Diabetes Mellitus

Diabetes is a status in which the organic structure either fails to properly respond to its ain insulin, does non do adequate insulin, or both. This causes glucose to roll up in the blood, frequently taking to assorted complications. It is a life endangering status. Holocene WHO calculations indicate that worldwide about 3 million deceases per twelvemonth are attributable to diabetes.

23.6 million people in the USA i.e. 7.8 % of the population have diabetes. 2.3 million people in the UK are diabetics doing 8.8 % of population. In Pakistan 22.04 % of the population in urban and 17.15 % in rural countries suffer from diabetes mellitus. [ 2 ] Currently, it is projected that 150 million people on the Earth have diabetes [ 2 ] . This figure is expected to increase to 300 million by the twelvemonth 2025 ; most of these instances will be type 2 diabetes [ 2 ] .

The prevalence of type 2 diabetes varies widely between populations, reflecting differences in both familial susceptibleness and environmental influences  . The Asia and the Pacific have really high rates of diabetes and this is peculiarly due to the effects of modernisation, life style and the ripening of populations [ 1 ] . In fact, despite increasing consciousness of the turning job of diabetes and the recent publication of a figure of anticipations of current and future prevalence of diabetes worldwide, the U.S. is the lone state in the developed universe with dependable informations on national prevalence  .

We conducted this survey in Civil Hospital Karachi, a third attention infirmary to measure the current state of affairs of the rapid rise in diabetes in our patients and to place the associated factors which have contributed to this. After finishing this survey we recommended alterations to the relevant authorization on territory and National degree so that appropriate stairss can be taken to screen out this job which is increasing the economic load on our state where the wellness budget is less than 2 per centum.

Methodology

This is a cross-sectional survey conducted at Civil Hospital Karachi over a period of 7 months ( from 1st January to 31st July 2009 ) Data was collected by questioning the patients sing Medical OPD of Civil Hospital Karachi through a good structured questionnaire. Stress degrees were evaluated by inquiring patients about insomnia ( in the past one month ) . A written consent for the afore-mentioned was taken from each patient. Initially a pilot survey was conducted questioning 10 patients sing medical OPD of Civil Hospital Karachi. Any lacks in the questionnaire and method of the survey were corrected. The sample size was 450 ( approved by the DUHS Ethics and Research Dept. ) . which was non likely purposive sampling.

Our chief aim was to measure the frequence of diabetes mellitus and associated factors in patients go toing medical OPD for which the patients included were holding a Fasting Plasma Glucose ( FPG ) degree of 126 mg/dL or above, which was confirmed by reiterating the trial on another twenty-four hours or an Oral Glucose Tolerance Test ( OGTT ) 2-hour glucose degree of 200 mg/dL or above which was confirmed by reiterating the trial on another twenty-four hours, A random, blood glucose degree of 200 mg/dL or higher, and the presence of increased micturition, thirst and unexplained weight loss other symptoms can include weariness, blurred vision, increased hungriness, and sores that do non mend. Diabetic Patients with a diagnosing of high blood pressure i.e when the norm of 2 or more diastolic BP measurings on at least 2 consecutive visits is 90 millimeter Hg or when the norm of several systolic BP readings on 2 or more subsequent visits is invariably 140 millimeter Hg.

PASW-18 ( Predictive Analytics Software ) was used for statistical analysis. For uninterrupted response variables like age, BMI, weight were presented by average ± SD. General distribution was presented by ratio ( M: F ) or per centums. For comparing demographic and basic diabetes variables were used.

The survey was given blessing by the morals Review Committee of Dow University Of Health Sciences ( DUHS )

Consequences

The frequence of Diabetes found in patients go toing medical OPD was 19.71 % .The Mean BMI was 25.2489±5.733. The frequence of Type 1 was 14 % and type 2 was 85.7 % .The most susceptible age group was 50-60 with a prevalence per centum of 19.8 % . The patients who besides reported stress related issues were 60.2 % and the patients with first grade relations holding diabetes were 51 % . Patients who besides complained of Hypertension along with diabetes were 58.2 %

Discussion

The frequence of Diabetes mellitus in patients go toing medical OPD was 19.72 % . This is significantly higher from the prevalence as far because we chiefly collected our informations from an already High Risk Population. Harmonizing to W.H.O 2.8 million i.e. 9 % in UK and 22.04 % in Pakistan are diabetics.

WHO estimates that over the following 10 old ages ( 2006-2015 ) , China will lose $ 558 billion in bygone national income due to bosom disease, shot and diabetes entirely.

Numerous surveies have been conducted in the past linking Diabetes with assorted hazard factors. These surveies showed that additions in fleshiness and diabetes among US grownups continue in male and female, all smoke degrees, all ages, all educational degrees, and in all races reasoning that fleshiness is strongly associated with several major wellness hazard factors. In 2001 the prevalence of fleshiness ( BMI 30 ) was 20.9 % vs 19.8 % in 2000, an addition of 5.6 % . The prevalence of diabetes increased to 7.9 % vs 7.3 % in 2000, an addition of 8.2 % . The prevalence of BMI of 40 or higher in 2001 was 2.3 % . Overweight and fleshiness were significantly associated with diabetes, high blood force per unit area, high cholesterin, asthma, arthritis, and hapless wellness position.

