There are three types of diabetes mellitus: type 1, type 2 and gestational diabetes. Type 1 diabetes appears as a result of destruction of beta cells by the immune system. The deficiency of beta cells in the pancreas leads to inadequate insulin and presence of anti-islet cell antibodies in the blood system (Mandal, 2017).
Type 2 diabetes is caused by low levels of insulin and not total deficiency. This means that the body cannot produce sufficient insulin, a condition that leads to deficiency of beta cells and peripheral insulin resistance (Mandal, 2017). Peripheral insulin resistance is a state where there is high levels of insulin and absence of hypoglycemia in the blood.
Gestational diabetes is mainly caused by extreme levels of counter insulin hormones during pregnancy, which leads to high blood sugar and insulin resistance. This condition can damage insulin receptors (Mandal, 2017).
Pathophysiology of Diabetes Insipidus
Diabetes insipidus is caused by unstable antidiuretic hormone (ADH) levels. ADH is produced by the hypothalamus and stored by the pituitary glands. It regulates excretion of fluids from the blood stream by affecting the aquaporins, which control permeability of transmembrane vessels (Mandal, 2017).
Differences between Diabetes Mellitus and Insipidus
Diabetes mellitus is a pancreatic disorder, whereas diabetes insipidus is a hypothalamic disorder (Huether & McCance, 2017). This implies that the two diseases produce different effects on hormonal regulation. In case of diabetes mellitus, the hormone insulin is involved (secreted by the cells located in pancreas). When the condition emerges, it implies that the level of insulin either becomes too low, or the body is incapable of responding to it in a proper way. As for diabetes insipidus, anti-diuretic hormone (or vasopressin) is involved. It is produced by hypothalamus. The disease is characterized by either its deficiency or inability of kidneys to react to it.
There is an occurrence of ketone bodies in the blood of diabetes mellitus patients. These bodies are absent in diabetes insipidus patients. Urine in the case of diabetes mellitus is of normal concentration although it is very dilute in diabetes insipidus. Rise in blood cholesterol and glucose level which result to higher rates of excretion are clear in diabetes mellitus although they do not occur in insipidus (Hammer & McPhee, 2014). Mellitus is also characterized by excessive hunger which is unlike normal eating habits in diabetes insipidus.
Similarities between Diabetes Mellitus and Insipidus
Diabetes mellitus patients often experience excessive fatigue due to high or low levels of blood sugar while fatigue in diabetes insipidus result from inadequate hydration (Hammer & McPhee, 2014). Excessive thirsty in diabetes mellitus is caused by high glucose levels in the body while it is caused by lack of vasopressin in diabetes insipidus. Blurred vision in diabetes mellitus is a result of excess glucose while in diabetes insipidus it results from extreme dehydration (“Diabetes insipidus vs mellitus,” 2015).
Gender and Ethnicity Effects
Generally, men are at a higher risk of being diagnosed with diabetes than women. The major reason is that fat they have is stored in their inner organs (as compared to women whose fat is distributed on the surface). This implies that women can gain more fat before the condition becomes threatening to their health. However, the development of the disease is more complicated for women than for men, which results in higher death rates.
As for the effect of ethnicity, Mexican Americans, African Americans, Asian Americans, Native Hawaiians, American Indians, and Pacific Islanders are at a greater risk of diabetes, partially due to their propensity to be overweight. Treatment differences are not dramatic among genders and ethnicities.
In both females and males of diverse ethnicities and races, the treatment of type 1 diabetes usually includes insulin injections, low-carbon diet and regular physical activity (Mandal, 2017). Patients who are overweight and have high daily doses of insulin can also benefit from the intake of metformin as it helps to control blood sugar level more efficiently by improving glucose metabolism (Viollet et al., 2012).
However, the use of this drug is more common for the treatment of diabetes type 2, whereas the insulin is not used in this form of the disorder. Lifestyle modifications are recommended for the intervention of diabetes type 2 as well. Additionally, since this form of the disease is associated with increased blood pressure, patients can be prescribed with calcium channel blockers and ACE inhibitors that are effective in reducing hypertension and preventing organ damage (Ganesh & Viswanathan, 2011).
