MSEM111.pdf

11/20/23, 5:24 PM Realizeit for Student Diabetes Diabetes is a group of metabolic diseases characterized by hyperglycemia (an elevated level of glucose in the blood) resulting from defects in insulin secretion, insulin action, or both (Centers for Disease Control and Prevention [CDC], 2020). Care...

11/20/23, 5:24 PM Realizeit for Student Diabetes Diabetes is a group of metabolic diseases characterized by hyperglycemia (an elevated level of glucose in the blood) resulting from defects in insulin secretion, insulin action, or both (Centers for Disease Control and Prevention [CDC], 2020). Care of the patient with diabetes, formerly known as diabetes mellitus but now more commonly referred to as diabetes, requires an understanding of the epidemiology, pathophysiology, diagnostic testing, medical and nursing care, and rehabilitation of patients with diabetes. The field of diabetes is dynamic with constant advances in technology, research, and medications that can improve the life and well-being of people with diabetes. Nurses care for patients with diabetes in all settings. This module focuses on the nursing management of patients with diabetes. Epidemiology It is estimated that more than 34.1 million adults in the United States have diabetes, although almost one third of these cases are undiagnosed (CDC, 2020). The number of people older than 20 years newly diagnosed with diabetes increases by 1.7 million per year. If this trend continues, one in every three adults in the United States could have diabetes by 2050. In 2018, the percentage of adults with diabetes increased with age, reaching 28.3% of those age 65 years or older (CDC, 2020). The rate of prediabetes is also steadily increasing. It is estimated that 35.5% of U.S. adults aged 18 years or older (88 million people) had prediabetes in 2018, based on laboratory findings. Nearly half (48.3%) of adults aged 65 years or older had prediabetes (CDC, 2020). Over $237 billion a year is spent in medical costs and $90 billion a year is lost in productivity related to diabetes (CDC, 2020). Ethnic and racial minority populations are disproportionately affected by diabetes. The age-adjusted prevalence of diabetes is increasing among all gender and racial groups, but compared with Caucasians, African Americans, and members of other racial and ethnic groups (Native Americans and persons of Hispanic origin) are more likely to develop diabetes, are at greater risk for many of the complications, and have higher death rates due to diabetes (CDC, 2020). Chart 46-1 summarizes risk factors for diabetes. Diabetes can have far-reaching and devastating physical, social, and economic consequences, including the following (CDC, 2020; Virani, Alonso, Benjamin, et al., 2020): https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX2deLl%2f4FdfKSHmHSZ7peJYyAcbNSqCsVXJC0jIBoVz… 1/5 11/20/23, 5:24 PM Realizeit for Student In the United States, diabetes is the leading cause of nontraumatic amputations and end-stage kidney disease (ESKD). Diabetes is the seventh leading cause of death in the United States and the leading cause of new blindness in adults aged 18 to 64 years. Emergency department visits and hospitalization rates for adults and children with diabetes are greater than for the general population. The economic cost of diabetes continues to increase because of increasing health care costs and an aging population. Classification The major classifications of diabetes are type 1 diabetes, type 2 diabetes, gestational diabetes, latent autoimmune diabetes of adults (LADA), and diabetes associated with other conditions or syndromes (American Diabetes Association [ADA], 2020). The different types of diabetes vary in cause, clinical course, and treatment (see Table 46-1). The classification system is dynamic in two ways. First, research findings suggest many differences among individuals within each category. Second, except for people with type 1 diabetes, patients may move from one category to another. For example, a woman with gestational diabetes may, after delivery, move into type 2 diabetes. Prediabetes is classified as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) and refers to a condition in which blood glucose concentrations fall between normal levels and those considered diagnostic for diabetes (ADA, 2020; CDC, 2020). Pathophysiology https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX2deLl%2f4FdfKSHmHSZ7peJYyAcbNSqCsVXJC0jIBoVz… 2/5 11/20/23, 5:24 PM Realizeit for Student Insulin is a hormone secreted by beta cells, which are one of four types of cells in the islets of Langerhans in the pancreas (Norris, 2019). Insulin is an anabolic, or storage, hormone. When a person eats a meal, insulin secretion increases and moves glucose from the blood into muscle, liver, and fat cells. In those cells, insulin has the following actions: Transports and metabolizes glucose for energy Stimulates storage of glucose in the liver and muscle (in the form of glycogen) Signals the liver to stop the release of glucose Enhances storage of dietary fat in adipose tissue Accelerates transport of amino acids (derived from dietary protein) into cells Inhibits the breakdown of stored glucose, protein, and fat During fasting periods (between meals and overnight), the pancreas continuously releases a small amount of insulin (basal insulin); another pancreatic hormone called glucagon (secreted by the alpha cells of the islets of Langerhans) is released when blood glucose levels decrease, which stimulates the liver to release stored glucose. The insulin and the glucagon together maintain a constant level of glucose in the blood by stimulating the release of glucose from the liver. Initially, the liver produces glucose through glycogenolysis (the breakdown of glycogen). After 8 to 12 hours without food, the liver forms glucose from the breakdown of noncarbohydrate substances, including amino acids, through the process of gluconeogenesis. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX2deLl%2f4FdfKSHmHSZ7peJYyAcbNSqCsVXJC0jIBoVz… 3/5 11/20/23, 5:24 PM Realizeit for Student https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX2deLl%2f4FdfKSHmHSZ7peJYyAcbNSqCsVXJC0jIBoVz… 4/5 11/20/23, 5:24 PM Realizeit for Student Example https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX2deLl%2f4FdfKSHmHSZ7peJYyAcbNSqCsVXJC0jIBoVz… 5/5