Diabetes Rate among Indigenous Australians - Term Paper Example

Diabetes in Australia Student name: Student Number: HSNS 201 Nursing Practice Development 1 Lecturer: Length: 1939 words University of May 24, 2013 Diabetes Introduction Diabetes is considered a chronic illness that occurs when there is an excess of blood glucose, as the body cannot produce insulin or insulin is not used properly. Diabetes type 1 is characterised by insulin deficiency, while diabetes type 2 is distinguished by resistance of insulin. Diabetes type 1 is a chronic, life-long illness that brings about major social, economic, and health burdens for people with the illness, their families, and the community. Diabetes type 2 was formerly considered to be an adult disease. However, with the increase of obesity and overweight in children, diabetes is presently being diagnosed more often among young individuals, especially the Torres Strait Islander and Aboriginal children and youth. This essay presents various issues regarding diabetes, particularly diabetes type 2. In addition, it will compare and contrast the two types of this chronic disease and its developments, along with patient lifestyles. Finally, it will explain nursing management and the education of clients with diabetes. The incidence/prevalence and main causes of diabetes in Australia Around 3.6 million people in Australia have pre-diabetes or diabetes (AIHW, 2011). It is stated that the mortality rates as a result of diabetes are two to four times greater within the aboriginal communities compared to the general population in major cities in Australia. This higher disease burden within rural regions can be greatly attributed to health’s social determinants (Australian Diabetes Council, 2013). It is stated that with fewer indigenous individuals living a conventional lifestyle and often having to adapt to the current westernized way of life, with plenty of foods rich in sugar and fat, cigarette smoking, sedentary lifestyle, and alcohol, their metabolism, which was once efficient, might no longer be favourable, hence a higher increase of diabetes (Faulks & National Diabetes Data Working Group, 2009). The genetic composition that facilitated the survival of aboriginal people when food was scarce might now be the greatest disadvantage, enhancing increases in weight, diabetes, and related conditions such as heart disease and high blood pressure (Australian Diabetes Council, 2013). Research has indicated that indigenous individuals living a lifestyle that is westernized have greater rates of hypertension, obesity, and impaired tolerance of glucose (AIHW, 2011). It is estimated that in 2008, more than 5,700 children 0–14 years of age had diabetes type 1 in Australia (Australian Diabetes Council, 2013). Presuming that new diabetes type 1 cases in 0–14 year-old young people continue to increase at the rate observed between 2000 and 2008, it is estimated that the rate of prevalence will rise by nearly 10% between 2008 and 2013. As reported by AIHW (2011), 88% of people with diabetes have diabetes type 2, which is estimated to have contributed to 94% of the entire diabetes burden in Australia in 2010. There are various risk factors related to diabetes type 2, including family history, age, and ethnicity (Saudek et al., 2010). Other factors, such as poor nutrition, poor management of weight, smoking, and absence of physical activity, mean that diabetes type 2 can be prevented or delayed, to some extent, via lifestyle modifications (AIHW, 2011). The disease processes of diabetes type 1 and type 2 have some similarities, but also some important differences (compare and contrast these two conditions) It is imperative to carry out a comprehensive assessment in order to distinguish the type of diabetes that a patient has, in order to facilitate proper treatment and management. There is a powerful inherited affinity to diabetes type 2 development compared to diabetes type 1. Diabetes type 1 development is not frequently related to lifestyle habits, insulin resistance, or obesity, but rather, to an immunity issue (Saudek et al., 2010). Levy (2011) states that diabetes type 1, also referred to as insulin-dependent diabetes, occurs when the required insulin is no longer produced by the pancreas. Diabetes type 2, or non-insulin-dependent diabetes, occurs when the insulin produced by the pancreas is not enough and the insulin cannot work effectively. Diabetes type 1 represents around 10–15% of all diabetes cases. Diabetes type 2 is more common in adults, although occurrences in children have been reported due to the sedentary westernized lifestyle that people live (Saudek et al., 2010). Regarding symptoms, there is typically an abrupt onset in diabetes type 1. Symptoms can include excessive urination and thirst, fatigue and weakness, irritability, and unexplained loss of weight. On the other hand, in type 2 diabetes, symptoms occasionally go unnoticed, as the illness develops slowly. Management is fundamental to both types