Type 2 diabetes, characterized by target-tissue opposition to insulin, is like an epidemic largely in industrialised societies and is strongly associated with fleshiness ; nevertheless, the mechanism by which increased adiposeness causes insulin opposition is ill-defined.

A survey was conducted to find the prevalence and impact of corpulence and fleshiness among patients with type 1 and type 2 diabetes mellitus on glycaemic control and cardiovascular hazard factors in patients go toing a secondary attention diabetes clinic in the United Kingdom. The consequences showed that Obesity is common among patients go toing this infirmary ‘s diabetes clinic, with 86 % of those with type 2 diabetes were corpulent. Among the Chinese Adult population steps of cardinal fleshiness are better forecasters of glucose tolerance abnormalcies prevalence than BMI. A WHtR cut-off point of 0.5 for both work forces and adult females can be considered as optimum for foretelling ( pre- ) diabetes and may be a utile tool for testing and wellness instruction.

In the US Nurses ‘ Health Study, 114,247 adult females were followed for 8 old ages and 2,333 instances of type 2 diabetes were confirmed. After commanding for multiple hazard factors, the comparative hazard of diabetes was 1.42 among adult females who smoked 25 or more coffin nails a twenty-four hours compared with non-smokers, proposing a sensible association between smoke and the consequent development of diabetes.  A similar survey of 41,810 in-between aged work forces found that those who smoked more than 25 coffin nails daily had a comparative hazard of diabetes of 1.94 compared with non-smokers.  Smoking compounds the diabetic jobs Smoking which causes type 2 diabetes can impact the other manner unit of ammunition, excessively. Diabetics who smoke are at more hazard of worsening their wellness jobs.

Diabetics who smoke are at a higher hazard ( three times ) to decease of bosom onslaught and shot than diabetics who do non smoke moreover blood glucose, blood force per unit area, cholesterin degrees and the opportunity of infections shoots up among diabetics as smoke amends the blood vass of these patients which makes harder for their organic structure to mend. They can eventually stop up in amputations. Diabetics who already suffer from kidney, nervus and joint disease can damage the same when they smoke. Diabetics who continue to smoke face trouble in contending against cold and other respiratory diseases and are prone to develop dangerous malignant neoplastic diseases in oral cavity, pharynx, lung and vesica. They besides have greater hazard of being impotent taking to psychological and societal jobs.

Decision

Pakistan has a quickly lifting prevalence of diabetes and other classs of unnatural glucose tolerance. Pakistan is in one of the most High hazard countries of the universe where Diabetes is prevailing. The prevalence of diabetes in Pakistan is one of the highest yet reported from a developing state with a contrasting background as compared to the western states.

The frequence of Diabetes mellitus found in our research survey was 19.71 % .

The most important associations were Patient ‘s age, Obesity, Stress, Family History, Ethnic group, diet and Hypertension.

Recommendations

Early sensing and bar of diabetes in the high hazard group is of import in order to forestall the morbidity and mortality associated with diabetes mellitus. Designation of High hazard group their societal, life manner and dietetic alteration may cut down the development of diabetes.

The survey was conducted in order to place the incidence and associated factors of diabetes in our population.

The world is fast changing: the pace of events is massive. The apparently big world is shrinking into a global village as democracy spreads, western civilizations encroach on other civilizations and globalization becomes a household concept. Technological advancements and improvements in the information and communication technology have perverted all spheres of human endeavor. While this is happening on one hand, health care delivery has not improved significantly. Many patients and clients complain of the lack of coordination in the health sector: they are not happy about the reduced utility derived from health care facility they patronize.

There is a growing reduction in number of competent staff as well as insufficient fund for the health sector. These factors have made it necessary to evaluate the impact of information and communication technology on health care service. This need has become more important for chronic disease where collaboration between health care service providers is important. And with increasing incidence of chronic diseases and their attendant complications, this need cannot be overemphasized. Besides, the cost of managing some of the chronic diseases, for example diabetes, epilepsy and seizure disorders, with the traditional method is reasonably high.

The prospect ICT brings is improved quality of care due to collaboration between health care workers through a comprehensive shared care system adequately powered by ICT solutions and reduced overall cost for the management of chronic diseases like diabetes. In this paper, diabetes is the focus chronic disease. I will attempt to evaluate the requirements for an Irish ICT system to supply the model of shared care. However, a brief review of diabetes mellitus and shared care will be undertaken to unravel areas of focus for ICT intervention.

Diabetes mellitus: Review Diabetes mellitus is a syndrome of chronic hyperglycemia due to relative or absolute insulin deficiency, resistance or both. It affects over 100million people worldwide. Diabetes is usually irreversible, and patients can have a reasonably normal lifestyle; however its later complications which include macrovascular disease lead to increased risk of develop coronary artery disease, peripheral vascular resistance; and microvascular complications such as diabetic nephropathy, retinopathy and neuropathy.

