Introduction of Clinical Management of Diabetes Mellitus

Running Head: Diabetes Mellitus 1
Diabetes mellitus
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Diabetes Mellitus 2
DIABETES MELLITUS
Introduction
Diabetes mellitus is classified amongst chronic conditions whose characteristics are production
of little amounts of insulin by the pancreas in the human body. Reduced amounts of insulin
results in blood glucose concentration, a situation called hyperglycemia. This leads to poor
metabolism of fats, proteins, and carbohydrates in the body (Rochmawati, 2018). Prolonged
hyperglycemia affects most of the body tissues and is linked to various other diseases of the
organs in the body system, such as the kidneys, the eyes, the body nerves, and the blood vessels.
The rate of prevalence of diabetes in the whole world has been increasing dramatically. It affects
classes of every people and people of all gender from the young to the old. Its onset is mostly at
15 to 16 years of age in children and 40years amongst the middle-aged. The most prevalent
gender towards diabetes is women and girls as compared with men and boys consecutively.
The disease has several aspects, which include its natural history, its prevalence rate, incidences,
mortality, and morbidity in the entire world’s population. When the cause of this disease is
identified, it is possible to come up with its preventive measures amongst the health
professionals and help patients to arrest or delay its onset. There is no part of the world that has
so far not reached to high diabetes proportions.
From the concept map, the four community concepts for diabetes include that diabetes is
common amongst individuals, it is a chronic condition, it has no cure, and its treatment is
expensive. Offering information discussed in the concepts in this paper is very helpful in the
society.

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THE CONCEPT THAT DIABETES IS COMMON AMONGST INDIVIDUALS
Community members should be aware that Diabetes is a condition that is common amongst
individuals in the whole world. The community health nurse has the duty to educate the
community members about the pathophysiology of diabetes, signs and symptoms, and how it can
be managed. the nurse does this in line to diabetes evidence based practice as they offer care and
give information on how the community members can prevent the condition and manage it
amongst the members having it already.
Its pathophysiology is that diabetes mellitus is classified into three types, which include Diabetes
type 1(juvenile diabetes), type 2 diabetes, and gestational diabetes ("Pathophysiology and
Complications of Diabetes Mellitus," 2012).
Diabetes type 1
There are various characteristics of Type1 diabetes. An autoimmune process destroys the beta
cells, which leads to the absolute deficiency of insulin in the bloodstream. There is the presence
of the anti-glutamic acid decarboxylase, insulin antibodies, or islet cells whose function is to
identify the autoimmune processes which lead to the destruction of beta cells. To maintain
normoglycemia, all type 1 diabetes patients need insulin therapy (Walkey, 2018). Diabetes type 1
is linked with HLA on chromosome 6, where the HLA system confers the genetic susceptibility
of type 1 diabetes. The HLA molecules provide presentations of antigens that produce T – helper
cells that initiate specific islet cells autoantigens for an immune response. The T – cells formed
in the immune response can kill the cells producing insulin in the Islet of Langerhans, resulting
in the formation of autoantibodies (Walkey, 2018).

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There are also Islet cell antibodies (ICA) that act against the antigens found in the cytoplasm of
endocrine cells in pancreatic islets. Insulin autoantibodies are commonly found in the diseases of
the immune system at the onset of diabetes type one in toddlers. The presence of ICA and IAA
increases the risk of developing type 1 diabetes in an individual. Environmental factors also
facilitate the development of diabetes type 1 in individuals such as cow’s milk, viruses such as
mumps, and various chemicals emitted into the environment (Tripathi & Saboo, 2019).
According to Skyler et al. (2016), between 2001 and 2009, the number of youth with diabetes
type 1 in the U.S increased by 21%, and its prevalence rate is increasing per year in the globe by
3%. Its diagnosis occurs at childhood, while the adults who live with it are 84%. Both genders
are affected equally by this disease, and the life expectancy of an individual is decreased by 13%.
The incidences and prevalence rate of diabetes type 1 is different across the globe where for
example, the extremes of the diabetic cases have been reported to be 0.1 /100 000 and
0.6/100,000 in China and Finland consecutively. Diabetes type 1 is reported to progress during
the colder seasons where many people have a diabetes diagnosis, and the islet autoimmunity
appears to increase during the winter and autumn season than it is in summer and spring. The
members of the community should be made aware of this type of diabetes and its associated
signs and symptoms to enable its management on time. Diabetic management teams in the
community should perform this task together with the community health care nurses. Its signs
and symptoms include increased thirst, frequent urination, unintended loss of weight, extreme
hunger, mood changes, and irritability, the onset of bedwetting, especially in children who did
not wet the bed earlier, fatigue, weakness, and blurred vision (ScholarlyBrief, 2013). When the
members of the community identify such signs and symptoms at individual levels, they should

