Diabetes and hyperglycemia management in hospitalize patients Introduction Worldwide, Diabetes mellitus is one of the most significant causes of morbidity and mortality, and its global impact is likely to accelerate over the next coming decades. International Diabetes Federation (IDF) 2015 reports, 415 million people have diabetes. By 2040 this will rise to 642 million. In every country, the number of people with type 2 diabetes is increasing. According to the IDF, 1 in 10 adults will have diabetes by 2040. The global cost of diabetes—based on statistics from the World Health Organization and the International Diabetes Federation Diabetes Atlas—was $1.31 trillion for 2015 [2]. Diabetic patients have a 3 fold greater chance of hospitalization …show more content…
The American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) consensus on inpatient hyperglycemia defined stress hyperglycemia or hospital-related hyperglycemia as any blood glucose concentration >140 mg/dl (>7.8 mmol/l) [12,13]. Measurement of an HbA1c is indicated in patients with hyperglycemia without a history of diabetes to differentiate between stress hyperglycemia and previously undiagnosed diabetes [32-34]. The Endocrine Society recommendations indicate that hospitalized patients with elevated blood glucose and an HbA1C of 6.5% (48 mmol/mol) or higher can be identified as having diabetes [12]. PATHOPHYSIOLOGY OF HYPERGLYCEMIA DURING …show more content…
Several mechanisms explain the detrimental effects of hyperglycemia (Fig. 1). Hyperglycemia causes osmotic diuresis that leads to hypovolemia, decreased glomerular filtration rate, and prerenal azotemia. Hyperglycemia is associated with impaired leukocyte function, including decreased phagocytosis, impaired bacterial killing, and chemotaxis, leading to hospital infections and poor wound healing. In addition, acute hyperglycemia results in the activation of nuclear factor κB (NF-κB), the production of proinflammatory cytokines, and oxidative stress, leading to increased vascular permeability and mitochondrial dysfunction (29,30). Furthermore, hyperglycemia impairs endothelial function by suppressing formation of nitric oxide and impairing endothelium-dependent, flow-mediated dilation
The blood glucose level has very limited range for humans to survive and stay healthy. Generally, people are able to remove excess glucose rapidly from the body but this is not the case when they are diagnosed with diabetes and insulin resistant situations. The lack of insulin resistance can also lead to a decrease in glycogen synthesis and storage as it usually converts glucose to energy for cell’s use (Jensen & et al. 2011). When insulin is produced under insulin resistance, the cells are incapable of using them effectively which then leads to high blood sugar level as ketones and ketoacids are produced as an alternative energy source for the body. The rise of ketoacid causes the blood pH acidic and the patient may also be diagnosed with ketoacidosis (Newton & Raskin 2004). There would also be less intake of lipid and more of stored triglycerides as the lipids are effected by the insulin. As the glucose levels increase, the muscle glucose uptake will decrease while the liver glucose production and blood fatty acid concentration will also increase within the body (Lichtenstein & Schwab 2000). Excess glucose within the blood are converted to fat which can lead to Diabetic Dyslipidaemia and furthermore to obesity, hypertension and
Diabetes Mellitus is a growing issue for health care providers internationally. The World Health organization estimated in 2013 there were 347 Million diabetics worldwide, predicting that Diabetes will be the 7th leading cause of death by 2030 (WHO, 2013). In both type 1 and type 2 diabetes Mellitus, factors such as poor compliance with diet and medication, infection, acute medical or surgical illness or trauma can lead to poor glycaemic control, precipitating a hyperglycaemic emergency such as Diabetic Ketoacidosis (DKA) (Scobie & Samaras, 2009). In Type 2 Diabetes, another equally dangerous
Diabetes affects over 180 million people in the US and is projected that by 2025 this figure will increase to 300 million.