In a normal person, the blood glucose concentration is narrowly controlled in order to prevent the devastating complications that may follow reduced or increased blood glucose concentration. This normal glucose level is 80-90mg/100ml or 3. 5-5. 0mmol/l. This concentration usually increased to 120-140mg/100ml during the first hour after a glucose meal. The feedback mechanism of the body is alerted to reduce this level to tolerable levels by the body by the conversion of glucose to glycogen for storage under hormonal influence particularly insulin.

However, in the fasting state, glucose is produced from glycogen and other substrates and released into the blood to maintain the blood glucose concentration. The various mechanisms for achieving this level of glucose control are as a result of hormonal influence, the activities of organs such as liver, skeletal muscle and the particular glucose concentration. The liver is a major metabolic organ that is important in the blood glucose buffer system: this is done by the storage of glycogen formed from glucose under the influence of insulin, a hormone produced by the pancreas, in the liver.

It also releases glucose into the blood in the fasting state. Insulin and glucagon function as important feedback control systems for maintaining a normal blood glucose concentration. When the glucose concentration rises too high, insulin is secreted from the Islet cells of Langerhans, the endocrine portion of the pancreas; the insulin in turn causes the blood glucose concentration to decrease toward normal. Conversely a decrease in blood glucose concentration stimulates glucagon secretion; the glucagon then functions in the opposite direction to increase the glucose concentration toward normal.

Under most normal conditions, the insulin feedback mechanism is much more important than the glucagon mechanism, but in instances of starvation or excessive utilization of glucose during exercise and other stressful situations, the glucagon mechanism also becomes valuable. Diabetes mellitus is a syndrome of impaired carbohydrate, fat and protein metabolism caused by either lack of insulin secretion or decreased sensitivity of the tissues to insulin.

It could be primary or secondary; primary diabetes is inherent while secondary diabetes can be due to Cushing syndrome, pheochromocytoma, cystic fibrosis, chronic pancreatitis, malnutrition-related pancreatic disease, pancreatectomy, and hereditary hemochromatosis, carcinoma of the pancreas, thiazide diuretic use, corticosteroid therapy, atypical antipsychotics, congenital lipodystrophy and acromegaly. There are two general types of diabetes mellitus: Type I diabetes also called insulin-dependent diabetes mellitus [IDDM]; this is caused by lack of insulin secretion.

Type II diabetes, also called non-insulin dependent diabetes mellitus [NIDDM] is caused by decreased sensitivity of target tissues to the metabolic effect of insulin. This reduced sensitivity to insulin is often referred to as insulin-resistance. The basic effect of insulin lack or insulin resistance on glucose metabolism is to prevent the efficient uptake and utilization of glucose by most cells of the body, except those of the brain. As a result, blood glucose concentration increases, cell utilization of glucose falls increasingly lower and utilization of fats and proteins increases.

Injury to the beta cells of the pancreas or diseases that impair insulin production can lead to type I diabetes. IDDM is immune-mediated and has been associated with other autoimmune conditions like pernicious anaemia, alopecia areata and Hashimoto disease. Viral infections or autoimmune disorders may be involved in the destruction of beta cells in many patients with type I diabetes, although heredity also plays a major role in determining the susceptibility of the beta cells to destruction by these insults. HLA-DR3 or DR4 is found in more than 90% of patients.

In some instances, there may be a hereditary tendency for beta cell degeneration even without viral infections or autoimmune disorders. The usual onset of type I diabetes occurs is less than 30 years; this is why it is called juvenile-onset diabetes mellitus. Type II diabetes mellitus is caused by diminished sensitivity of target tissues to the metabolic effects of insulin, a condition referred to as insulin resistance. This syndrome, like Type I diabetes mellitus is associated with multiple metabolic abnormalities although high levels of keto-acids are usually not present in type II diabetes mellitus.

Type II diabetes mellitus is far more common that type I, accounting for 80-90% of all cases of diabetes mellitus. In most of these cases, the onset of type II diabetes mellitus occurs after age 40. There is usually no immune disturbance. Therefore, this syndrome is often referred to as adult-onset diabetes mellitus. Patients with diabetes present with acute manifestations which include polyuria, polydipsia, weight loss and ketonuria; they also present with subacute symptoms like lethargy, reduced exercise tolerance, vulvar pruritus, and visual disturbance.

They also could also present with some of the complications of the disease such as staphylococcal disease, retinopathy, polyneuropathy, erectile dysfunction and peripheral neuropathy. Investigations that are necessary in the diagnosis of diabetes mellitus include fasting plasma glucose >7. 0mmol/l, random plasma glucose >11. 1mmol/l; routine investigations include urinalysis for protein and acetone, full blood count, urea and electrolytes, liver biochemistry and random lipids. Management of diabetes mellitus: avenue for shared care The management of diabetes required community participation and patient education.

The importance of glycemic control in the management of diabetic patient cannot be overemphasized: patient should adequately understand the favorable outcome associated with good glycemic control, the implication and concomitant complications that may result from poor plasma control. This is the core of self management of diabetes. Patient should also know the dietary requirement and comply with/adhere to drug use. Besides this self-care, community care is very essential as this constitutes family and general practitioner care. There is monitoring of patient’s compliance to medications and dietary advice.