References
Diabetes insipidus vs mellitus. (2015). Web.
Ganesh, J., & Viswanathan, V. (2011). Management of diabetic hypertensives. Indian Journal of Endocrinology and Metabolism, 15(Suppl4), S374–S379.
Hammer, G. D., & McPhee, S. J. (2014). Phathophysiology of diseases: An introduction to clinical medicine. (7th ed.). New York: McGraw-Hill Education.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Mandal, A. (2017). Diabetes Pathophysiology. Web.
Viollet, B., Guigas, B., Sanz Garcia, N., Leclerc, J., Foretz, M., & Andreelli, F. (2012). Cellular and molecular mechanisms of metformin: An overview. Clinical Science (London, England : 1979), 122(6), 253–270.
As a company that deals in the provision of diabetes supplies to the general public, Salehiya Medical can be described as an institution that is well poised to assist the general public when it comes to its expertise in the field of diabetes treatment and detection. This is an important factor to consider since it’s home market, Saudi Arabia has one of the highest diabetes prevalence rates in the world. Studies such as those by Alhumaidi, Agha & Dewish (2013) have indicated that within Riyadh alone adult males that are within the age range of 30-70 years have a diabetes prevalence rate of 23.7% with women having a similar rate at 26.2%. The rate seen among children was also shown to be at 14% with roughly 68 percent of the child population in Riyadh showing symptoms of diabetes when examined by the local health department (Alhumaidi, Agha & Dewish, 2013). What this shows is that within Riyadh, there is an endemic case of diabetes within the population which can start at a very young age and contributes to the relatively high rate of diabetes seen in the adult half of the population.
The Working Class and Diabetes
While the proliferation of cases of diabetes may seem like a good thing for Salehiya Medical since this means that more people will be buying the company’s products, the inherent issue within Riyadh is that despite having a reputation for extravagance which can be seen through its various upscale malls, condominiums, and luxury cars, the fact remains that there has been little in the way of progress by the government in helping working-class citizens elevate the quality of life that they are currently experiencing. Within the context of diabetes treatment and detection, this means that the poor in the country do not know whether they have diabetes or not and also lack the means to be able to pay for proper testing and long term treatment options (Habeb, Al-Magamsi, Eid, Ali, Hattersley Hussain & Ellard, 2012).
As explained by Alhowaish (2013), the money that is earned by the working class of society often goes towards survival with allocations towards medical expenses, often being their lowest priority. The result of such a condition is the continued untreated progression of certain sicknesses which, more often than not, causes a member of the urban working class to die (Alhowaish, 2013). It is based on this that alternatives need to be implemented within the context of diabetes treatment and detection in Riyadh to prevent needless deaths.
Preventing the Proliferation of Diabetes
As mentioned earlier, since Salehiya Medical is well poised to be able to provide the necessary medical and technical expertise to address such an issue, the company should attempt some means of providing a positive contribution towards the local community in Riyadh. The problem though is that proper diabetes testing and implementing treatment procedures is incredibly expensive due to the necessity of insulin shots along with the fees associated with hiring medical personnel for checkups. Since 23.7% of men and 26.2% of women have been noted as having diabetes in Riyadh, with a vast majority of them belonging to the urban working class, it becomes immediately obvious that Salehiya Medical simply does not have the resources to be able to treat them all or provide the care they need. Diabetes is a life long illness that requires constant vigilance and medical treatment and, as such, the company cannot give out treatments for free simply because people cannot afford it (Al-Rubeaan, Youssef & Subhani, 2014). Alternative methods of preventing the proliferation of diabetes within Riyadh need to be developed that are both economically feasible and effective.
