This paper will discuss the case study of a patient suffering from diabetes. It will throw light on the local, national and international prevalence of this condition, how it impacts the financial aspect and how it has become a burden on the healthcare service. The pathophysiology of diabetes, symptoms, diagnostic tools and interventions will also be discussed. The physical, social and psychological changes this disease brings with itself are also mentioned in the paper. The benefits of an integrated approach of care to the patient have also been discussed.
Impact of diabetes
Diabetes is defined as a chronic condition in which the level of glucose present in the bloodstream of a person rises excessively high. It can be said that the most common type of diabetes is Type 1 diabetes and type 2 diabetes. Any of the two kinds have a negative influence on how the person leads his life. It also possesses a major threat to the health of the public (Whicher, O’Neill, and Holt, 2020). In current times more and more individuals are affected by diabetes. Type 2 diabetes affects more individuals than it has ever been. Diabetes affects around 537 million persons aged 20 to 79 in the whole world. By 2030, it is expected that around 643 million people will be suffering from diabetes and it is going to reach 783 million by the year 2045. Three out of every four adults with diabetes live in a low- or middle-income country (International Diabetes Federation, 2022). By 2030, there is an estimate that around 5.5 million individuals in the UK will suffer from the condition of diabetes if something is not done regarding it. Around 90 per cent of people who suffer from diabetes are diagnosed with Type 2 diabetes. Type 1 diabetes affects about 8% of diabetes patients. In the United Kingdom, the number of people affected with diabetes is more than 4.9 million. 13.6 million people are currently at risk of developing this condition. In the year 2017/18 NDA, individuals who were represented as black were twice as probable to be under 50 as those who were documented as white, and the individuals belonging to the Asian community were two and a half times more at risk of developing Type 2 diabetes. Despite the lack of abdominal fat, black African-Caribbean people have been proven repeatedly documented to have severe resistance to insulin and greater incidences of high blood pressure than other ethnic communities. The people living in the United Kingdom, who belong to the Black community are much more probable than white British individuals to have diabetes which is not diagnosed. South Asians who have less BMI are found to develop diabetes 5-10 years sooner than White Europeans, so it is critical for care workers to monitor the South Asians who are above the age of 25 regarding diabetes (Diabetes UK, 2022).
According to a recent analysis issued in the publication Diabetic Medicine, the NHS's yearly expenditure on diabetes cases in the United Kingdom would jump from £9.8 billion to £16.9 billion within the next 25 years, representing a 17 percent growth in the NHS's overall funding. According to Impact Diabetes research, the expense of managing complications of diabetes is anticipated to nearly double by 2035/6, from £7.7 billion to £13.5 billion (Diabetes.co.uk, 2022).
It has a negative influence on the healthcare system and is now becoming a strain as it is responsible for increasing the rate of mortality by 1.8 times, the heart attack risks also increase by 1.8 times, and is the main culprit of renal failure, amputations of the feet, and vision issues such as blindness (Roglic, 2016).
Case study of the patient
Jack is a 53-year-old guy who is 1.74 m tall and weighs 88 kg, with a BMI of 31 kg/m2 (obese). He is self-employed. He stays with his wife and four kids. He admits to smoking three cigarettes a day and drinking during social gatherings. As per the patient, his father's side has a history of high blood pressure and renal failure, while there is a history of hypertension from his mother's side. He has not reported allergy to anything. The patient had been diagnosed with high blood pressure 15 years prior. He has never been diagnosed with diabetes ever. On measuring his vitals, it was found that the blood pressure was 157/95mmHg, SPO2 was 97 percent, pulse rate was 72bpm, the temperature of his body was 35.4°C, and respiration rate was 21 breaths per minute, according to his vitals. The glucose level in his blood was 560 mg/dl.
Whereas the specific reasons of what exactly causes diabetes are unknown, it is recognized that there are certain factors that are responsible for increasing the probability of having different types of diabetes. Becoming overweight or obese (carrying a body mass index – BMI – of 30 or more) is a risk factor for type 2 diabetes. People who are obese are 80 to 85% vulnerable to suffering from type 2 diabetes, and a recent study has suggested that obese persons are close to 80 times higher certain than someone with a BMI of lesser than 22 to acquire type 2 diabetes. It is common knowledge that if a person falls under the category of being obese, the probability of getting type 2 diabetes increases, especially if a person has excessive weight around their stomach (abdomen) (Diabetes.co.uk, 2022).
