Diabetes mellitus

Diabetes is a chronic disease effecting the body’s production of insulin and its ability to utilise glucose. The number of people effected by type two diabetes has risen sharply in recent years, with poor diets and lack of exercise being the leading causes. There are currently 422 million people around the world with some form of diabetes leading to 1.6 million deaths (WHO, 2017). 4.6 million of those people are in the UK, with 90% of them having the type two form, with another 12.3 million people at risk (Diabetes UK, no date). Cornwall now has nearly 30,000 people diagnosed with diabetes.

Type One

T1DM is caused by a lack of pancreatic beta cells that produce insulin, preventing cells from taking up glucose from the blood. This can be caused by autoimmune disease or be idiopathic. These diabetics are therefore insulin dependent for life.

Type Two

T2DM is characterised by the bodies inability to utilise insulin effectively and is strongly associated with poor diet and lack of exercise. Historically only seen in adults, the number of children with T2DM is increasing as childhood obesity becomes more prevalent.

Gestational

GDM is diabetes first diagnosed in pregnant women with no previous history of diabetes. It is managed in the same way as T2DM and can be well controlled, however it does increase the incidence of complications such as pre-eclampsia. Most cases will resolve following delivery although some women can go onto develop T2DM.

Others

There are several other types of diabetes which effect smaller groups of people. One example is called Maturity Onset Diabetes of the Young (MODY), which is caused by a genetic defect in beta cells, although there are further subtypes. Patients who have had their pancreas removed will also develop diabetes.

Living with Diabetes

Different people will manage their diabetes in different ways and depending on the type they may require other treatments. The majority of T1DM patients are diagnosed at a young age and often know a lot about how to manage their disease, although you will always come across a few poorly controlled patients. This goes the same for all other types of diabetes, although most T2DM will be diagnosed later in life, and may have other comorbidities to go with it.

Often the most debilitating thing about diabetes is the knock-on effects from having high blood sugars, including retinal and peripheral neuropathies, cardiac conditions and increased risk of strokes. Losing your eyesight or the feeling in your hands and feet can be particularly devastating and can impact on every part of the persons life. Part of the nursing role is to help support patients in managing their comorbidities, ensuring that they’re checking their feet for sores, getting regular opticians appointments and their flu vaccines.

So what?

You cannot go through a nursing career without meeting a lot of people with diabetes and each of them will have different coping mechanisms, different treatment options and different comorbidities. Some patients will be beautifully controlled and will know more about their disease than the leading consultant, but more likely they will be poorly controlled and be making bad decisions about their health; the impact of this may not be seen until later in life. Nurses need to remember though, that people are within their rights to make bad decisions, and if they want to eat all the sweets, then they can and we must respect this decision. It’s about supporting that person to live the life they want to live, ensuring they’re making informed choices and are safe.

References

Diabetes UK (no date) Facts and Figures. Available at: https://www.diabetes.org.uk/professionals/position-statements-reports/statistics (Accessed: 26 October 2018).

WHO (2017) Diabetes. Available at: http://www.who.int/news-room/fact-sheets/detail/diabetes (Accessed: 26 October 2018).

 

 

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