of diabetes. In type 1, there is a need for lifelong daily insulin injections or use of an insulin pump, healthy eating, regular blood glucose level tests, and regular physical exercise. Healthy eating and regular physical exercise are very important in type 2 diabetes as well. With time, treatment might progress from modification of lifestyle to requiring insulin injections and/or tablets that lower blood glucose (Saudek et al., 2010). The relationship between type 2 diabetes and one resulting chronic condition and the pathophysiological changes that occur and result in the development of the chronic condition One of the complications brought about by diabetes type 2 is diabetic cardiomyopathy, which is a heart muscle disorder among diabetic type 2 individuals. This complication can result in the heart’s inability to circulate blood throughout the body successfully, a state that is referred to as heart failure, in addition to fluid accumulation in the legs, known as peripheral oedema, or within the lungs, known as pulmonary oedema (Clark & McFarlane, 2007). Diabetic cardiomyopathy is characterised functionally by myocyte hypertrophy, outstanding interstitial fibrosis, ventricular dilation, and preserved or decreased systolic function in the presence of diastolic dysfunction. Although it has been clear for a while that diabetic complications are significantly related to the hyperglycaemia connected with it, numerous factors have been associated with the disease’s pathogenesis. Etiologically, there are four major causes that are responsible for heart failure development in diabetic cardiomyopathy: autonomic neuropathy, microangiopathy, and associated endothelial dysfunction; alterations in metabolism, such as increased oxidation of fatty acids and abnormal use of glucose; production and accumulation of free radicals; and changes in ion homeostasis, especially calcium transients (Angel et al., 2013). Diabetes can alter the makeup of the blood vessels, which can result in cardiovascular disease (Saudek et al., 2010). The lining of the blood vessels may become thicker, thereby impairing blood flow, and heart problems and risk of stroke can also occur (Galmer, 2008). Management of diabetes type 2 and patient education It is imperative that diabetes patients receive appropriate education. Diets high in protein and low in carbohydrates have been shown to improve body composition, lipoprotein and lipid profiles, and regulation of glycaemia related to management of weight loss and obesity. Based on these outcomes, low-carbohydrate, high-protein diets are being examined for the management of type 2 diabetes, metabolic syndrome, and heart disease (Geil & Ross, 2009). Low-carbohydrate, high-protein diets have been shown to have encouraging effects on decreasing heart disease risk factors, including raising HDL cholesterol, decreasing serum triacylglycerol, raising LDL particle size, and decreasing blood pressure (Galmer, 2008). In type 2 diabetes, these diets have shown positive outcomes on glycaemic control, including lower fasting blood glucose levels, insulin response, and postprandial glucose. It is argued that among people with diabetes type 2, replacing saturated fat with monounsaturated fat might be more helpful in reducing CVD risk compared to carbohydrate replacement (National Institute for Health and Clinical Excellence, 2009). The fundamental aim in managing diabetes is adherence (Saudek et al., 2010), and the patient will have to undergo major lifestyle changes to achieve this goal. One of the lifestyle changes required is diet. Sensitivity to insulin can improve within days of commencing a diet lower in calories. Eating foods that are high in fibre is very important, including a good selection of fruits, beans, whole grains, and vegetables, particularly green vegetables. The patient should try to consume vegetables and fruits in a variety of colours to aid in filling every nutritional need and lessen cravings that result from nutritional deficiencies. The patient should eat meals small, frequent meals throughout the day (Galmer, 2008). It is important to aim for a diet that is moderately low in carbohydrates. This will involve working with a dietician to establish the right quantities of carbohydrates required. An important factor to consider is to limit saturated fats to no more than 7% of the daily intake of calories. Examples of good monounsaturated fats include nuts, avocados, and olive oil; walnuts and fish contain omega-3 fats. When choosing proteins, the patient should opt for chicken, fish, and legumes. It is important to consult a dietician regarding the quantity of protein that can be consumed, as some conditions, such as kidney disease, might place limitations on the amount of protein that a patient should eat (Holt, 2010). One of the nursing interventions is to involve the patient in planning his meals as indicated (LeMone et al, 2011). Exercise is another significant lifestyle change diabetic patients must make to achieve