Diabetes-Related Nephropathy: A Case Study

Diabetes is a common chronic disease that causes problems in the way the blood uses food. The inability of the body to transform the sugar into energy is called diabetes. Glucose, a simple sugar, is the primary source of fuel for our bodies. When food is digested, some of the food will be converted into glucose which is then transferred from the blood into the cells however, insulin, which is produced by beta cells in the pancreas is needed. In individuals with diabetes, this process is impaired.

Diabetes is a chronic illness that requires continuous medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications[ ].

With an impact of over 300 million people worldwide, diabetes has become the fastest developing chronic disease (Bonner, et. al, 2016, p. 1). Uncontrolled diabetes mellitus type II has serious health implications such as chronic hyperglycemia, heart disease, stroke, retinopathy, neuropathy, and nephropathy (Bonner, et. al, 2016, p. 2). Whether you have Type I or Type II diabetes, you have an increased risk for developing an open wound or ulcer on your foot. Ulcers usually happen because a person has diabetic nerve damage, known as neuropathy. About 20% of these patients with infected foot wounds end up with some type of lower extremity amputation (Wu, et. al, 2013, p. 1) . In 2015, 9.0% of Rhode Island adults (about 76,300 people) reported

Uncontrolled diabetes can affect nearly every organ of the body; of which, heart disease and kidney failure are most commonly impacted. Known as diabetes mellitus, a collective term for various blood abnormalities, the term diabetes refers to either a scarcity of insulin in the body or the body’s inability to accept insulin. Though the symptoms of diabetes are manageable, many are unaware as to having it. According to the CDC report “2011 Diabetes Fact Sheet,” approximately 6 million people in the United States have undiagnosed diabetes. Undetected, diabetes can become deadly. In a recent World Health Organization report “Diabetes Action Now: An Initiative of the World Health Organization and the International Diabetes Federation,” it

Diabetic neuropathy is the most common factor in almost 90% of diabetic foot ulcers [9, 10]. Nerve damage in diabetes affects the motor, sensory, and autonomic fibers. In patients with peripheral diabetic neuropathy, loss of sensation in the feet can cause further damage such as repetitive minor injuries that are undetected at the time and may subsequently prompt foot ulceration. In addition, structural deformities and abnormalities of the foot further increase the risk of ulceration. Other risk factors include a previous history of foot ulceration or amputation, visual impairment, diabetic nephropathy, poor glycemic control, and cigarette smoking. This may increases the chance of infection to the ulcer. Lack of wound healing, systemic sepsis,

Diabetic nephropathy (DN) is one of the leading causes of chronic kidney diseases worldwide and most of the affected patients have T2DM. A considerable number of patients newly diagnosed with T2DM may already have developed nephropathy due to a preceding period of undiagnosed diabetes and impaired glucose tolerance [11]. According to the classification of American Diabetes Association, DN is divided into three stages, incipient nephropathy (micro-albuminuria), clinical diabetic nephropathy (macro-albuminuria) and ESRD. To diagnose those DN patients in its early stage can effectively prevent or delay the progression to ESRD [12]. Renal biopsy is a useful way to diagnose DN but is an invasive method so we are in need to simple, accurate and non-invasive test for early diagnosis and/or monitoring DN progression [13]. Several mechanisms, including hyperglycemia, advanced glycation end products (AGEs), oxidative stress, and inflammation are the main contributors to DN pathogenesis through activation of nuclear factor κB (NF-κB) signaling which is the key regulator of inflammation and apoptosis [14].

The Registered Nurses Association of Ontario (RNAO) (2009) reported, “an estimated two million Canadians have kidney disease or are at risk for it” (p. 17). According to Porth (2011) and the Kidney Foundatoin of Canada (n.d.c), chronic kidney disease (CKD) has several different causes that combined cause a loss in renal function over 3 months or more, resulting in kidney failure, and its progression is classified into five stages. The two main causes for CKD are diabetes and hypertension (HTN) (National Kidney Foundation, 2012a). Practical nurses caring for adults with chronic kidney disease must consider the importance to their practices and to the adults and their families and the care and education needed to assist the adult and family.

