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Etiology of Primary Diabetes
Mellitus
IDDM results
from autoimmune disease process, many factors maybe contributory
such as Genetic susceptibility, Inheritance in which if a
child of an insulin dependent diabetic patient has an increased
chance of developing IDDM, this risk is greater with diabetic
father than that of diabetic mother, Viral infection
viruses maybe responsible for initiation or precipitation of
diabetes, Pancreatic pathology and Immunological
factors. Although NIDDM’s exact cause is unknown, some
factors maybe responsible such as Genetics, identical
twins of a patient with NIDDM have almost 100% chances of
developing diabetes, Environmental factors over
eating specially when combined with obesity probably acts as a
diabetogenic factor which increases resistance to the action of
insulin and Pancreatic pathology.
Clinical
Manifestations
Patients with
type 1 diabetes or IDDM usually present with Polyuria,
caused when blood level exceeds the renal threshold, Thirst,
weight loss, Blurring of vision, Postural Hypo-tension, it
results from lower plasma volume, and Paraesthesias a temporary
dysfunction of peripheral sensory nerves. Patients with type 2
or NIDDM may have history of increased urination and thirst but
majority of them are a-symptomatic initially. Type 2 patients
usually present with lack of energy, delayed wound healing,
visual blurring (due to glucose induced changes in refraction)
and fungal infections such as pruritus vulvae or balanitis.
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Nursing
Assessment
As far as
nursing assessment is concerned there are many test involved
such as if fasting blood sugar (FBS) test is more that 126 mg/dl
on more than one occasion, diabetes is conformed. While if
random blood sugar (RBS) test is more that 200 mg/dl, diabetes
is labeled, however FBS is more reliable than RBS. Glucose
tolerance test is required for confirmation of diabetes, where a
patient’s s required to take 75g of glucose with 250-300 ml of
water after an overnight fast, if fasting blood glucose is more
than normal but less than in diabetic range i.e. in between
110-126 mg/dl. Use of Glycosylated hemoglobin for screening of
diabetes is controversial, because its sensitivity is about 85%
indicating that diabetes can not be excluded by a normal value,
however elevated levels are quite specific (91%) in identifying
the presence of diabetes. Urinalysis is another test used for
detection of glucose in urine
Medical and
nursing management
There are
three methods available for the treatment of diabetes Diet
alone, Diet and oral Hypoglycemia drug, and Diet insulin. About
60% of diabetic patient can be treated adequately by diet alone.
The diet should be balanced i.e. it should contain fat, protein
and carbohydrates. A diabetic patient’s diet must include
calories, proteins, carbohydrates, salt and sweeteners as
directed by the physician.
Insulin
Insulin is
indicated in all patients with type 1 diabetes (IDDM) and type 2
diabetes (NIDDM) when hyperglycemia is not controlled with diet
therapy or combination of diet and oral hypoglycemic agents.
There are three types on insulin’s, Ultrashort acting insulin
(insulin lispro), Short acting or regular or plain insulin and
intermediate acting insulin.
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Oral
Hypoglycemic Agents
These drugs
are valuable in the treatment of patients with type 2 diabetes (NIDDM)
who fail to respond to simple dietary restrictions. Oral
hypoglycemic are contraindicated in pregnancy. Sulphonylureas
and biguanides are traditional drugs, which are mainstay of
treatment while there are certain new drugs available now such
as Alpha- Glucosidase inhibitors. Sulphonylureas are used in
non-obese patients of diabetes. These drugs act by increasing
insulin secretion, reducing peripheral resistance to insulin
actions and reducing hepatic release of glucose. Commonly used
sulphonylures include Daonil, Diamicron and Minidiab.
Sulphonylureas should be replaced by insulin during major
surgery and severe illness as it has side effects.
Biguanides
drugs act by decreasing glucose absorption from the gut. They
are used in NIDDM when patient is over weight, and with the
combination of Sulphonylureas when Sulphonylureas alone have
proved inadequate to treat NIDDM. Commonly used Biguanides is
Glucophage.
Alpha-
Glucosidase inhibitors drugs inhibit glucose absorption from the
intestine by inhibiting alpha glucosidase enzymes situated on
brush border of intestine Commonly used Alpha-Glycosidase is
Acarbose.
References
The
Doctor's Guide to Diabetes and Your Child: New Therapies for
Type 1 and Type 2
Allan E. Sosin
Diabetes
Sourcebook: Basic Consumer Health Information About Type 1
Diabetes (Insulin-Dependent or Juvenile-Onset Diabetes), Type 2
Diabetes
Karen Bellenir
The First
Year Type 2 Diabetes: An Essential Guide for the Newly Diagnosed
Gretchen Becker
Medical
Diagnosis and Management
Mohammad Inam Danish
Clinical
Medicine
Anne Ballinger and Stephen Patchett
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