Essentially, the management of diabetes is multidisciplinary: dieticians, cardiologist, ophthalmologists, neurologists, internal medicine physicians, endocrine experts. There is growing need to integrate this range of practitioners. Metabolic control of diabetes can be tested by urine tests, home blood glucose testing and glycosylated hemoglobin. Urine tests are carried using dipsticks these methods are simple and give a good feedback on the blood glucose control. Patients can also be taught finger-prick and use blood glucose monitoring device to measure blood glucose.

They can then interact with specialist through appropriate communication facility for automated scheduling and medication. Epidemiologically, there are 200,000 persons in Ireland with diabetes; this figure represents 3-5% of western populations. It is estimated to double by 2010. It consumes 10% of total health budgets. About €350 million annual cost is spent in Ireland where 59% of which is spent treating complications: 50 countries endorsed measures to reduce diabetes complications by one-third Shared Care What is shared care?

Shared care is a concept where all the professionals involved in the management of a case collaborate by exchanging information on the patients’ care. In this way, patient also has input into the care because his/her self-management better informed from the avalanche of information provided by the care network. Shared care is an approach to care where professionals share joint responsibility with respect to an individual’s care using their skills and knowledge. It also talks about adequate monitoring and exchange of patient data within the limits of confidentiality and privacy.

Shared care is both systemic and local: it collaborates the systems involved while there is local interaction between clinicians. Shared care impacts on the iron triangle of health. This triangle includes quality, access and cost. Shared care improves quality of patient care for patients with complex chronic disease like diabetes. There is increased access to patient information by health care professionals, and the patient can also easily access the professionals’ especially when the shared system is backed up by information and communication technology. Patient is also satisfied with the service rendered.

This model has been suggested to be better than the conventional method of treatment afforded to patients. The treatment is appropriate because the health care givers agree on best available method based on evidence-practice. Competence is also guaranteed and services are effective and efficient. On the hand, there is improved provider satisfaction: because there is reduced contact with the utilization of tertiary level of health care service. Definitions of terms Self-management: this is about goal-setting. It is the core of self management about medication and body care.

Diabetic patients need to understand the implication of self care to monitor the progress of symptoms and emergence of complications. Home care monitoring is also very useful because it helps patients to monitor their response to treatment and glycemic control. Prevention: primary prevention is important to reduce the possibility of a worsening condition especially for patients with multiple complex co-morbidities. Community of practice: this refers to the people involved in the share care. They include providers and organisations, citizens and patients with families and support groups.

Models of shared care: shared care is found in Primary Care which is the emphasis of The European Forum for Primary Care (EFPC), Secondary Care, Community Based Care and mental health. The focus of shared care includes inter-professional relations and patient management. Inter-professional relations include collaborative provision of clinical services, communication and information exchange, use of treatment and referral guidelines, shared responsibility for patient care, regular face-to-face contact, and joint professional education. Patient Management is based on individual patient goals.

It includes patient and family in the decision making protocol of management and patient-centered focus. There is no rigid working modality; with shared care, increased patient access to care reduced fragmentation of care and increased integration and continuity of care. There is a strong link at all levels of health sector-improved working relationships between providers and improved satisfaction among patients and providers. Diabetes-shared care-ICT solutions There is no doubt that information and communication technology is inevitable in the management of chronic diseases like diabetes.

In order to set-up an Irish ICT unit for diabetes, the requirements will be considered within the limit of the community of practice which includes providers and organization, citizens and patients. The concept of ICT solutions is branded as eHealth. It is a promising field that will incorporate all the professionals who are directly and indirectly involved in the management of a case to properly integrate their knowledge and skills for the appropriate care of a diabetic patient while making the emphasis: glycemic control convenient for providers and patients.

It is imperative to elucidate the aspect of health care that are relevant to ICT input: the idea of ICT use is to integration of information to improve access. This implies that patients’ information are made available at a common centre and accessible to the patient, their health care providers and researchers. The components include Clinical database: this contains the information of patient. There is a central repository of health care information of the patient. It includes the electronic patient record which is but a segment of the repository.

For diabetics, the information about their presentations, clinical features, investigations, treatment plans and modalities are combined, classified and ordered in accessible manner at the clinical database centre. This database centre is secured as the confidentiality and privacy of the patient’s data has to be maintained. It is also prevented from use by third parties unless there is due consent by the patient. This central unit is fed by local diabetes databases from local hospitals. The data is made accessible to general practitioners, community health care providers and patients.

Decision support tool: this is second important part of ICT solutions in shared care for diseases including diabetes. It contains specialized information guide for experts and simple algorithms of decisions for patients. Specific Requirements Providers and organization The tools that are required to have an effective shared care plan for diabetes includes: Internet: the internet has become the most influential means of connecting people, and exchanging information in this age. It is therefore unequivocal that it is useful in health information systems to achieve a collaborative network of professionals who care for diabetic patients.

