The Nutritional Management of Diabetes - Literature review Example

Diabetes management case study Diabetes mellitus also known as type two diabetes is the most common form of diabetes accounting for 90% of all the diabetes cases (Johnstone & Veves). This disease has shown high potential in causing cardiovascular diseases through a number of ways such as coagulation and hormonal derangements (Johnstone & veves; Huxley, Barzi and Woodward 2006). Scientists believe this disease increases the risk of heart disease because persistent elevated levels of blood sugar damages arteries. Marcheti and Giannarelli (2007) say that “Both T1DM and T2DM increase cardiovascular risk by up to fourfold when compared with the general population, and cardiovascular disease (CVD) accounts for 70% to 75% of deaths in diabetic patients” (p 214).The authors say that the relationship between the two is detected in the hyperglycemia, insulin resistance, dyslipidemia, hypertension, and endothelial dysfunction. Furthermore the relationship between the two is detected through the diabetic cardiomyopathy (DCM), which is considered to be a distinct disease process. Diabetes causes changes in the myocardial cellular level, causing structural abnormalities that eventually result in left ventricular hypertrophy, and systolic as well as diastolic dysfunction (Park, Sohn, Cho & Kim 2009). The high blood pressure levels are also associated with increased left ventricle (LV) mass, diastolic dysfunction and reduced chamber compliance LV dilation which all combine to bring about the eventual heart failure. In a meta analysis carried out by the Huxley, et al (2006) to estimate the relative risk of coronary heart disease in 37 studies that in total involved a sample of 447 064 men and women showed that the risk of fatal coronary disease was higher than those who did not suffer diabetes. Women with diabetes in particular showed that they were 50% more likely to suffer from cardiovascular illnesses that those women who were diabetes free which is way higher than in men. These discrepancies along gender lines is attributed to body functioning and in particular the adjustment in the lipid level in the body which are directly affected by diabetes. In short the risk of cardiovascular illness for persons suffering from diabetes is higher in women than in men. To further strengthen their findings the authors reviewed existing literature and found that “the relative risk for fatal coronary heart disease associated with diabetes was significantly greater in women than it was in men,” however this observation is not explained as they say that “This greater attenuation in the relative risk among women with diabetes may be due in part to both the significantly higher levels of other cardiovascular risk factors compared with their male equivalents and the much larger difference in levels of risk factors between women with and without diabetes, compared with men with and without diabetes” (Huxley et al p.75). Prior to admission Before admission, John had been on the following medication Metformin 1g TDS, Gliclazide 160mg BD and Atorvastatin 10mg daily. Each of these form of medication had a different effect on his body. Metformin 1g TDS This drug belongs to the class of biguanides that helps lower that lowers blood sugar level by preventing the liver from making excess glucose and by making muscle and fat cells more sensitive to available insulin. This drug also lowers the risk of diabetic complications such as lowering the cholesterol and triglycerides levels in the blood. Cholesterol and Triglyceride are very active in constricting arteries which causes heart attack. This drug is preferred by many practitioners as it does not causes some of the side effects associated with many drugs used to treat blood sugar level with majority of them causing additional weight to the users (Park et al 2009). Another advantage of this drug is that when used alone to treat diabetes, it does not cause low blood glucose (hypoglycemia). On the other hand, this drug causes diarrhea, cramps and vomiting. Gliclazide 160mg BD This drug falls under the sulfonylurea class. McLaughlin & Bulla (2009) say that this is one of the most common drugs administered alongside metformin in fighting diabetes. On the other hand, Ansari (2008) notes that the drug has been classified both as a first generation and second generation sulfonylurea bringing confusion into its exact class. The drug has the same effect as metformin as it prevents hyperglycemia. In particular, gliclazide stimulates beta cells of the islet of langherhans of pancreases to release insulin. The drug improves on the body’s glucose uptake and utilization. The drug also enhances peripheral insulin sensitivity and reduces hepatic glucose production. Compared to metaformin, this drug has a longer lasting effect and a diverse role as it also reduces the platelet adhesiveness and aggregation common in arteries which is caused cholesterol. Atorvastatin This drug belongs to the statins class which generally reduces the level of cholesterol in the blood. This is possible through inhibiting the activities of the HMG-CoA reductase enzyme in the liver which is responsible for manufacturing cholesterol. However, not all cholesterol is bad for the body. As such, Atorvastatin, reduces the concentration of LDL which is considered to be harmful to the body and promotes the concentration of HDL which is considered to be good to the body. In fact, by reducing the concentration of LDL, Atorvastatin has the potential to reverse coronary artery disease. The efficiency of this drug is dose related or quantity related. For patients with relatively high levels of LDL cholesterol, they have to take high doses of the drug. For starters with cholesterol levels, 10mg dosage is recommended (Feinglos & Bethel 2008). After admission It is apparent that all the drugs that John was using were primarily meant to lower his blood sugar level and his cholesterol in the blood system. Given that diabetes has a high possibility of causing heart diseases, the inclusion of Atorvastatin was very informed as it reduced the possibility of arteries blocking and eventually causing a cardiovascular attack. After admission, John was put on a different medication as follows; Aspirin 