According to research, stomach obesity leads fat cells to emit 'pro-inflammatory' substances, that can render the body to become less responsive to the insulin that is produced by affecting cells that respond to the insulin and capacity to react to insulin. Insulin resistance is a defining feature of type 2 diabetes (Leitner, et al., 2017). Core or obesity of the abdomen is an elevated risk kind of obesity defined by excessive fat on the abdomen (that is a large waistline). The body also undergoes metabolic alterations because of obesity. Fat tissue or adipose tissue releases molecules of fat into the bloodstream as a result of these alterations, which can damage insulin-responsive cells and impair sensitivity to insulin. Obesity promotes prediabetes, a physiological state that often progresses to type 2 diabetes, according to another explanation proposed by scientists (Verma and Hussain, 2017).
Symptoms represented by the patients
Frequent urination, blindness or hazy eyesight, elevated thirst, tiredness, and increased perspiration (Careyva and Stello, 2016) were among his complaints when he arrived at the clinic. He has been suffering from these symptoms for the past month. He came to the clinic today because he was experiencing significant vertigo and fatigue while at work.
Type 2 diabetes mellitus is among the most prevalent metabolic illnesses worldwide, and it is triggered by a mixture of two basic elements: when the cells of the pancreas release an insufficient amount of and the failure of insulin-sensitive cells to react to insulin (Galicia-Garcia, et al., 2020). The release of insulin and its effect must always be exactly timed to satisfy the metabolic requirements of the body as a result, the molecular pathways engaged in synthesizing and releasing insulin, as well as insulin sensitivity in cells, must be properly controlled. As a result, flaws in either of the processes concerned can cause a metabolic disequilibrium, which can contribute to T2DM pathogenesis. If the pathogenesis of this condition is discussed, a breakdown of the feedback loops connecting insulin effect and insulin production causes unusually high levels of glucose in the blood (Galicia-Garcia, et al., 2020). There is a reduction in the production of insulin, in the malfunctioning of the beta-cell, restricting the ability of the body to retain the physiological blood sugar levels. The condition of insulin resistance leads to the elevated synthesis of glucose as well as reduced absorption of glucose in muscle, liver, and adipose tissue. Beta-cell failure is frequently more serious than IR, although both activities occur initially in the pathophysiology and lead to the progression of the illness. Hyperglycaemia is increased when both beta-cell dysfunction and IR are involved, contributing to the advancement of Type 2 diabetes mellitus (DeFronzo, 2018).
The first symptom of Jack is that he is urinating more frequently. If an individual needs to pee frequently at night time, he may question if anything is wrong. Throughout 6-8 hours in bed, many adults do not need to go to the bathroom multiple times. It is referred to as nocturia by physicians. It could indicate an issue such as diabetes. The desire to urinate more frequently throughout the day is among the most prevalent early indicators of diabetes. It can, however, occur at any time of day or night. The kidneys need to strain more to eliminate too much glucose present in the blood, which occurs if someone has diabetes. They are compelled to produce extra urine as a result of this. Simply because one is sleeping does not mean the procedure is finished. Diabetes can harm the kidneys and bladder as well. Both of these things can make someone urinate frequently (Begic, Arnautovic and Masic, 2016).
The retina is a cellular layer that is very much sensitive to light that turns light into electrical impulses at the back of the eye. The impulses are delivered to the cells of the brain, where they are transformed into the visuals people see. The retina requires a steady amount of blood, which is delivered via a system of microscopic blood capillaries. A chronically high level of sugar in the blood damages these blood arteries in three phases across time: Background Retinopathy is a condition in which small lumps form in the veins and arteries, which might bleed little but do not typically impair eyesight, pre-proliferative retinopathy — the blood vessels are affected more severely and widely, resulting in more considerable haemorrhage into the eye and proliferative retinopathy is a condition wherein scarred tissue and fresh blood vessels form on the retina, which becomes fragile and bleeds readily, and can cause blindness (NHS, 2021).
Among the first indicators that someone may have diabetes is increased thirst. Whenever someone develops diabetes, their body is unable to efficiently utilize glucose from meals. Glucose builds up in the bloodstream as a result of this. To remove the additional glucose, the kidneys surge into overdrive when the level of sugar in the blood is high. To assist remove the additional glucose from the body, the kidneys must produce more urine. the person probably has to urinate more frequently and with a larger amount of urine. This depletes the body's water supply. Water is even drawn from the tissues to aid in the removal of excess glucose. Since Jack is losing a lot of water, he is feeling really thirsty. To prevent dehydration, the brain will advise us to drink plenty of water. As a result, more urine occurs. If the level of sugar in the blood is not stabilized, the diabetic urination and thirst pattern will persist (Iftikhar, 2019).
