Topic: Nursing Interventions to Decrease Complications of Diabetes
护理专业essay代写 Which entailed intake of insulin three or more times in a day or the use of subcutaneous insulin via an infusion pump……
Diabetes is one of the most common chronic conditions that has plagued the society with more and more people beginning to get diagnosed with it. If, it is not adequately controlled. Then it may result in acute metabolic complications, for example DKA in type 1 (diabetic ketoacidosis) and HONK in type 2 diabetes (hyperosmolar nonketotic coma). In the early 1920s, insulin was discovered which determined its use as a therapeutic agent. This in turn, led to the miraculous recovery of those patients who were diagnosed with DKA. And hence, were saved (Bliss, 1982).
However, it became apparent that while insulin therapy helped the patients steer away from life threatening diseases. The management of the disease in the long term became a huge challenge. Therefore, it became very important to address and find solutions for the complications of chronic diabetes that type 1 and type 2 patients faced. As is apparent, in the long term. The complications of diabetes can affect nearly all of the systems of the body. Such as the nervous system, the eyes, kidneys, and such. 护理专业essay代写
However, through proper research it was deduced that such complications can be reduced and even prevented when proper care is taken by the patient. The challenge is whether or not a patient is willing to learn and educated himself or herself regarding the challenges and their prevention.
Literature & Review
The world is faced with a diabetic crisis. With an increase in the number of people being diagnosed with diabetes especially type 2 diabetes, the prevention of its complications, or at least minimizing them. Is an important objective for all health care providers (Jillian Hill, 2004). Let us first have a look at the different complications that a person with diabetes is likely to face.
There are two types of complication that can occur in diabetes patients, 1) those caused due to complication of the microvascular system (nerves and organs) and b) those that are caused by the macrovascular system damage, and c) a combination of both of the aforementioned complications.
The duration of diabetes such as how long a person has had it, hypertension, hyperglycaemia. Unhealthy lifestyles and dyslipidemia are all significant factors which help complications develop in diabetic patients (Jillian Hill, 2004). Following are all of the complications discussed in detail.
This involves all the nerves and organs such as the small blood vessels of the eyes i.e. the retina, kidneys, and nerves. This can result in diabetic retinopathy, nephropathy, and neuropathy. This microvascular complications occur due to hyperglycaemia. As deduced in a study by Pirart. These complications were less common is people with good glycaemic control. 护理专业essay代写
When the blood vessels that are present at the back of the eye are damaged. It can lead to blindness. Diabetic retinopathy is one of the most common causes of blindness. This is why it is essential to have annual eye screening through diluted pupils. So that the symptoms can be deduced at an early stage and the progression can be controlled (NICE, 2002).
In the early stage, the retina shows the blood vessels clotting up which can cause dilation of other vessels as well. Which results in microaneurism. Most often, treatment is not required at this stage. Unless the same occurs in the macula region. Which is the central part of the retina.
The best treatment that is suggested is laser therapy which can prevent blindness from occurring in the eyes by sealing the vascular leakage points from damaged blood vessels. While this will npt restore the sight. It can definitely help in prevention of utter blindness.
Diabetes affects the kidneys severely as well. Diabetic renal disease is one of the major causes of mortality in people who have type 1 diabetes. While it is rare in type 2 diabetes, it is still quite a prevalent issue. If the blood pressure is controlled aggressively and glycaemia is also monitored and controlled, then the nephropathy can slow down. ACE (Angiotensin – converting Enzyme) helps in reducing the pressure in the kidney and reduces loss of urinary albumin.
This is the most common complication of diabetes and it is highly difficult to provide treatment for it. Because once this complication appears then nothing can be done except manage it. It is a result of the macrovascular system getting damaged which is primarily responsible for supplying blood to the autonomic and peripheral nerves.
The nerves are damaged. Which causes burning in the hands and feet, i.e. the limbs of the patient. And reduces sensation of the body, and may even lead to pain and paraesthesia. However, it is very difficult to manage the painful peripheral neuropathy. 护理专业essay代写
Nocturnal burning pain as mentioned earlier is often accompanied with this condition, and hence tricyclic antidepressants are very helpful in easing the pain. Motor neuropathy can cause atrophy of the muscles such as gait changes and hammer toes, which can sometimes lead to the formation of calluses and ulcers. Autonomic neuropathy sometimes leads to dry cracked skin which is usually a result of a reduction in sweating. And arteriovenous shunting, which results in an abnormal blood flow within the foot.
Diabetic foot disease is the most common cause of non-traumatic amputation in the UK - someone with diabetes is at 15 times greater risk than someone who does not have diabetes (Williams and Pickup, 1999). However, the number of patients requiring amputations has been increasing over the past decade.
Macrovascular damage 护理专业essay代写
The large blood vessels are affected in macrobascular damage, which are linked to the heart, legs, and brain. And may lead to coronary heart disease, stroke, myocardial infarction, and peripheral vascular disease. Hypertension, dyslipidaemia and smoking may cause this more easily then hyperglycaemia. This is one of the most common causes of death among patients with Type 2 diabetes (Campbell, 2001).
Who develops complications?
