugs are identified (Katzung, 2004, and Turkoski, Lance, & Bonfiglio, 2005). (1) Insulin—Multiple forms and brands available; each has different storage and administration specifics. D Purpose is to provide replacement for the lack of beta cell produced insulin. Available insulins were originally obtained from beef or pork pancreas. Today, only pork insulin is still available; however, the most frequently used insulin is human insulin manufactured through recombinant DNA techniques. The human insulins are considerably less likely to cause an allergic reaction than any animal insulin (Katzung, 2004, and Turkoski, Lance, & Bonfiglio, 2005). (2) Oral antidiabetic agents—These agents can all be used as monotherapy, in combination with another oral agent, or in combination with insulin. When combination therapy is used, the potential for hypoglycemic reactions may increase and patients should be monitored closely. In addition, there is a suspicion that oral hypoglycemic agents may be associated with an increased cardiovascular mortality as compared to treatment with diet alone or diet plus insulin(Katzung, 2004, and Turkoski, Lance, & Bonfiglio, 2005). However, it requires continuing attention to many aspects, (1) insulin administration, (2) blood glucose monitoring, (3) meal planning, and (4) screening for comorbid conditions and diabetes-related complications. These complications consist of microvascular and macrovascular disease, which account for the major morbidity and mortality associated with type 1 diabetes. There are more newer treatment approaches which have facilitated improved outcomes in terms of both glycaemic control and reduced risks for development of complications. Nonetheless, major challenges remain in the development of approaches to the prevention and management of type 1 diabetes and its complications (Katzung, 2004, and Turkoski, Lance, & Bonfiglio, 2005). 4. Side effects of the treatment Administration of insulin can be done only by injection. It cannot administered by mouth (gastric enzymes destroy insulin). The only administration is short-acing regular insulin which are normally administered intravenously. Some are available for intramuscular use, and most are administered by subcutaneous administration. There are two types of insulin administered to provide for both immediate and longer coverage. Hypoglycemia is found as the primary adverse reaction. The timing of this reaction differs among formulations. The potential for hypoglycemic reactions increases when insulin is used in combination with any of the oral antidiabetic agents. Other adverse effects include (1) palpitations, (2) tachycardia, (3) urticaria, (4) mental confusion, (5) hypothermia, (6) loss of consciousness, (7) increased hunger, (8) muscle weakness or tremor, (9) blurred vision, and (10) anaphylaxis or injection site reaction (Turkoski, 2006). 5. Prognosis (expectations for the individual with the pathological problem and expectations for the future treatment and prevention of this pathology) There is no cure for diabetes. It is a chronic disease, and managing or controlling diabetes is a lifelong process. To achieve normal or near-normal blood glucose levels and prevent the adverse complications of diabetes, patients must be involved in a program of education, diet, exercise, and medication. Nurses in any setting interacting with patients who have diabetes can play a vital role in helping patients manage and control their disease. Nurses knowledgeable about diabetes will be able to reinforce beneficial practices people have for managing their established diabetes; educate patients with newly diagnosed diabetes about their medications and the benefits of a balanced diet, regular exercise, and glucose monitoring; or dispel myths about diabetes for both peers and patients (Turkoski, 2006). Read More