Fatigue or weariness is a sign which is generally linked to the condition of diabetes. There are several types of factors that can lead to fatigue, even the complications that are caused due to diabetes. It is one of the common symptoms of diabetes. Jack can be feeling fatigued because of reasons such as changes in the level of blood sugar, other symptoms that he is facing, psychological issues that he is facing because of this, or obesity. If the body cells are not utilizing the glucose produced in the body, it can start accumulating in the blood. Glucose is required for the production of energy. When the cells do not have enough energy, it can lead to fatigue or weariness. As Jack is not able to sleep properly due to excessive thirst it can also result in fatigue (Fletcher, 2019).
Jack has also complained about excessive sweating on occasions. Diabetes can end up making it harder for the body of the person to keep a consistent temperature and create enough perspiration to stay cool. Diabetic neuropathy is a deterioration of neurological function caused by elevated levels of sugar in the blood for an extended period of time. Injury to the nerves that regulate glands responsible for sweating cause them to transmit the erroneous signal, or no information at all, to the glands. This can lead to excessive perspiration (Hillson, 2017).
Dizziness can occur in individuals with diabetes as a manifestation of the disease, as well as a side effect of dehydration or certain drugs (Albernaz, 2016).
For the confirmation of diabetes, certain diagnostic tests were suggested for Jack. The glycated haemoglobin (A1C) test is commonly used to identify type 2 diabetes. The normal level of sugar in the blood that has been present for the last two to three months is evaluated with the help of this test. There is a certain range on the basis of which the results are predicted such as A percentage of less than 5.7 per cent is considered normal, prediabetes affects 5.7 per cent to 6.4 per cent of the population., diabetes is diagnosed when a person's blood sugar level is 6.5 per cent or above on two different tests. The HbA1C value for Jack was found to be 8.0 per cent which means that he is diabetic (Chatterjee, Khunti and Davies, 2017).
Following a fasting state for the whole night, a blood specimen of Jack was collected. The following is how the results are perceived: It is normal to have a blood sugar level of less than 100 mg/dL (5.6 mmol/L). Prediabetes is defined as a blood sugar level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L). Diabetes is diagnosed when blood sugar levels are 126 mg/dL (7 mmol/L) or greater on two different tests (Redmon, et al., 2014). The blood sugar level of Jack was recorded as 560 mg/dl which indicates diabetes.
The nurse began by looking for indicators of hyperglycaemia. The level of HbA1c-glycosylated haemoglobin in the patient was measured. Jack was requested to weigh himself every day to assist determine the sufficiency of his dietary consumption. The nurse should check the temperature, pulses, colour, and sensation of the feet to monitor peripheral perfusion and neuropathy. Creatinine >1.5 mg/dL is a sign of renal failure. The ratio of urine albumin to serum creatinine for renal failure was examined since microalbuminuria is the earliest symptom of diabetic nephropathy (Ong, et al., 2018). Insulin was given at both the basal and prandial levels. Tissue perfusion is aided by compliance with the therapy schedule. Maintaining a stable glucose level reduces the advancement of microvascular disease. The indications of morning hyperglycaemia were closely monitored. A nurse should record a blood pressure reading of higher than 160 mm Hg (systolic). the nurse must provide hypertensive medication as directed. The patient should be told to prevent using heating pads and to regularly walk in shoes. The patient must be given oral hypoglycaemic medicines as indicated. The patient was reminded of the necessity of maintaining blood sugar control. Three meals of identical size, regularly scheduled meal times (5-6 hours apart), and one or two snacks were recommended. The patient was instructed on how to keep food consistent and how long to wait between meals. The patient was informed regarding the advantages of exercise and its relevance of it in diabetes treatment (Vera, 2022).
The patient took the medication that was recommended to him. Metformin was used twice a day, and the patient's level of glucose in the blood was monitored after each dose. It was evaluated as the level of blood sugar was found to be 104 mg/dl after fasting 140mg/dl after a meal. The patient was urged to go to the hospital if he experienced any negative effects in the future or if his complaints were not addressed adequately (Ain and Sadeeqa, 2018).
The care plan was developed under the NICE guidelines. This recommendation addresses type 2 diabetes management and treatment for people (aged 18 and up). Patient education, nutritional recommendations, blood glucose concentration management, and recognising and addressing long-term problems are all covered. a personalized strategy to diabetes management that is customized to Jack's requirements and conditions, attempting to take into consideration his personal opinions as well as his probability of benefiting from long-term interventions (NICE, 2022).