A large bandwidth is required for the volume of information that is processes, exchanged and implemented in shared care practice for diabetic patients. Interprofessional Communication systems: Diabetic care requires effective interdisciplinary communication so that management decision is both cost-effective and evidenced based. A huge communication network is therefore required. Mobile and wireless Infrastructure: these also form ICT tools which are used in database processing, exchange and monitoring, they are required in order to facilitate the integration of the patient, and more importantly improves providers access to information

Data storage: since clinical database is an integral part of ICT solutions for shared care plan for diabetics. Data must be stored in a way that is accessible to providers. This implies that strict measures and guidelines must be in place to ensure the database is well-structured. Intelligence systems: Websites must be secured. Database must be protected from intrusion by third party parties. Patient’s data must be confidential and kept private and guideline of medical ethics with respect to this must be maintained. Therefore a sophisticated intelligence network is imperative to accomplish this gargantuan task.

E-learning for medical education: there is need to provide facility for providers for training and retraining. They need to update their knowledge base so that thy can offer quality service to clients. This can be achieved by making such up-to-date information available through an accessible means, for instance, the internet. Medicolegal/Ethic Issues: ICT input into health care must be maintained within the limits of ethical guidelines and mediolegal regulations for data management, exchange and implementation. It addresses problems of public interest, patient autonomy, third party involvement and international regulation against threats.

Citizens and Patients The requirements for the patients include E-learning device for the patient: this will teach patient the modus operandi of the collaborative health information system, their role and why it is important they adopt it. It will also give useful information about diabetes. Decision support tools: this should contain factual information that can guide the patient to make informed choice with respect to their management. Patient home management: this includes clinical signs monitoring, automated scheduling and medication.

It also comprises access to health educators and professionals. Areas of ICT use have been well documented in the literature: they are basically Teleconsultation: this is a kind of telemonitoring between patient and caregiver via phone, email, automated messaging tools and the internet Videoconferencing: this is face-to-face contact via such equipments as television, digital camera, videophone to connect between caregivers and patients. Both have proven useful in diabetic care. And this is widely reported in many papers from across the world. Issues and challenges

Diabetes Mellitus (DM) is a chronic disorder of impaired carbohydrate, protein, and lipid metabolism that is caused by a deficiency of insulin. A deficiency of insulin results in hyperglycemia. Type 1 DM is nearly absolute deficiency of insulin; if insulin is not given, fats are metabolized, resulting in ketoanemia. Type 2 DM is a relative lack of insulin or resistance to the action of insulin; usually insulin is insufficient to stabilize fat and protein metabolism but not deal with carbohydrate metabolism. (Silvestri, 2006, p. 638)

There are a lot of people who are diagnosed with Diabetes Mellitus. Contributing factors to the development of diabetes are hereditary, obesity, sedentary lifestyle, high fat low fiber diets, hypertension and aging. There is no cure for this disease but continuous studies and research have offered effective medical management therefore giving patients options as to which treatment are they willing and capable to maintain. Physicians may advise patients to follow changes in their diet. Incorporate diet into individual client needs, lifestyle, and cultural and socioeconomic patterns.

Exercise will also be included in the dietary adjustments. Physicians may prescribe oral medications and insulin according to patients needs. Clients should always monitor their blood glucose levels before meals, and before, during, and after exercise. This will give client awareness as to how they will deal with their insulin requirements. Insulin therapy should be carefully followed up and referred to a Diabetician. Clients, who can religiously follow administration of medications, maintain proper diet and exercise may lessen the complications of the disease or the treatment itself.

Health is a priority so it is important to set appointments for annual physical exam. In this way we are aware of our medical status and we can prevent illnesses, if there is, from being grave. If in case diagnosed with DM or any disease, regular checkups must be done. And most importantly, one should be well educated regarding the disease and its treatment to avoid any risks that would threaten life. Silvestri L. A. (2006). Saunders Comprehensive Review for the NCLEX-RN Examination. Philippines: Elsevier, Inc.

Diabetes mellitus is a group of metabolic diseases characterized by elevated levels of glucose in the blood or hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Normally a certain amount of glucose circulates in the blood. The major sources of this glucose are absorption of ingested food in the gastrointestinal tract and formation of glucose by the liver from food substances (Kozier et. l, 2002). Client’s name is Mr. Harvey, 48 years old and has three children and he is newly diagnosed having Type 1 Diabetes. He is a college undergraduate and has experienced working in a restaurant as chief cook until now where in he works for 6 hours. He is also a small businessman and is greatly affected by the economic condition as of the present.

He only earns enough for his kids since he is a single parent; he earns about 350 dollars a day including his earnings in his small business. These factors aforementioned greatly influence to his ability to access the necessary healthcare that he should have. Yes, he has a job but his earnings is not enough for him to be thoroughly be checked by healthcare professionals, and also because he has three kids which are all studying as well.

As a single parent, it is his job also to look after his children and this means all his extra time will be devoted to them and he will not be able to attend to his own needs and other self- care practices needed for his condition. Although he can do some modification in his diet still he cannot manage to consistent all throughout because he still has a lot of things to attend to, but nevertheless as a college undergraduate he has some basic knowledge about the condition he has which is Type 1 Diabetes.

