Management of Diabetes and Hyperglycemia in Hospitalized Patients in a Critical Care Setting

Diabetes is a disease where the body is unable to produce or use insulin effectively. Insulin is needed for proper storage and use of carbohydrates. Without it, blood sugar levels can become too high or too low, resulting in a diabetic emergency. It affects about 7.8% of the population. The incidence of diabetes is known to increase with age. It’s the leading cause of end-stage renal disease in the US, and is the primary cause of blindness and foot and leg amputation. It is known to cause neuropathy in up to 70% of diabetic patients. Individuals with diabetes are twice as likely to develop cardiovascular disease. There are two types of diabetes: Type 1 and Type 2.

The American Diabetes Association (2004) defines diabetes as a subset of metabolic diseases associated with hyperglycemia secondary to insulin failing to release, act, or both. Complications related to chronic diabetes can be detrimental to one’s health including but not limited to: heart disease, stroke, kidney disease, amputations, blindness, and other optical diseases. Furthermore, the prevalence of diabetes is rising at an astronomical rate within the United States as well as internationally. According to the Center for Disease Control and Prevention (CDC) (2016) an estimated 29 million people suffer with diabetes and 86 million are prediabetic within the United States (US). Without major interventions from the healthcare community,

These include hospital stay and the high rate of readmission to hospital for screening and due to complications. Medications for the patients also contribute significantly to diabetes management since the drugs are prescribed for maintenance of the condition and thus need to be taken regularly. Inpatient visits to the hospital is the leading value of cost in the management of the disease (American Diabetes Association, 2013). The people who have diabetes are sicker and weaker when compared to the general population. The cost of their health care spending is also higher than the cost for healthy individuals. On the view of indirect costs due to diabetes, there are several conditions that lead to an increase in expenditure of the patients. For instance, the likelihood of developing disabilities due to complications as a result of diabetes is quite high. The workforce is therefore negatively affected and leads to a decline in the economy of the country. Out of all the deaths reported in the year 2012, the number in which diabetes was named as the primary cause amounted to 30% diabetes (American Diabetes Association, 2012; National Diabetes Statistics Report, 2014; American Diabetes Association, 2013). The premature deaths due to diabetes led to loss of income and loss of productivity in the country. The public therefore needs to be educated to reduce this cost as it is shown that the cost of managing diabetes is reduced when the patient has enough information about the condition. For instance, persons with better glycemic control have low levels of developing complications and report a decrease in visits to a doctor with those with uncontrolled diabetes having to visit the hospital three to eight times more (Handelsman et al.,

Diabetes mellitus (DM) is a pandemic that affects millions of people. The growth rate of unrecognized pre-diabetes in America is expected to rise up to 52% by 2020 (Lorenzo, 2013). As the prevalence of diabetes increases, so will the complications and burden of the disease. One of the leading causes for cardiovascular disease, renal failure, nontraumatic lower limb amputations, stroke, and new cases of blindness is DM (Lorenzo, 2013).

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

Egi et al. (2016) conducted a level II multicenter, multinational, retrospective observational study to study the impact of pre-morbid glycemic control on the association between acute hypoglycemia in intensive care unit patients and subsequent hospital mortality in critically ill patients. The study took place in hospitals in the United States of America, Japan, and Australia. All adult patients admitted into

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[ ].

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

Did you know diabetes is the seventh leading cause of death in the United States? (Fukunaga, 2011). Many are unaware approximately 25.8 million American’s, 8.3% of the population suffer from diabetes. Type II Diabetes Mellitus (DM II) is by far the most prevalent and accounts for 90-95 percent of the 25.8 million diabetic patients. The long term complications of DM II make it a devastating disease. It is the leading cause of adult blindness, end-stage kidney disease, and non-traumatic lower limb amputation (Lewis, Dirksen, Heitkemper, & Bucher 2014, p. 1154). Not only is diabetes debilitating to patients but also the health and employment costs are substantial. According to Fukunaga (2011), “The estimated national cost of diabetes exceeds

When speaking with healthcare provider Denead Buoy, RN, MSN, she explained that diabetes mellitus is a condition in which one has elevated blood glucose levels due to an inadequate insulin production or because the body responds inappropriately to the absorption of insulin into cells. In some patients, both of these options could be the problem. On average there are about 15 patients in her in-patient unit; out of the 15 patients that she gets, usually 8 to 10 either has had a history of diabetes or has diabetes mellitus as their primary problem (D. Buoy, personal communication, October 17, 2014). Buoy stated that even if the disease is not the primary reason they were admitted into the hospital, diabetes is usually related to their primary condition.

Diabetes is an ongoing problem in not only the United States, but also the world. Diabetes is a condition where there is too much glucose in the blood

Diabetes is a major cause of kidney disease, non-traumatic lower limb amputations, heart disease, blindness, and stroke (American Diabetes Association [ADA], 2014). The National Diabetes Statistics Report estimates that there are about 29.1 million people of the

As America’s 7th leading cause of death, Diabetes is steadily rising as a consequential result to the contagious sedentary lifestyle involving a very poor diet lacking in nutritional value and an increase in sugar or high fructose corn syrup. Many contributing risk factors are prevalent and attribute to the expanding number of the population who acquire diabetes. Signs and symptoms of Type I and Type II diabetes can be a distinguishing factor of the disease. Hyperglycemia and hypoglycemia can be compared and contrast in many different manners as can the differences of diabetic ketoacidosis (DKA) with hyperglycemic hyperosmolar non-ketotic coma (HHNKA). Thankfully, with medical technological advances, diabetic sufferers have many medications and treatments available to help control the symptoms. Complications may arise with this disease if the patient isn’t compliant in adhering with the nursing care plan given. Being diagnosed with diabetes is the first step into the right direction of a long-term care plan.

Diabetes is a major problem in our society today. Many people have heard about the disease; however, they do not know too much about its complications. Diabetes is a chronic, progressive and lifelong condition that affects the body’s ability to use the energy found in food (WebMD, 2016). Many new cases are confirmed every year and unfortunately, many go undiagnosed for years. Diabetes is a serious disease and need to be taking seriously. The disease can lead to many other health problems such as blindness, nerve damage and kidney diseases. The more the community understand and made aware of the seriousness of the disease, the better it can be control and or prevented.

The management of patients with diabetes is classified in the current review under the following categories: a) Non-Pharmacological, b) Pharmacological, c) Monitoring of glycemic control, d) Prevention, e) Clinic organization and f) Referral and admission.