This will be emphasize on the implementation phase of the audit, which aim to educate and create awareness amongst the treating doctors and nursing staff about hypoglycemia prevention. This might be a very challenging task especially in the elderly patients with inconsistent and poor food intake, swallowing difficulties, progressive sarcopenia, or behavioral management issues related to cognitive impairment. More than one third (75%) of patient in our audit is on premixed insulin, which required a fixed dose to be given in the morning and evening. It is impossible to reserves the insulin if patient were to miss a meal after the dose is given, resulting in hypoglycemia. Other alternatives would be using rapid-acting insulin after meals, so the insulin can match the amount of carbohydrate intake. (ilvio E. Inzucchi, 2012) However, it will increase the amount of subcutaneous
In edition to acute complications of short term elevations of glucose, long term elevations of blood glucose lead to severe complications; microvascular damage resulting in heart attacks, strokes and gangrene, microvascular damage resulting in kidney damage and blindness due to retinopathy (peyrot 1999). For this reason the main goal of diabetes treatment is to maintain blood glucose as close to normal as possible. Medication is the theme of treating disease based on the biomedical outlook that disease is biological. Unfortunately, the biomedical model of medicine fails to take into consideration the social and psychological factors that play a role in the treatment of this illness. The biomedical approach fails to consider the psychologic and behavioral process involved in stress and coping with glucose control, as well as the interaction between biological and psychosocial factors and how this affects patient coherence with treatment. Studies have established that many people diagnosed with diabetes have difficulty in adapting to biomedical therapy; in order to improve health outcomes it is important to address the psychological and physical stresses of diabetes with specific adaptive and coping strategies (awah).
When experiencing symptoms of hyperglycemia or hypoglycemia, medical attention needs to be directed to the individual immediately. Diabetes cannot be cured, but if ignored, the disease can be fatal (American Diabetes Association).
C.S. is a morbidly obese 32-year-old female admitted to the hospital on 8/26/05 with an admitting diagnosis of poly-drug overdose. According to the patient, the last thing she remembers is going to bed and then waking up in the hospital 2 days later without any recollection of what had happened. She has a history of suicide twice in the past, but denies suicidal ideations this time. C.S. also has a history of Diabetes type II that is normally controlled with oral medications. She states that she checks her blood glucose at home and it has been in the 200mg/dl range for the past month. Current blood glucose is 256mg/dl. C.S. is to be discharged tomorrow with a new prescription for insulin.
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 silent killer” (Demille 2005, p.5). It is a metabolic disorder that can result in impaired quality of life and serious complications. This study aims to understand the case of Mr. Skyler Hanson who is newly diagnosed with Diabetes Mellitus Type 1 that leads to diabetic ketoacidosis which was confirmed by the presence of moderate to high ketones in the urine and a high blood glucose level. It was noted that he has a history of fatigue, headache, abdominal pain, nausea and frequent urination. Furthermore, it was disclosed that he has difficulty in adjusting to his diagnosis and he occasionally missed administration of insulin dose when socialising. Subsequently, he was admitted in the Critical Care Unit for rehydration,
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 is a serious issue and 29.1 million people in the US are diagnosed for Diabetes. Diabetes is caused by your pancreas not making enough insulin. Insulin is used for controlling your blood pressure and if your body doesn’t have enough insulin you will get hyperglycemia.
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.
To understand the reasoning of this event, this case study will explain the anatomy and physiology of what is happening in this patient’s body. This will include a brief understanding of the endocrine function and how it maintains blood glucose normally versus that in type 1 diabetic patients. It will also explain the pathology of a type 1 diabetic, the acute pathophysiology of the hyperglycaemic event and why it should be presented as an acute
Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, et al. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008 Oct 2;359(14):1464-76. Epub 2008 Sep 8.
Relationship of Glucose Values to Sliding Scale Insulin (Correctional Insulin) Dose Delivery and Meal Time in Acute Care Patients with Diabetes Mellitus
Another complication is the slow healing of cuts and wounds. High blood sugar slows down your body’s immune system’s healing mechanism. Cuts and wounds that don’t heal fast enough are susceptible to infections, which can lead to tissue necrosis or an amputation.
Diabetes mellitus is a disease characterized by the body’s inability to metabolize glucose. Glucose is the body’s main source of fuel for energy. Too much or too little of it can cause some serious complications in the body. Normal glucose level in the blood should be between 70-120mg/dl. An increased level of more than 250 mg/dl is called hyperglycemia. Signs and symptoms “include the three ‘polys’: polyuria (excessive urination), polydipsia (excessive thirst), and polyphagia (excessive hunger)” (Rosdahl, 2012). Other signs and symptoms may include
Diabetes is a systemic disease caused by a decrease in the secretion of insulin or reduced sensitivity or responsiveness to insulin by target tissue. (Beale, et al., 2011) The incidence of diabetes is growing rapidly in the United States and worldwide. An estimated 347 million people around the world are afflicted with diabetes. (Whalen, et al., 2012) According to World Health Organization (WHO), Diabetes prevalence among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. It is the major cause of blindness, kidney failure, heart attack, stroke and limbic amputation. World Health Organization (WHO) projects that diabetes will be the 7th leading cause of death in 2030. It is a complex and costly disease that can affect nearly every organ in the body and result in devastating consequences. The leading cause of non-traumatic lower extremity amputations, renal failure, and blindness in working-age adults, diabetes is also a major cause of premature mortality, stroke, cardiovascular disease, peripheral vascular disease, congenital malformations, perinatal mortality, and disability. (Cefalu, 2000) Insulin therapy and oral hypoglycemic agents have demonstrated improvement in glycaemic control. However, Insulin therapy has some disadvantages such as ineffectiveness following oral administration, short shelf life, of the need for constant refrigeration, and fatal hypoglycaemia, in the event of excess dosage.