good quality of life. Exercise facilitates the reception of insulin by the cells and lowers blood sugar and insulin levels, and it increases the sensitivity of insulin. As such, exercise improves the general health of the patient. While regular physical exercise is essential for each person, it is considered even more important for people who have diabetes type 2. Exercise that raises heart and respiration rates facilitates the reduction of blood sugar levels without medication (Galmer, 2008). In addition, it burns extra fat and calories, so that the diabetic person can manage his or her weight. Exercise can also improve blood flow, which is why diabetic patients with cardiovascular disease need appropriate education on the importance of physical exercise (Hawley & Zierath, 2008). A correct diet coupled with exercise is considered the basis of diabetic management, with a higher amount of physical exercise producing better outcomes. Aerobic exercise, for instance, results in a reduction in HbA and increased sensitivity to insulin. Another useful exercise is resistance training; combining both types of exercise might be most helpful (Hawley & Zierath, 2008). A diet that promotes loss of weight is very important in managing diabetes. Culturally, proper education can assist individuals with diabetes type 2 to control their blood sugar levels for nearly six months at minimum (Galmer, 2008). Another lifestyle change that the diabetic patient needs to consider is weight loss; the definitive goal is to obtain a BMI that is healthy. However, loss of weight can be very tricky for individuals who already have diabetes type 2; therefore, it is important to focus on goals that are realistic. Another important factor is to reduce stress, as it is known that severe stress can increase blood sugar levels, which ultimately increase the level of insulin (Galmer, 2008). Patient teaching on management of diabetes is very fundamental towards achieving an optimal health outcome (Brown, & Edwards, 2008). Conclusion This paper has discussed various issues relating to diabetes. It is noted that the increased diabetes rate among indigenous Australians is believed to be brought about by diet, obesity, genetic susceptibility, poor living standards, lack of physical exercise, and reduced access to medical care. Diabetes type 1 and type 2 have similar characteristics; therefore, it is important to establish key differences in order to institute proper management. While diabetes can result in life-long complications, such as cardiovascular disease, with proper management, life expectancy can be prolonged. Nutritional remedy is regarded as the cornerstone of diabetes management. For proper management of diabetes, it is important that the appropriate changes in lifestyle and diet be considered in order to keep diabetes under control, because this is a lifelong condition. Poor management can only worsen the condition. Reference Angel, A., Dhalla, N., Pierce, G., & Singal, P. (2013). Diabetes and cardiovascular disease: Etiology, treatment, and outcomes. Heidelberg: Springer Verlag. Australian Diabetes Council. (2013). Diabetes Facts. Retrieved from http://www.australiandiabetescouncil.com/About-Diabetes/Diabetes-Facts Australian Institute of Health and Welfare (AIHW) 2011. Prevalence of type 1 diabetes in Australian children, 2008. Diabetes series no. 15. Cat. no. CVD 54. Canberra: AIHW. Retrieved from http://www.aihw.gov.au/publication-detail/?id=10737419239 Brown, D., & Edwards, H. (2008). Lewis's medical-surgical nursing: Assessment and management of clinical problems. Marrickville, N.S.W: Elsevier Australia. Chawla, R. (2012). Complications of Diabetes. New Delhi: Jaypee Brothers Medical Pub. Clark, L. T., & McFarlane, S. I. (2007). Cardiovascular disease and diabetes. New York: McGraw-Hill Medical. Faulks, K., & National Diabetes Data Working Group (Australia). (2009). Insulin-treated diabetes in Australia, 2000–2007. Canberra: Australian Institute of Health and Welfare. Galmer, A. (2008). Diabetes. Westport, CT: Greenwood Press. Geil, P. B., & Ross, T. (2009). What do I eat now?: A step-by-step guide to eating right with type 2 diabetes. Alexandria, VA: American Diabetes Association. Hawley, J. A., & Zierath, J. R. (2008). Physical activity and type 2 diabetes: Therapeutic effects and mechanisms of action. Champaign, IL: Human Kinetics. Holt, R. I. G. (2010). Textbook of diabetes. Chichester, West Sussex: Wiley-Blackwell. LeMone, P., Luxford, Y., & Fagan, A. (2011). Medical-surgical nursing: Critical thinking in client care. Frenchs Forest, N.S.W: Pearson Australia. Levy, D. (2011). Type 1 diabetes. Oxford: Oxford University Press. National Institute for Health and Clinical Excellence (Great Britain). (2009). Type 2 diabetes: The management of type 2 diabetes: quick reference guide. London: National Institute for Health and Clinical Excellence. Saudek, C. D., Margolis, S., & Johns Hopkins Medicine. (2010). Diabetes. Baltimore, MD: John Hopkins Medicine. Read More