Diabetes is the most rapidly growing incurable, chronic disease worldwide, which slowly but surely can kill those suffering from it. In Australia alone, the approximate effected population is expanding to over 1.7 million people and an estimated 3.3 million by 2031, with around 100 000 newly
In a study by Umpierrez et al. (2012), a task force composed of a chair, members of The Endocrine Society, six additional experts and a methodologist, composed clinical practice guidelines for the management of hyperglycemia in hospitalized non-critically ill patients. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to develop and describe the strength of the recommendations and quality of evidence. Consensus was based on group meetings, emails, and conference calls. Endocrine Society members, ADA, American Heart Association, American Association of Diabetes educators, European Society of Endocrinology, and the Society of Hospital Medicine all reviewed and commented on the preliminary guidelines
Diabetes mellitus has a worldwide prevalence of 8.3 percent of the population with the amount of new cases diagnosed per year
Diabetes is a major medical problem in the US. In the year 2015, it was reported that 86 million Americans are diagnosed with prediabetes (ADA, 2016). Diabetes is the seventh leading cause of death in the United States (CDC, 2016). Research has
Type II Diabetes is a growing disease that according to Ley, Ardisson Korat, Qi, Tobias, Cuilin, Lu and ... Hu (2016) approximately 415 million adults are affected by this disease worldwide and in the United States in 2015, $348 million dollars was spent on treatment for
In England alone about three million people have type 2 diabetes. It is nearly four times as common as all types of cancer combined. It is regarded by some experts as the 21st century’s primary public health threat. It accounts for approximately £9bn of the annual NHS spend, and is responsible for more than 20,000 early deaths each
Hyperglycaemia is when blood sugar levels increase to above the normal. If blood glucose levels remain high for a long time it damages proteins by binding directly to them and building up. This in turn leads to poor peripheral circulation which leads to serious damage to tissues, and
In 2012, 29.1 million Americans, or 9.3% of the United States population, had diabetes. Nearly 28% of those with diabetes were undiagnosed (“Statistics about diabetes”, 2014). Diabetes remains one of the leading causes of death, but minimal attention has been given to the screening opportunities that exist in acute-care settings for undiagnosed patients. This has been largely due to the misconception that hyperglycemia in the acute setting is a common occurrence related to stress and does not warrant any special consideration. According to Dugan (2009), “stress hyperglycemia is defined as a transient elevation of the blood glucose due to the stress of illness and typically resolves spontaneously” (1798). Despite stress
Hyperglycemia is the condition where the blood glucose level is abnormally high and often related to diabetes mellitus. It is also the hallmark of diabetes Type 1 and Type 2.
Diabetes (Diabetes mellitus) is a chronic disease caused by number of reasons. Diabetic patient characterized by hyperglycemia (high blood in sugar) resulting from defect of insulin secretion (Mellitus, 2005). World Health Organization (2008) defined the Diabetes untreated disease, known by chronic rise of the concentration of sugar (glucose) in the blood. Glucose is major source of energy in our body, food is convert to fats, protein, and carbohydrate. Carbohydrate when eat, convert to glucose, the glucose is source of energy in the body. The World Health Organization (2008) estimate 171 million people in the world with diabetes in 2000 and the number will increase to 366 million by 2030.
Diabetes has been known to be one of the most widespread lifelong disorders among the American people. The brochure chosen was published by The Joint Commission to be a part of the “Speak Up” campaign. The “Speak Up” campaigns were created to be able to promote awareness of the nationwide patient safety goals that were developed by The Joint Commission. This brochure lists the significant ways to be active in your care while a hospital setting. This brochure is most critical and supportive to people who currently live with Diabetes, whether it is type I or type II, and need to improve their way of managing it throughout their life. Client’s with diabetes will also benefit from
Diabetes specialists are specialists for a reason – they are familiar with the nature of the disease and how to combat or manage diabetes with each individual case. Their responsibility within the hospital environment is to effect cure and therefore their involvement in the patient’s experience in hospital is very intermittent, intervening with patients in small chunks, leaving most of the care to the nurses (Gloubermann & Mintzberg, 2001). Their perspective is less centred around caring for patients or working collectively but more independent in their decision making, following the direction of the physician profession and working for the interest of the patient. Although diabetes specialists do talk to patients and offer advice on the management of diabetes, most of their time and energy goes into administering cure, and the perspective they therefore hold regarding type 2 diabetes services is that what is most important is improving the health of the individual diabetics they treat, and having the freedom to make the decisions surrounding treatment and management they feel is in the best interests of the patient (Gloubermann & Mintzberg,