Although he has a job and a business of his own it still does not erase the fact that he is a single parent of three kids, maybe he can buy some medicine for his condition but it will not be continuous because he will tend to prioritize other things. Prognosis of his condition would be poor because he cannot focus on the treatments that he should be getting to alleviate his condition; Diabetes is such a silent killer especially when complications arise. Lastly, diabetes can be fatal.

Diabetes mellitus refers to “a group of metabolic diseases characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or action, or both. ” (Mathur, 2009) This chronic medical condition occurs when the production of insulin, a hormone released by the pancreas in order to regulate the blood sugar levels, is absent or insufficient. Two major types of diabetes are 1. ) type 1 diabetes which requires the affected person to be insulin-dependent as his pancreas has been damaged by auto-immune attacks, making it unable to release the hormone and 2. type 2 diabetes which is also called non-insulin diabetes mellitus as the patients who suffer from this disease can still produce their own insulin.

As a matter of fact, for the latter, excessive amounts of insulin are produced by the body. This, however, damages the beta cell, the part of the pancreas that releases insulin, and causes the depletion of the production of insulin in the long run. This paper will focus on diabetes mellitus 2, the causes of this chronic disease as well as the physiological limitations that it can impose on a person’s exercise program.

It will also include the symptoms that a fitness instructor must watch out for when training an individual suffering from type 2 diabetes. This information will be used to create an exercise program for a subject with this chronic disease. In this section, the intensity, frequency, duration and the method for determining how the program should progress will be identified. Any prescribed medication that may affect the person’s performance should also be considered in the creation of this program.

Although diabetes mellitus II is coined adult-onset diabetes as it normally develops in adults who are forty years and above, the number of children who have been diagnosed with this disease has also increased in number. Although genetics or complications during pregnancy may play a role in the development of this disease, obesity is still identified as the major cause of this problem. An individual who has a Body Mass Index (BMI) that is 20% higher than the ideal has a higher chance of becoming diabetic.

Other major risk factors associated with diabetes are age, family history, race, a history of previous impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), hypertension, a history of gestational diabetes mellitus (GDM) and polycystic ovarian syndrome. (Votey & Peters, 2009) In the past, people ages 40 and above are more prone to this disease. But, now, due to the sharp increase in the number of children with this disease, this might as well be considered as a pediatric disease. A person’s family history should also be considered when determining a person’s risk to acquire this disease.

People with first degree relatives who are diabetic can have a higher chance of acquiring this disease. They may have acquired the gene that stimulates the production of a protein that inhibits the role of insulin in cellular glucose transport. A person’s ethnic group can also increase a person’s risk of acquiring this disease. Afro-Americans, Hipic Americans, Pacific Islanders, American Indians and Asians have a higher chance of becoming diabetic. A person’s blood pressure and cholesterol level can also determine if he is prone to diabetes.

People with a blood pressure of 140/90 mmHg and above, a cholesterol level of 35 mg-dL-1 or below or a triglycerol level of 250 mg-dL-1 will have a higher risk of becoming diabetic. (McArdle, p. 452, 2007) For people with type 2 diabetes, an increase in glucose levels occur because of relative insulin deficiency or the insufficient production of insulin by the pancreas, insulin resistance or the decrease in the effects of insulin on peripheral tissues, especially muscles, or a combination of these two problems.

Of course, insulin resistance, doesn’t necessarily mean that a person has diabetes. This, however, can cause diabetes in the long run, especially if the person’s diet is rich in simple carbohydrates. Because of insulin resistance, glucose is converted to triacylglycerol and is stored as fat. Since fat cells have a tendency to be insulin-resistant due to its reduced insulin receptor density, the person’s insulin resistance can reach a level that exceeds the maximum output of the pancreas.

Both resistance and aerobic training can help in the management of these factors by improving insulin are glucagon responses. Since skeletal muscles consume a lot of glucose, approximately 70 to 90% of the glucose present in the body, resistance training which increases muscle mass can increase insulin sensitivity, leading to better glucose control. Endurance training, on the other hand, “maintains the blood level of insulin and glucagon during exercise closer to resting values. ” (McArdle, p. 451, 2007)

Ideally, the management of diabetes involves dieting, exercising and taking in the prescribed medication, if there is any. There are, however, some cases when the blood sugar level of the patient is too high and exercise needs to be put off. At the same time, although exercise can be very beneficial to diabetics, it can be counterproductive if the condition of the client is not examined properly. Before a client is given a program, the instructor must first make sure that he has his doctor’s consent.

The instructor should also know if the client has the following complications: retinal hemorrhage, increased proteinuria, acceleration of microvascular lesions, cardiac arrhythmias, ischemic heart disease, excessive blood pressure during exercise, postexercise orthostatic hyerptension, increased hyperglycemia, increased ketosis, foot ulcers, orthopedic injury related to neuropathy and accelerated degenerative joint disease. The exercise should be adjusted based on these factors.