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visit the nearest health facility to get tested for their blood glucose levels and, at the same time,
get the right education on how to manage this type of diabetes.
Diabetes type 2
This disease develops when B-cells fail to secrete enough insulin to keep up with the body’s
demand due to increased insulin resistance (ScholarlyBrief, 2013). Most of the people diagnosed
with type 2 diabetes do not have islet autoimmunity. The main risk factor for diabetes type II is
obesity, associated with complex genetic, environmental aetiology. Due to ectopic fat deposition
in the liver and body muscles, there develops insulin resistance. At the same time, there might be
an accumulation of fat on the pancreas that leads to the declined functioning of the B-cell,
inflammation of the islet, and consequential death of the B-cell. There are different levels of
body fat composition that type II diabetes occurs in individuals. For example, it happens at a
lower BMI in Asians and Asian Americans whereas in the susceptible people; a fat threshold
may occur due to epitopic fat accumulation that leads to a worsened resistance of insulin that and
B-cel decompensation (ScholarlyBrief, 2013). Due to weight loss sensitivity of insulin in the
skeletal muscle and the liver increases, which results in the accumulation of pancreatic fat. There
are insulin secretion defects, which are partially reversible with restriction of energy and weight
loss in prediabetes and onset of type II diabetes. Most of the people suffering from type II
diabetes experience intra-abdominal obesity due to insulin resistance. This individual also suffers
from hypertension and dyslipidemia. Diabetes type II is associated with family history, older age,
obesity, and failure to engage in exercise activities. It is common in women, especially those
who have ever suffered gestational diabetes, the Blacks, native Americans, the Hispanics.
Environmental factors also lead to type II diabetes. This information is essential to the
community members to enable them to seek medical check-up when they note the signs and

Diabetes Mellitus 6
symptoms of diabetes type two which include increased thirst, excessive hunger, increased
frequent urination, blurred vision, tiredness, slow healing of wounds, dark skin patches, pain,
numbness or tingling in the feet or the hand (ScholarlyBrief, 2013).
Gestational diabetes mellitus
This diabetes is mostly common in expectant women, and it is not life-threatening to the baby or
the mother. It happens due to neonatal morbidity, incidence jaundice, macrosomia, and neonatal
hypoglycemia. The pathophysiology of this diabetes is unknown though research shows its
causative factors include diabetes mellitus family history, previous pregnancy complications,
obesity, and advanced age in the mother. Most women who develop GDM during pregnancy
experience it in the third trimester of pregnancy, and after birth, the condition disappears.
Pregnant women should always get advice on the need to visit antenatal clinics where through
doctor’s check, the signs and symptoms of gestational diabetes can be identified. The community
diabetes team should mobilize its people and give them information about gestational diabetes to
avoid worries at pregnancy. Other signs and symptoms of gestational diabetes include high level
of thirst, frequent urination, vomiting, nausea, fatigue, blurred vision and frequent infections
such as skin and bladder infections. Sugar is found in urine when tests are done in the lab.
Other specific types of diabetes mellitus
These groups are heterogeneous and include infection-induced diabetes mellitus, other
endocrinopathies, genetic defects in insulin actions, drug or chemical induced diabetes mellitus,
exocrine pancreas diseases, and B-cell functioning defects. There are rare forms of immune-
mediated diabetes.