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According to the American Diabetes Association (2011), 25.8 million children and adults have been diagnosed with diabetes in the United States. Approximately 2 million more are diagnosed every year, with another 79 million people considered to be in a pre-diabetes state. These millions of people are at risk of several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. Since diabetes has a major impact on the health of millions of people around the world, it is essential for nurses to understand the pathophysiology and associated alterations of this disorder. In this Discussion, you compare two types of diabetes—diabetes mellitus and diabetes insipidus.
• Review Chapter 19 in the Huether and McCance text and Chapter 18 in the Hammer and McPhee text.
Read the DISCUSSION by “AMINA” below & Respond the following ways:
• Share insights on how the BEHAVIORAL factor impacts the pathophysiology of diabetes mellitus and diabetes insipidus.
• Offer ALTERNATIVE diagnoses and prescription of treatment options for diabetes mellitus and diabetes insipidus.
• Validate an idea with your own experience and additional research.
DISCUSSION TO RESPOND TO
Diabetes mellitus is a group of four categories and includes Type 1, Type 2, gestational, and maturity-onset of youth (MODY). (Huether & McCance, 2017) Type 1 diabetes mellitus is either idiopathic or autoimmune and has a slow progression that is usually diagnosed around age 12. (Diabetes Overview, n.d.) This happens when autoimmune T cells attack the beta cells of the pancreas caused by genetics and environmental factors. (Huether & McCance, 2017) The combination of genes and environmental exposure lead to autoantigen formation on the beta cells causing cellular and humoral immunity. This leads to the destruction of beta cells causing insulin production to decline leading to hyperglycemia. (Huether & McCance, 2017) In addition to the decrease in insulin production there is a decrease in amylin which is also made in the beta cells and is responsible for suppressing glucagon release from the alpha cells. (Huether & McCance, 2017)
Type 2 diabetes mellitus is a result of insulin resistance and decreased insulin production by the beta cells. (Huether & McCance, 2017) It is also related to genetics and environment. Insulin resistance is usually related to obesity which can cause an increase in hormones such as adipokine which decreases insulin sensitivity. (Huether & McCance, 2017) Obesity can also lead to an increase in the number of triglycerides and cholesterol which can affect insulin signaling. (Heuther & McCance, 2017) In addition to this obesity if linked to hyperinsulinemia, decrease insulin receptors, and increased inflammatory cytokines which are cytotic to beta cells. (Huether & McCance, 2017) This leads to a decrease in the number of normally functioning beta cells and causes the ones that are functioning to become exhausted from the increased demand for insulin. (Huether & McCance, 2017) Similar to Type 1 there is also a deficiency in amylin causing in increase in glucagon.
Diabetes insipidus is not related to diabetes mellitus. It is a rare condition that leads to increased thirst and urination. Similar to diabetes mellitus, there are several different types of diabetes insipidus. This is caused by damage to the pituitary gland or hypothalamus and usually results from an injury, surgery, or tumor. This leads to a decrease in the amount of anti-diuretic hormone (ADH). (Diabetes Insipidus, n.d.) This is known as central diabetes insipidus and it is the most common form. Nephrogenic is when there is enough ADH but the kidneys cannot properly respond to it and is usually a result of lithium, sickle cell disease or genetic disorders. (Diabetes Insipidus, n.d.) Dipsogenic can be related to a metal illness that causes excessive thirst which can lead to low sodium levels and brain damage. (Diabetes Insipidus, n.d.) Pregnancy related diabetes insipidus is caused by a substance that is made by the placenta that can affect ADH. (Diabetes Insipidus, n.d.)
Genetics play a role in both diabetes insipidus and diabetes mellitus. Nephrogenic diabetes insipidus is usually diagnosed in an infant and is caused by an inherited gene that affects the kidneys. (Diabetes Insipidus, n.d.) If a child has signs of diabetes insipidus part of their assessment should include a through family history. Although diabetes insipidus usually affects men, women can pass the gene onto their sons. You would also want to do blood work to check for electrolyte imbalances. (Diabetes Insipidus, n.d.) The treatment for the genetic form of diabetes insipidus would include anti-inflammatory medications and diuretics and continued careful monitoring for dehydration and electrolyte imbalances. (Diabetes Insipidus, n.d.) Diabetes mellitus has a strong genetic association and is seen with HLA class II alleles HLA-DQ and HLA-DR. If a patient has a family history of diabetes that would be a good reason to test them for diabetes if they are showing symptoms of type 1 or type 2 (Heuther and McCance, 2017) Treatment would depend on the type of diabetes the patient has. Type 1 will be treated with insulin, where type 2 can be treated with diet or insulin. (Huether & McCance, 2017)
Behavior does not have much impact on diabetes insipidus, unless the patient participants in behaviors that could increase this chance of a head injury that could lead to diabetes insipidus. (Diabetes Insipidus, n.d.) Type 2 diabetes mellitus can be affected by human behavior such as obesity, physical inactivity and diet choices. (Huether & McCance, 2017) Education during treatment for type 2 diabetes may help to keep the patient from needing insulin to manage their disease. Promotion of diet and exercise may even prevent prediabetes from becoming type 2 diabetics. (Huether & McCance, 2017) Educating patients to follow a diet low in fats, less simple sugar, high in complex carbohydrates, protein, and fiber.
Diabetes Insipidus. (n.d.). Retrieved from https://www.hormone.org/diseases-and-conditions/diabetes-insipidus
Diabetes Overview. (n.d.). Retrieved from https://www.diabetes.org/diabetes
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
THE RESPONSE GRADING RUBRIC
• Response exhibits critical thinking and application to practice settings.
• The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
• Communication is professional and respectful to colleagues.
• Response to faculty questions are fully answered if posed.
• Provides clear, concise opinions and ideas that are supported by two or more credible sources.
• Response is effectively written in Standard Edited English.
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