Obese individuals, for example, should be given lesser weight-bearing exercises. At the same time, they should also be given longer rest periods in order to avoid increase in blood pressure. People with heart and blood pressure problems must not be allowed to exercise when the temperature is too high or the atmosphere is too humid. They should also be given ample rest in between sets. They should also avoid isometric exercises as well as exercises that involve raising the weight overhead or holding positions wherein the head is lower than legs.

Aside from the risks caused by complications, the instructor should also pay attention to signs of hypoglycemia, especially if the client is taking in insulin or oral hypoglycemic agents. Mild hypoglycemia is characterized by trembling or shakiness, nervousness, palpitations, increased sweating and excessive hunger. People with moderate hypoglycemic reactions experience headaches, irritability and abrupt mood changes, impaired concentration and attentiveness, mental confusion and drowsiness.

In severe cases, the individual becomes unresponsive and unconscious and experiences convulsions. For such instances, the instructor must be attentive to these symptoms so that he can react immediately. Since some patients take ß-blocker medication, hypoglycemic unawareness should be expected and it is up to the instructor to make the client stop exercising, measure his glucose level and have him eat some simple carbohydrates like hard candies and sugar cubes if hypoglycemia is confirmed. The client should then be asked to rest for ten to fifteen minutes.

After that, his glucose level should once again be measured before allowing him to continue the exercise regiment. Another risk that should be avoided is late-onset hypoglycemia wherein the diabetic’s blood sugar remains low even after four to forty-eight hours has passed. This can happen if the client’s exercise is too strenuous for him. For this reason, high-intensity exercise should not be administered to a diabetic individual, especially if he has been prescribed some insulin or hypoglycemic agents.

He should begin with a low-intensity program that gradually increases in intensity. Changes in intensity must be made after a period of three to six weeks so that the individual would be given enough time to adjust. According to Erikkson’s study (Janot & Kravitz, 2009), doing some resistance training twice a week is enough to show results. Beginning with this frequency is also advisable as the instructor would be given the time to observe the client’s reaction to the exercise. He would also be able to clear him of late-onset hypoglycemia.

The study done by Ishii and his colleagues (Janot & Kravitz, 2009) shows that the range of the load given to diabetic individuals should be 40 to 50% of their 1 rep max. They should do around 2 sets of 25 repetitions. And, they should be given 30 to 120 seconds of rest in between sets. Based on the FITT principle, people with type 2 diabetes can have 3 to 5 times a week of aerobic exercise. The intensity should be 40 to 60% of the maximum HR and the duration should be around 30 to 60 minutes, unless the person is taking hypoglycemic agents or insulin.

General Purpose

To inform the audience about the condition, Brittle Diabetes Mellitus Specific

Purpose

To provide information on (1) the condition’s factual descriptions and (2) impact to a person’s life Central Idea: The presentation centers on the general description of Diabetes Mellitus, then proceeds in elaborating the actual condition of BDM. Factual description, signs and symptoms, related medical interventions, incidence and the impact of the disease to an individual are the focal points of this presentation.

Introduction

Attention Strategy

The presentation shall utilize persuasive and factual illustrations of the case to obtain the necessary attention from the audience. The study utilizes an evidenced-based analysis to further the discussion and obtain the attention of the general audience. In addition, it employs real life basis from the medical case of Cathy who died due to severe complications of BDM.

Revelation of Topic

The study reveals the danger and complexities of the rare type of diabetes, which is BDM.

During BDM presentation, the principal revelations include (1) the specific case of BDM and its difference from the typical DM Type 1/Type 2, (2) the increased chances of diabetic complications in BDM than the common DM cases, and (3) medical history of individual who have suffered the case of BDM.

Credibility

The credibility of the presentation lies with countless hours of research, references from credible authors and scholarly literatures, academic background on EMT-B, CNA and being a paramedic student, and an experience from an Aunt who died from BDM complications.

Discussion

Diabetes Mellitus (DM) is a clinical syndrome characterized by the deficiency or insensitivity of the body to insulin, and exposure of organs to chronic hyperglycemia is the most common medical complication of the disease (DeCherney and Nathan, 2002 p. 326). There are three known types of DM, namely (1) Type-1 or Insulin-Dependent DM (IDDM), (2) Type-2 or Non-insulin-Dependent DM (NDDM), and (3) Gestational DM (GDM). According to Marso and Stern (2003), these three types of DM are all characterized by the increased sugar levels in the blood (hyperglycemia); however, these are differentiated by their nature of occurrence and etiology.

Type-1 occurs due to the genetically impaired insulin receptor that prevents the insulin from binding to these receptors that provide the necessary signal for glucose cellular absorption. Type 2 occurs as a product of acquired metabolic impairment, particularly obesity, that also impairs the binding between insulin and cellular receptors due to the extensive distribution of fats. Lastly, GDM occurs during pregnancy as a product of bodily modification, specifically carbohydrate intolerance, on the pregnant mother’s body (Montella, Keely and Lee, 2008 p. 216).