The complications related to diabetes can occur in patients having type 1 diabetes as well as those with type 2 diabetes (Audit Commission, 2000). Type 2 diabetes results in a complex condition which can lead to more problems if care is not taken. At times, patients with Type 2 diabetes are suffering from it far longer than they know. And it is deduced later on that they have Type 2 diabetes. 37% of diagnosed patients showed signs of retinopathy in a study on diabetes held in the United Kingdom (UKPDS, 1994).
The duration of the diabetes determine the complications one is likely to face for example, diabetic retinopathy is uncommon in patients who have Type 1 diabetes for five years or less. But for patients who have had the condition for over twenty years, the condition is more commonly seen. 30% of these patients also show signs of persistent proteinuria.
Which shows that there has been renal damage (Pickup and Williams, 1999). The level of glycaemia also determines whether or not a patient will be faced with such complications. Along with other underlying factors which include smoking, hypertension, dyslipidaemia and self care skills.
The recognition of the devastating impact of complications, and the need for well-organised diabetes care to prevent them, resulted in a World Health Organization commitment to take effective action in the early 1990s (Jillian Hill, 2004).
The focus nowadays of modern diabetes management is to enable the patients suffering from either type of diabetes to have a good quality of life. With ease day to day achievement of activities. And to help them minimize the risks associated with long-term complications. When the diabetes is kept within control. And in parameters then it can allow the person to live a healthy lifestyle.
The question that the study wanted to address was how effective both treatments were in reducing the complications faced by diabetic patients.
The objective of the study was to help determine the effectiveness of the two therapies and determine which one was more effective in reducing the chances of getting complications from diabetes.
Many researches have been conducted to determine how best to reduce the complications arising from diabetes. A large scale study with 1440 patients was conducted in 29 centers of the United States of America. To come up with a solution. Patients were randomly selected and then distributed into groups of conventional therapy i.e. intake of insulin once or twice in a day along with monthly clinical appointments, and intensive treatment.
Which entailed intake of insulin three or more times in a day or the use of subcutaneous insulin via an infusion pump, which was follows up by monthly clinical appointment as well along with weekly telephone calls from the nurse. These patients made sure to keep a tab on their blood glucose level and measured them in order to adjust their insulin level as and when required to maintain a tight control on their blood glucose.
The study was conducted for over decade after which it was determined that after nine years of care, microvascular complications in diabetics were significantly reduced for those patients who opted for intensive treatment along with nephropathy, neuropathy. And retinopathy which were reduced in varying rates from 35 – 75%. Through tight control, existing complications’ progress was also slowed with early retinopathy being reduced to 50% (Diabetes Control and Complications Trial Research Group, 1993). 护理专业essay代写
While it is true that glycaemic control is very important to prevent macrovascular problems and damage. Improvement in blood pressure showed that there was a significant reduction in microvascular and macrovascular complications. Having regular screening done so that early indications of these complications arising in the body could be deduced is essential to ensure that the person’s diabetes is managed correctly (Jillian Hill, 2004).
Nursing Implications & Interventions
Diabetes can affect people from all walks of life and in all ages. Which means that many of the nurses will come in direct contact with the patients. Nurses need to be educated about the conditions and what its implications are so that their interventions while interacting with the patient can be of benefit to both of them. They need to be supporting so that the people with diabetes can understand how to manage it better and they should help them understand the importance of proper management.
At the same time, the nurses need to be well adept at identifying the complications and guiding the patients better. In case better help is available elsewhere. This means the nurse will be responsible for arranging the necessary services that will benefit the patient and allow them access to it while at the same time reminding them about their annual eye screening. Or refer them to specialists who may be able to better help them in managing their condition.
Specialist clinics have been set up for patients suffering from erectile dysfunction. 护理专业essay代写
To which they can be guided by the nurse, of give them proper guidance in case if a foot ulcer is detected. Patients need support in order to maintain a good control on their diabetes and nurses are the key in providing them that much needed support.
There are many patients who deny any symptoms of feelings of hyperglycaemia, when they are inadequately controlling their diabetes, which makes their daily lives difficult. A good nurse will be able to identify such problems. While at the same time motivate the patient to take better care of themselves by following the prescribed usage of the medication. And at the same time maintaining a healthy lifestyle.
For those patients who already have been diagnosed with complications. Then their management can be a challenge and it is usually suggested to follow a multi-disciplinary approach. In this scenario, the patient should have an access to a medical assistance. A nurse to guide on glycaemic control, a dietitian, a podiatrist and a orthoptist for any patient who may have a foot ulcer.
District as well as Practice nurses are an integral part of providing superior care in the dressing required for foot ulcers and support of diabetics. Often times reducing the need for the patient to be admitted to a hospital (Jillian Hill, 2004).
With the passage of time, diabetes has become one of the most common diseases of this era. And the number of people who are being diagnosed with it are increasing. If this is not properly controlled then it can lead to more problems which in turn do more harm than good. The risk of complications emerging from diabetes is far greater in people who do not maintain a healthy lifestyle and are hence. Prone to the various problems and complications that have been discussed throughout the paper.
In order to lead a good life, nurses play a significant role in both educating as well as supporting the diabetics to manage the condition efficiently and adequately so that the risk of complications can be reduced. And these conditions can be prevented or the development be delayed.
After viewing the research it can be recommended that patients should opt for intensive care as that is far more beneficial for them and will help in reducing the chances of getting the complications as discussed above.
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