Proposed Plan for Resolving the Issue
The proposed plan for addressing this issue comes in the form of Salehiya Medical funding a localized information campaign within Riyadh to make people more aware about diabetes, its symptoms and how many people within the city have the condition. Through an information campaign and then sponsoring various non-government organizations to help tackle the issue, this strategy should help in addressing the issue of diabetes without costing the company significant amounts of money. The best method of resolving this issue is not to target diabetes directly since there is no way for the company to examine every single person in Riyadh to check whether they have diabetes or not, rather, a more effective method would be to discourage the consumption of food that leads to developing diabetes and targeting children within the local schools in the country (Hashim, Yasser & Khatib, 2013). One way in which this can be accomplished is by encouraging the development of new legislation that focuses on informing children regarding the dangers certain types of food could have towards their long term health. With its medical expertise on the subject, Salehiya Medical would be able to create an effective strategic plan to determine what types of food children should be discouraged to eat in large amounts.
Justification for the Proposed Plan
Information campaigns have always been a way in which governments have controlled the consumption of particular types of food products that are considered bad for the public. For example, government-sponsored information campaigns that discourage the consumption of tobacco and alcohol are common in many countries. Through an enacted policy that focuses on discouraging the consumption of food identified as being the cause of diabetes, this would help to limit their consumption, which would result in fewer cases of diabetes in the future. The advantage of this plan as compared to possible alternatives is easy to see when taking into consideration the fact that the parents do care about the future of their children.
By being more informed about the dangers consumption of certain types of food have on the health of their kids; it is likely that they would prevent their children from eating those types of products in large amounts. On the other hand, it should also be taken into consideration that there would obviously be a backlash from the various companies in Riyadh that produce and sell products that lead to a person developing diabetes, however, the fact remains that should such a government policy be put into effect, the rate of diabetes would definitely decrease and this could save thousands of lives in the process.
Conclusion
Based on what has been presented so far, it can clearly be stated that Salehiya Medical has a responsibility to the local community in Riyadh to make them more aware about the various issues related to diabetes and help to institute policies to help the government address such an issue. As such, if Saudi Arabia is to resolve the problem of diabetes, the country needs to put in place the proper programs to help the rural poor and prevent the proliferation of the illness within the country.
Reference List
Alhowaish, A. K. (2013). Economic costs of diabetes in Saudi Arabia. Journal Of Family & Community Medicine, 20(1), 1-7.
Alhumaidi, M., Agha, A., & Dewish, M. (2013). Vitamin D Deficiency in Patients with Type-2 Diabetes Mellitus in Southern Region of Saudi Arabia. Maedica – A Journal Of Clinical Medicine, 8(3), 231-236.
Al-Rubeaan, K., Youssef, A. M., & Subhani, S. N., (2014). Diabetic Nephropathy and Its Risk Factors in a Society with a Type 2 Diabetes Epidemic: A Saudi National Diabetes Registry-Based Study. Plos ONE, 9(2), 1-9.
Habeb, A., Al-Magamsi, M., Eid, I., Ali, M., Hattersley, A., Hussain, K., & Ellard, S. (2012). Incidence, genetics, and clinical phenotype of permanent neonatal diabetes mellitus in northwest Saudi Arabia. Pediatric Diabetes, 13(6), 499- 505.
Hashim, F., Yasser, M., & Khatib, O. (2013). Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Eastern Saudi Arabia cohort of the A1chieve study. Indian Journal Of Endocrinology & Metabolism, 17(S2), S453-S457.
Currently, there are many various types of equipment that can help diabetic patients care for themselves and monitor their health remotely. According to Gonder-Frederick, Shepard, Grabman, and Ritterband (2016), such devices as “the blood glucose meter, insulin pump, and continuous glucose monitor” were developed and refined for people to use (p. 577). Moreover, this technology allows diabetic patients to create a system where they are able to fully automatize the process of insulin delivery. The activities connected to the monitoring of patients are also becoming more and more computerized. Blood glucose (BG) meters help individuals to stay informed about their well-being, while insulin pumps help them to dose the injections and deliver the medicine on time.
