FNP 592, week 2: discussion question-evidence-based practice
reply to Maria
Diabetes is a multifaceted medical condition that can potentially impact individuals across various age groups, races, and socioeconomic strata. This condition is caused by either the body’s inability to produce enough insulin or its impaired ability to use insulin. Insulin is a hormone naturally produced by the pancreas to regulate sugar levels in the blood. Impaired insulin production or function can cause high glucose levels, leading to various health issues. The complications associated with diabetes can affect multiple organ systems and severely impact the quality of life of those affected. Cardiovascular disease, a common complication of diabetes, can result in severe heart conditions such as heart attacks and strokes. Neuropathy, retinopathy, and nephropathy are some of the complications of diabetes. Effective management of diabetes-related complications requires a comprehensive and interdisciplinary approach to diabetes care (Sugandh et al., 2023).
To ensure that patients with diabetes receive adequate care and health promotion, it is crucial to follow evidence-based practice guidelines for diabetes screening. For nonpregnant patients, this can be determined through the fasting plasma glucose (FPG) value, a 2-hour glucose (2-h PG) value, during a 75-g oral glucose tolerance test (OGTT). For a nonpregnant patient, hyperglycemia may present as a random glucose value in conjunction with classic hyperglycemic symptoms, such as polyuria, polydipsia, unexplained weight loss, or hyperglycemic crises. To clarify the criteria for clinical guidelines, a person’s A1C level should be equal to or greater than 6.5% (or 48 mmol/mol), and the test should be conducted in a laboratory using a specific method that is NGSP-certified and standardized to the DCCT assay. Fasting plasma glucose (FPG) should equal or greater than 126 mg/dL (or 7.0 mmol/L) after at least 8 hours of no caloric intake. The oral glucose tolerance test (OGTT) is a simple procedure wherein the 2-hour plasma glucose level should be equal to or greater than 200 mg/dL (or 11.1 mmol/L), using a glucose load that contains 75 g anhydrous glucose dissolved in water as specified by the American Diabetes Association standards of practice. Additionally, if a person shows classic hyperglycemia or hyperglycemic crisis symptoms, a random plasma glucose level should be equal to or greater than 200 mg/dL (or 11.1 mmol/L). The random is any time of day, regardless of the time since the last meal. The criteria for nonpregnant in prediabetes screenings are A1C 5.7–6.4% (39–47 mmol/mol) or FPG 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG) or the 2 hours PG during 75-gOGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) (IGT) (ElSayed et al., 2023). This approach involves regularly monitoring blood sugar levels, regulating insulin production with medication, and making lifestyle modifications such as healthy eating and exercise. In addition, patients may require regular checkups with specialists such as endocrinologists, cardiologists, nephrologists, and ophthalmologists to manage the various complications associated with diabetes.
References:
ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Gaglia, J. L., Hilliard, M. E., Johnson, E. L., Khunti, K., Lingvay, I., Matfin, G., McCoy, R. G., Perry, M. L., Pilla, S. J., Polsky, S., Prahalad, P., Pratley, R. E., Segal, A. R., … Gabbay, R. A. (2023). 2. diagnosis and classification of diabetes: standards of care in diabetes—2024. Diabetes Care, 47(Supplement_1). https://doi.org/10.2337/dc24-s002
Sugandh, F., Chandio, M., Raveena, F., Kumar, L., Karishma, F., Khuwaja, S., Memon, U. A., Bai, K., Kashif, M., Varrassi, G., Khatri, M., & Kumar, S. (2023). Advances in the management of diabetes mellitus: A focus on personalized medicine. Cureus. https://doi.org/10.7759/cureus.43697
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When diabetes is controlled poorly the long-term effects can be detrimental to one’s health. Diabetes can affect your heart, kidneys, nerve health, vision, foot health and more. High blood sugar has a damaging effect to large and small blood vessels. With regard to heart health it is important to monitor a patient’s blood pressure, triglycerides, and LDLs. A lipid panel would be appropriate at least once a year for diabetic patient’s. To avoid chronic kidney disease, it is also important to screen for proper kidney function. This includes CMP to monitor electrolytes, BUN, and creatinine. It is also important to monitor the glomerular filtration rate (GFR). Urine test is appropriate to monitor for albumin in the urine (CDC, 2022). Uncontrolled diabetes can cause vision loss and even blindness. When patients are diabetic it is important to monitor for diabetic retinopathy, macular edema, cataracts, and glaucoma, so it is important to get regular vision exams. As a result of nerve damage from high blood sugar the nerve health is compromised. Due to compromised nerve health it is vital to screen for wounds in your feet and to educate the patient on regular foot care. This includes washing your feet every day, making sure they are completely dry, wearing appropriate sized shoes, trimming toe nails straight across, getting yearly foot exams by your health care provider, and to always wear socks with your shoes (CDC, 2022). It is important that providers are knowledgeable on appropriate screening for diabetic patients. It is also important that patients are educated on these important screening items, so they may be participating in their health care.
Centers for Disease Control and Prevention. (2022). Prevent diabetes complications. CDC. https://www.cdc.gov/diabetes/managing/problems.htm…
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