These three types of DM are the most commonly known cases; however, a rare type of DM, known as GDM, also occurs to few people. According to Gill (2004), the case of GDM is similar to the manifestations of Type-1 DM although, with increased severity and frequency of occurrence (p. 11). Woodyatt in 1934 uses the term “brittle” to describe the main characteristic of the disease, which is the oscillation or instantaneous variations of glucose levels. According to mortality rates, the highest prone group is between 25 to 64 years (45%), followed by 65 to 74 age group (22%) and the youngest group of 16 to 44 (16.7%).

Patients experiencing this rare DM condition can experience multiple types of severe symptoms, specifically (1) ketoacidosis, (2) hypoglycemia, and (3) hyperglycemia. In the case of BDM, the occurrence of hyperglycemia and/or hypoglycemia can be very sudden and extreme in levels, which consequently makes diagnosis almost impossible due to the unpredictability of its manifestations. Ketoacidosis occurs during an extreme drop of insulin levels in the body that consequently increases blood sugar contents in the body making it thick in consistency (Backer, 2005 p. 201).

In addition, ketoacidosis occurs in a very unstable levels and unpredictable frequency. BDM can be very hard to control due to the severe swings on blood sugar levels. Medical practitioners commonly advice exercise, careful monitoring of diet and blood glucose levels at least every 30 minutes for the first 5 hours of BDM manifestations (Ballanoff, Yu and Stjernholm, 2004 p. 132). Signs and symptoms that need to be carefully monitored are fruity breath, dehydration, increased thirst, severe and instantaneous weight loss due to muscle wasting and increased frequency of urination (polyuria).

Meanwhile, severe complications that can result include (1) kidney damage due to nephropathy, (2) hypertension and heart damages (e. g. Cardiomegaly, Cardiac arrest, etc. ), (3) eye damage (e. g. glaucoma, cataracts, retinopathy, etc. ), (4) diabetic neuropathy affecting nerve functioning that eventually leads to leg and feet necrosis, GI peristaltic-related indigestion and impotence (erectile dysfunction), and (5) series of life-threatening conditions, such as hyperlipidemia, atherosclerosis and diabetic coma (Ballanoff, Yu and Stjernholm, 2004 p. 132-133).

One of the historically recognized records of BDM case is Cathy who was born in September 21, 1961 and eventually diagnosed with type 2 DM at the age of 20. Despite of different medical opinions and treatments on controlling her sugar levels, her blood sugar had continued to oscillate. In 1999, she had her child named, Sam, but her body rejected the baby during pregnancy due to severe diabetic complications. Things started going bad in the year 2000 as she was diagnosed with stroke and developed severe neuropathy on her feet.

As the years passed by, she had experienced BDM complications, such as heart attack in 2002, leg venous blockage in 2003 that eventually ended in surgery, and complete irreversible neck vein blockage in 2005. In 2007, Cathy had a stroke that destroyed almost all parts of her brain except for the remaining quarter piece of her brainstem. She lived for three days after the incident, and on May 22, 2007, Cathy’s body finally gave from the complications of BDM.

Conclusion

In conclusion, BDM is indeed a rare but tremendously life-threatening condition. Considering the standard DM treatments available, Diagnosis and treatment are both hard to administer due to the unpredictable and extreme drops or the rise of blood sugar in the body. The most common manifestations of BDM include severe hyperglycemia, hypoglycemia, and ketoacidosis. If these conditions pursue, minor complications, such as polyuria, dehydration, thirstiness, etc, can lead to more severe conditions, such as hypertension, heart problems, diabetic coma, etc.

To avoid these complications, medical experts had to suggest frequent blood sugar monitoring, diet restrictions, and exercise. One of the recorded cases of severe BDM is the progressive diabetic complications of Cathy. She first developed Type 2 DM indications at the age of 20. The doctors diagnosed her condition as BDM due to unpredictable and extreme rise of blood glucose levels. She was able to live a life of a common DM patient until she failed pregnancy in 2000, which eventually developed into severe BDM complications.

She died on May 22, 2007 due to the massive stroke that nearly damaged her entire brain.

References

1. Backer, H. D. (2005). Wilderness First Aid: Emergency Care for Remote Locations. New York, U. S. A: Jones & Bartlett Publishers. Ballonoff, L. , Yu, W. , & Stjernholm, M. (2004).
2. What to Do When the Doctor Says It’s Diabetes: The Most Important Things You Need to Know about Blood Sugar, Diet, and Exercise for Type I and Type II Diabetes. Tennessee, New Jersey: Fair Winds Press. DeCherney, A. H., & Nathan, L. (2002).
3. Current Obstetric and Gynecologic Diagnosis and Treatment. New York, U. S. A: McGraw-Hill Professional. Gill, G. (2004).
4. Unstable and Brittle Diabetes. Chicago, U. S. A: Informa Health Care. Marso, S. P. , & Stern, D. M. (2003).
5. Diabetes and Cardiovascular Disease: Integrating Science and Clinical Medicine. New York, U. S. A: Lippincott Williams & Wilkins. Montella, K. , Keely, E. , & Lee, R. V. (2008). Medical Care of the Pregnant Patient. London, New York: ACP Press.