Diabetes self-management education is a critical element of care for All people with diabetes and those at risk for developing the disease. It is necessary in order to prevent or delay the complications of diabetes and elements related to lifestyle changes and smoking one of them that are also essential for individuals with diabetes to know smoking complication.

One of the major concerns associated with contrast administration is the risk for renal impairment known as contrast induced nephropathy (CIN). Furthermore, CIN is a serious complication effecting patient outcomes and health care costs. Studies agree, while the true number of CIN occurrences is difficult to attain, pre-existing health factors and conditions, such as, advanced age, kidney disease, congestive heart failure, hypertension, hyperuricemia, hypovolemia, non-steroidal anti-inflammatories, diabetes mellitus, and Glucophage are known to increase the risk potential (Schwab et al., 1989). In addition to CIN, other contrast reactions include contrast induced bronchospasm, and mild systemic contrast reactions. Therefore, identification

In spite of the wide choice of effective and well-tolerated diabetic treatment large proportion of treated patients, do not achieve satisfactory Glycemic control. Poor therapeutic adherence is a major contributor for insufficient Glycemic control. Only 8.2% of people with diabetes adhere to self-monitoring of blood glucose levels.[4] ( Kim, & Jeong ,2003) Adherence has the largest effect on hyperglycemia.[5] (Brown & Hedges ,2004)The term adherence might imply a more holistic view about self-care than compliance because it places the patient in a central position.[6] (Toljamo & Hentinen,2001). Studies on adherence in patients with diabetes indicate that lack of knowledge and management skills are the main contributing factors to non-adherence.

Diabetes has become an epidemic in today’s society. Diabetes affects almost every system in the body, and with an estimated 346 million people in the world with diabetes, healthcare has been heavily affected by the disease (Ramasamy, Shrivastava, P., & Shrivastava, S., 2013). One of the biggest issues for healthcare workers when it comes to diabetes, is that it is such a complicated disease. With so many different systems being affected, medical professionals have had to learn how the disease process works, what causes diabetes to work through the systems, and the best treatments to address all these issues. Through much research, the healthcare system has grown very knowledgeable on diabetes. One important aspect of treating diabetes has been in the introduction of diabetic education. In the past, nurses and dieticians had been responsible for educating patients on diabetes, but now that role is also extended to other people in the healthcare team, including the patient (Tomky, 2013). In fact, patients taking an active role in the education process, including learning to self-care has now become a priority in diabetes treatment. The following paper will discuss diabetic education, the importance of self-care and how this affects a patient’s compliance.

The authors of this article hypothesize that early identification and intervention through the primary care clinicians will decrease the progression of chronic kidney disease (CKD) and improve patient outcomes overall. They evaluate a specialist nurse led intervention in the primary care setting to see if specific risk factors in a study sample of adults at “high risk CKD progression” which include uncontrolled type II diabetes, hypertension, and history of poor clinical attendance. This was clearly stated in the abstract of the article. It is reflected throughout the research by describing what specific measurements were used to evaluate this research question, and reiterated in the results and conclusion sections of the article. They want

Diabetes is a serious medical condition that can also be a risk factor for the development of many different diseases and conditions including dementia, heart disease, and CVA. Thus, effective management of diabetes is very important. Patient compliance can be difficult to achieve if the person affected with diabetes is not educated about the illness or treatment, has not fully accepted the diagnosis or its severity, will not change habits or believes that the prescribed treatment regime is too difficult or ineffective, has cultural beliefs conflicting with the treatment regime, experiences stressful events, lacks social support, or suffers from psychiatric issues unrelated to diabetes (Gerard, Griffin, & Fitzpatrick, 2010). As one may expect, adequate education programs are essential tools when dealing with diabetics. Solid education will provide the patient with information as well as teaching the necessary skills to manage the disorder. The primary focus of any diabetes education program must be to empower patients as a part of the multidisciplinary team. This team should be focused at integrating diabetes into the lives of the patients and this focus should be based on the decisions made by the patient, otherwise the treatment plan can be looked on as forced (Gerald et al., 2010). Every patient stricken with diabetes has the right to benefit from an education program of this type. First, basic education and facts should be administered directly following the diagnosis of

Self-management places most of the diabetic patients at the center of care and also it empowers