100mg mane, Atenolol 25 mg BD’ Frusemide 40mg mane, Enalapril 10mg mane and Prednisolone 25mg daily (Johnstone & Veves 2005). Aspirin Aspirin belongs to the analgesic class of drugs. Aspirin is used to treat several illnesses severe to mild such as pain, fever, allergy and heart attacks. In the treatment of cardiovascular illnesses, aspirin slows down platelet aggregation in the arteries by deactivating the platelet enzyme, cyclo-oxygenase, which produces the cyclic endoperoxide precursor of thromboxane A2. By limiting the functioning of this enzyme, aspirin prevents the binding of platelet molecules which aggregate and patch up torn out walls on the blood vessels. Although such a function is normal and healthy to the body, the major assumption here is that the lump made might too big to limit the free flow of blood. As such, aspirin is used on a long term basis as a preventive measure in people who are likely to suffer from stroke and heart attacks. Furthermore, aspirin is administered to persons who have experienced heart attacks to prevent second time attacks. Hanas (2007) writes that due to increased research and understanding of aspirin's properties, its therapeutic applications has widened. He says that there is increasing evidence that it reduces the risk of some cancers and certain pregnancy complications. Frusemide 40mg mane- This drug falls under the diuretic class (loop diuretic). It is considered to be the most powerful in its class. Basically this drug aims to increase the rate of water and electrolytes elimination in the body by the kidney. This drug functions in the body by inhibiting effects on electrolyte reabsorption in the distal renal and proximal tubules and in particular in the ascending loop of Henle. As such, frusemide reduces the swelling caused by fluid retention in the body such as in the heart and other organs. This drug has mild reactions with aspirin though in very rare cases (Feinglos & Bethel 2008). Atenolol The drug classified under beta blockers drugs works by slowing down the heart and reducing its workload. Ansari (2008) says that the drug is basically used for treating chest pains with minor uses in treatment of other diseases. Hanas (2007) says it used in the treatment of hypertension which is likely to be caused by diabetes. It can also be used in the treatment of cardiovascular diseases and complications such as coronary heart disease and angina. In other cases, the drug is used for preventative purposes and treats the symptoms of graves disease and antithyroid. Patients using this drug may experience, dry mouth, confusion, loss of hair, depression and even nightmares. Prednisolone This drug falls under the glucocorticoid class. It works by inhibiting the inflammatory response to a variety of stimulating agents and probably delay or slow healing. This pertains to preventing edema, fibrin deposition, leukocyte migration, capillary dilation, capillary proliferation, collagen deposition, fibroblast proliferation and formation of scars with inflammation. It is used in treating lymphatic leucome, inflectional non-specific arthritis, neurodermites, asthma etc. In elderly persons such as John, the drug may cause dementia (Johnstone & Veves 2005). Enalapril This drug falls under the angiotensin converting enzyme (ACE) inhibitors. This drug is primarily used in treating hypertension, congestive heart failure and also as a remedy after a heart attack. Treatment of diabetes Historically, diabetes has been treated using metaformin and a number of sulfonylurea. This combination has proved effective and has little counter indications. However, Ansari (2008) says that the best treatment for diabetes lies in nutrition and exercise with medication being the last option. Nonetheless, the option of medication should not replace the natural methods of diet and exercise but should be introduced alongside them. In the case of treating, diet and exercise were given second place to medication both by the health practitioner and the patient. The fact that John would forget his diet requirements and slip back in to drinking and smoking, shows that little seriousness and emphasis was placed on this to imply its importance to the patient. Registered nurses have a wider scope of work than other practicing nurses. One of the most outstanding roles of RN is training and educating patients on diseases and recovery management (Hanas 2007). Diabetes is one of the major diseases that requires full patient participation and cooperation for survival and recovery of the patient. Registered nurses also evaluate and assess the performance of patients in managing their conditions. John has indicated that either he is not serious with his medication or he is not well informed of the severity of his condition and the consequences of his lifestyle on his health. Despite being advised to exercise regularly, eat more healthily and even to avoid drinking and smoking, he still does that. It is the role of the registered nurse to educate John about the matters at hand; the risks brought about by his behavior and how he can actively play a role in maintaining his health. As earlier indicated diet and exercise are the core treatments of diabetes and cannot be replaced with medication. References Ansari, M. (2008). Best Methods for Treating Diabetes. New York: Research Press Feinglos, M. & Bethel, M. (2008). Type 2 Diabetes Mellitus: An Evidence-Based Approach to Practical Management. New Jersey: Hamana Press Hanas, R. (2007). Type 2 Diabetes in Adults of All Ages. London: Class Publishing Huxley, R., Barzi, F. & Woodward, M. (2006). “Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies.” British Medical Journal, Vol. 332, No. 7533 pp. 73-76 Johnstone M., & Veves A. (2005). Diabetes and cardiovascular disease. Ed 2. Humana Press, 2005 Marchetti , A . Coppelli, and R. Giannarelli, (2007). “Pathophysiological links between diabetes and heart disease.” Medicogeographia McLaughlin, M. & Bulla, S. (2009). Real stories of nursing research: the quest for Magnet recognition. London: Jones & Bartlett Learning Park, J., Sohn, I., Cho, J. & Kim, C. (2009). “Impact of Diabetes on the Left Ventricular Long Axis and Midwall Function in Patients with Hypertension.” Chonnam Medical Journal. Vol. 45, No. 1, pp. 27-32 Read More