Physical, social and psychological challenges
Diabetes causes levels of sugar in the blood to rise above normal. An excessive amount of glucose in the blood can produce difficulties in the body over time. It has the potential to cause damage to the eyes, kidneys, nerves, skin, heart, and blood vessels. Wounds and infections can form on the feet and skin. If it continues for an extended period of time, the toes, foot, or leg might have to be removed. Infection can produce discomfort, itching, or seeping in Jack's feet, legs, and other regions, limiting his mobility. His blood pressure and levels of cholesterol may become more difficult to regulate as a result of his diabetes. This can result in myocardial infarction, a stroke, or other complications (Lotfy, et al., 2017). Blood circulation to the legs and feet may become more difficult. Impairment to the body's nerves can result in pain, stinging, itching, and a loss of sensation. Injury to the nerves can also end up making it difficult for men to get an erection. He may have difficulty digesting the food he consumes. He might have difficulty bowel motions (constipation), or he might have loose, runny stool motions. Kidney impairment can be caused by hyperglycaemia and other issues. Jack's immune system may be weakened by diabetes. As a result, he may be more susceptible to significant consequences from routine infections (Papatheodorou, et al., 2016).
Controlling diabetes can seem like balancing a fine edge between maintaining a constant level of blood glucose and maintaining a constant social life. It is not always clear what to do when dealing with the social consequences of diabetes. Of fact, some people believe that diabetes has little impact on their social lifestyle. Others, on the other hand, may believe that with diabetes, social activities are simply preferred to ignore. Food and drink appear to be two of the most problematic parts of social life (Powers, et al., 2015). When Jack is alone, he may believe he has complete command over his meal and beverage, but whenever he is with his colleagues, it may appear that both the schedule and the number of carbohydrates are out of his grasp. It can be hard to tell how many carbohydrates he is eating or drinking if he does not prepare the food or drink himself, and he might experience a societal obligation to participate. Diabetic patients, who are no longer capable to sustain themselves, represent a source of distress for their families. If they get ill enough to seek medical assistance, they place extra pressure on a hospital system that is already overworked and overburdened (Speight, et al., 2020).
Psychological health issues such as sadness, anxiety, and binge eating disorder are unusually common among diabetics. Blood sugar variations can cause a lot of anxiety. Blood sugar fluctuations can induce mood swings and other psychological issues like weariness, difficulty thinking properly, and anxiety. Diabetes discomfort is a symptom that resembles stress, depression, and anxiety that is caused by having diabetes. Diabetes discomfort, unlike depression, can be traced back to diabetes-related causes. The concern of hypoglycaemia, or a dangerously low blood sugar concentration, for example, can be extremely stressful (Robinson, et al., 2018).
While the term "integrated care" encompasses a variety of methodologies, it has been presented as a potential option that has the ability to help both patients and healthcare organizations (Bunn, et al., 2020). Considering the variety of bio-psycho-social issues that persons with diabetes experience, optimal health care includes inputs from a variety of fields and occupations, including general practitioners, nurses, registered dietitians, physical therapists, healthcare team members, and psychiatrists (Riordan, et al., 2017). Actions such as specialized facilities with a range of healthcare providers can help to enhance care services for diabetes. This can lead to more information, expertise, and empathy being shared, which can help all members of the organization as well as the individual with diabetes. To construct an early plan of care, early outpatient appointments are organised as co-visits with the doctor and the professional pharmacist. With the purpose of executing the treatment plan, additional appointments are organised, switching between the community pharmacist and the registered nurse. Based on the treatment plan, these appointments can range from once a week to once a month. As required, referrals to diabetes instructors are provided (McGill, et al., 2017).
Health behaviour that needs to be addressed
Better health outcomes can result from behavioural management. People who suffer from diabetes need to focus on changes in behaviour which are lifestyle changes, remembering and administering the medicines, taking proper dosages on the medicines, talking to people who have diabetes, being prepared for emergencies, taking follow-ups, and so on. The nurses can help the patients by enhancing the behavioural theory. They can put efforts into motivating the patients to increase the changes in behaviour and self-managing diabetes. The nurses can follow the patient-centred approach in developing the intrinsic type of motivation. They can help the patient to pay attention to what is important to them personally and also help them in identifying their goals and in implementing them. They can increase the confidence of people to manage diabetes by themselves (Hood, et al., 2015).
Legal and Ethical issues related to the patients
The patient was informed of the procedures and all the data were collected after taking the consent of the patient. He was informed about the risk factors and implications if he does not follow the procedures properly. The patient was given the complete right to either choose or decline the treatment process. Any sort of decision was not forced on the patient.
In conclusion, it can be said that diabetes is a chronic condition that is affecting the entire world. It not only affects the individuals who are suffering from the disease but also affect a nation’s economical situation as well as its development. It has emerged as a burden on the healthcare system. Diabetes progress depending on certain conditions such as obesity, sedentary lifestyle, alcohol consumption and family history. It affects a person in physical, psychological as well as social aspects. A proper treatment plan and integrated approach are needed to control the situation from becoming worse.
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