Question

please fill these parts for diabetes

System Disord ACTIVE LEARNING TEMPLATE: STUDENT NAME DISORDER/DISEASE PROCESS Alterations in Health (Diagnosis) Pathophysiology Related to Client Problem

Answer 1

Diagnosis: Diabetes Mellitus

Confirmation of Diabetes:

• Plasma glucose in random sample or 2 hrs after a 75 g glucose load ≥ 11.1 mmol/L (200 mg/dL)
• Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dL)
• HbA1c ≥ 48 mmol/mol

Diagnosis:

Glycemia can be classified into three categories: normal, impaired and diabetes. The traditional way to diagnose diabetes or pre-diabetes has been by using random or fasting plasma glucose and/or an oral glucose tolerance test (OGTT). In 2011, the World Health Organisation (WHO) advocated the use of glycosylated hemoglobin (HbA1c) to diagnose diabetes and this has been adopted in some regions. When a person has symptoms of diabetes, the diagnosis can be confirmed with either a fasting glucose of ≥ 7.0 mmol/L (126 mg/dL) or a random glucose of ≥ 11.1 mmol/L (200 mg/dL). Asymptomatic
individuals should have a second confirmatory test. Diabetes should not be diagnosed on capillary blood glucose results. Alternatively, an HbA1c of ≥ 48 mmol/mol is also diagnostic of diabetes.

Pathophysiology:

Type 1 diabetes. Generally considered a T-cell-mediated autoimmune disease involving destruction of the insulin-secreting β cells in the pancreatic islets. Marked hyperglycemia, accompanied by the classical symptoms of diabetes, occurs only when 80–90% of the functional capacity of β cells has been lost. It is now recognized that pancreatic β cells can persist in some individuals with very long-standing diabetes and may never reach zero. On the contrary, some individuals present with much higher levels of β-cell viability (40–50%) and that may reflect lower levels of physical activity or increased body mass. Despite this uncertainty, in the natural history of type 1 diabetes there is initially a loss of first-phase insulin secretion, followed by a period of glucose intolerance and clinically non-diagnosed diabetes.

Autoimmunity in type 1 diabetes is identified by the presence of auto-antibodies to islet and/or β-cell antigens. Islet cell antibodies can be present long before the clinical presentation of type 1 diabetes, and their detection can be useful in confirming a diagnosis of type 1 diabetes, but they are poorly predictive of disease progression and disappear over time.

Type 2 diabetes. Initially, insulin resistance leads to elevated insulin secretion in order to maintain normal blood glucose levels. However, in susceptible individuals, the pancreatic β cells are unable to sustain the increased demand for insulin and a slowly progressive insulin deficiency develops. Some patients develop diabetes at a young age, usually driven by insulin resistance due to obesity and ethnicity; others, particularly older patients, develop diabetes despite being non-obese and may have more pronounced β-cell failure. The key feature is a relative insulin deficiency, such that there is insufficient insulin production to overcome the resistance to insulin action. This contrasts with type 1 diabetes, in which there is rapid loss of insulin production, resulting in ketoacidosis and death if the insulin is not replaced.
Insulin resistance and the metabolic syndrome Type 2 diabetes and its pre-diabetes antecedents belong to a cluster of conditions thought to be caused by resistance to insulin action. Thus, people with type 2 diabetes often have associated disorders including hypertension, dyslipidemia (raised LDL, cholesterol and triglycerides), and a low level of high-density
lipoprotein (HDL) cholesterol), non-alcoholic fatty liver disease and, in women, polycystic ovarian syndrome. This cluster has been termed the ‘insulin resistance syndrome’ or ‘metabolic syndrome’, and is much more common in individuals who are obese.

Therapeutic Procedures/Management:

• Achieve good glycemic control
• Reduce hyperglycaemia and avoid hypoglycaemia
• Assist with weight management
• Ensure adequate nutritional intake
• Carbohydrate: 50%: Sucrose: up to 10%
• Fat (total): < 35%
• Protein: 10–15% (do not exceed 1 g/kg body weight/day)
• Fruit/vegetables: 5 portions daily
• Weight management
• Exercise
• Low alcohol/No alcohol
• Oral hypoglycemic drugs (Biguanides, Sulfonylureas, Alpha-glucosidase inhibitors, SGLT 2 Inhibitors)
• Insulin therapy