Furthermore, different programs and applications allow diabetic patients to talk with physicians without visiting hospitals. For instance, Kennedy, Runge, and Brown (2016) state that existing and future devices give patients an opportunity to send the gathered information to their smartphones and computers, which then can be shown to physicians and medical establishments. Moreover, various mHealth applications can analyze data such as BG levels, injection schedules, and common patterns in order to predict possible issues and warn patients to act accordingly. The use of Internet-based systems also allows medical professionals to consult patients and monitor their health. For instance, psychologists can provide online consultations and assess individuals’ well-being. All in all, the current state of technology that helps people treat diabetes is very advanced.
Home Therapy
Monitoring devices are closely connected with equipment that helps patients to apply self-treatment. The insulin pumps described above, for example, can replace insulin injections. According to Liberman et al. (2016), the use of these devices often leads to patients experiencing less stress about their condition as they feel in control of their health. Moreover, diabetic patients that use technology for home therapy feel less pressured about their well-being. Liberman et al. (2016) state that many individuals with diabetes can be distressed by and tired of continuous monitoring of their BG levels. However, the use of automated programs and devices helps them not only to relieve stress but also to adhere to the treatment with success. Existing insulin-delivering devices do not require patients to do multiple injections a day, freeing them from the continuous strain of responsibility. Self-management of diabetes is becoming more dependent on technology than before as the development of new programs and devices gives patients an ability to monitor and treat themselves without regular check-ups at the hospital.
Billing and Insurance
Diabetic patients have to spend a substantial amount of money on their treatment. According to the Centers for Disease Control and Prevention (2017), lifetime medical costs for individuals with diabetes often put them in a challenging position as patients need to pay for the treatment of their condition and some possible complications that may follow it. Moreover, the financial burden of diabetes impacts the national health care system, as well.
Insurance can cover a part of the expenditures. For instance, Medicare.gov (2017) states that such equipment as BG test strips, BG testing monitors, insulin, and lancet devices and lancets can be obtained with insurance. However, only a number of providers work with insurance companies. Furthermore, more expensive equipment that would allow patients to automatize their processes is not covered. Thus, patients that want to have better technology to maintain their health have to spend significant amounts of money. Insurance also partially covers various treatment opportunities and exams, including a foot exam, a yearly eye exam, training for diabetes self-management, and nutrition therapy. These services are covered by some programs and are full of various rules and limitations.
References
Centers for Disease Control and Prevention. (2017). Modeling and economics. Web.
Gonder-Frederick, L. A., Shepard, J. A., Grabman, J. H., & Ritterband, L. M. (2016). Psychology, technology, and diabetes management. American Psychologist, 71(7), 577-589.
Liberman, A., Buckingham, B., Barnard, K. D., Venkat, M. V., Close, K., Heinemann, L.,… Laffel, L. (2016). Diabetes technology and the human factor. Diabetes Technology & Therapeutics, 18(S1), S-101-S-111.
Coping with type 2 diabetes (DT2) involves three major things. First, there is need for change in diet. A lot of fruits and vegetables is advised as opposed to high-sugar foodstuffs. However, for some who find it hard to drop the aforementioned, consumption is limited to periods of low blood sugar.
Secondly, it is important to exercise regularly as this will help burn out excess calories and keep the blood sugar level low. Some adopt regular exercise and good diet as a measure to keep blood sugar low in order to avoid the need of taking medicines (nytimes.com, 2009). Lastly, some attend diabetic classes to better understand and manage the disease (nytimes.com, 2009).
Constancy
People with DT2 need to permanently observe healthy eating habits and regular exercise explained above due to the chronic nature of the disease. They are also required to daily monitor their sugar levels and react as advised (nytimes.com, 2009). These enables them keep their blood sugar at normal level and thus prevent the development of adverse complications that come with high blood sugar.
Discouragement versus empowerment
Those diagnosed with the disease first experience a great deal of self-denial about their new health status (nytimes.com, 2009). This can be out of ignorance or fear. However, upon learning the facts about the disease from medical practitioners and personal efforts they shed this attitude and adopt new habits which lead to healthier lifestyles (nytimes.com, 2009). They gain attitudinal empowerment when they accept the reality and longevity of their new health status, the need for exercise, low-sugar diet, and regular medication.
Need for discipline, therapy, medication and diet
DT2 requires constant monitoring and intervention therapies. Personal discipline in observing doctors directives is important as most of the monitoring is carried out at home. For example, patients are required to daily set up, read and record their blood sugar levels sugar using an electronic monitoring kit (nytimes.com, 2009).
Therapy is vital as the symptomatic aspects of the disease worsen with time if there is no intervention of any kind. Medication is necessary to quickly lower blood sugar when it suddenly shoots up, a common occurrence in type 2 diabetes. Low-sugar diet rich in vegetables and fruits is necessary to manage blood sugar within safe levels and prevent debilitating symptoms.
Uncertainty of future
DT2 is said to be genetic and victims report the challenge of living with the knowledge that their offspring may also relive their experiences. There is also the fear of possible amputation of feet in the future given that it has been performed on some patients before. Many also despair about the possibility of early death (nytimes.com, 2009).
Pain
Pain is common in patients with type 2 diabetes. Patients have reported a burning sensation in the feet accompanied by sharp on-off pains (nytimes.com, 2009). In some cases headache and leg amputation have been reported (nytimes.com, 2009).
Experience of health professionals
From the podcasts, it can be discerned health professionals have difficulty breaking news of positive diagnosis to victims (nytimes.com, 2009). This is likely in the case of patients with little knowledge about the disease. Perhaps another challenge they face is getting the patients to drop negative attitude about the disease, observe medications and best practices such as healthy diet, regularly exercising and use of personal sugar monitoring kit.
A diabetic diet is a regiment that is an essential part of the treatment of patients that suffer from this condition. The most significant dissimilarity from others is that the overall purpose is different. The primary goal is to have an eating plan that includes only healthy foods to control glucose in the blood. Numerous foods are recommended for those who are affected by this condition. Fruits and vegetables are often preferred because they contain fructose. Also, it is paramount to understand which foods should be avoided. The most important fact that should be taken into account is that products that contain fats or sugar are especially dangerous because an overdose may lead to severe consequences. Medical nutrition is one of the significant cornerstones of successful management of this condition (Marsh, Barclay, Colagiuri, & Brand-Miller, 2011). It is also essential that another primary goal of this diet is to maintain weight at a certain level, where it would not cause any problems. Calories should always be limited, and individuals should not overeat. Specific rules also should not be disregarded. For example, it is not wise to drink alcohol on an empty stomach because it may affect blood sugar and others. The effectiveness of this diet varies from patient to patient, and necessary adjustments should be made to eliminate this issue.
History
Geography
The first known diabetes diet was developed in Egypt. People did not understand the cause of disease at that time, but they were able to determine that increased consumption of carbohydrates reduces the symptoms. Scientists have noted the connection between the diet and this condition over the years and tried to figure out the cause of diabetes. There were different kinds of therapies. Some of them focused on the increased consumption of potatoes and other vegetables. It is also quite interesting that there was an opinion that starvation can be used as a diet option to treat this condition by American scientists Frederick Allen and Elliott Joslin (Mazur, 2011).
The treatment was extremely controversial and ineffective and has resulted in numerous deaths because patients often suffered from starvation. However, it is essential to realize that there was no alternative way of fighting the disease at that time, and any possible solution should have been considered. Fasting and limitation of calorie intake were used as the primary treatment options. It could not be viewed as an effective method because it only increased the lifespan but did not address central issues. The diet in the nineteenth century in Italy consisted of lean meat and alcohol that was diluted (Sawyer & Gale, 2009). In 1995, it was discovered that Precose is the most effective with a particular diet to make sure that the amount of sugar in the blood is under control (Sattley, n.d.).
Nevertheless, the situation has drastically improved over recent years, and some available options are much more appropriate. Currently, numerous kinds of diabetic diets are quite efficient. However, the number of people that are affected by this condition has dramatically increased because of significant changes to production methods.
Culture
The fact that there are vast dissimilarities between this group of dieters and others should be addressed. One of the most significant differences is that it is much more critical for this group of individuals because their health and well-being are dependent on nutrition. This diet is a crucial part of the overall treatment and has a tremendous impact on the lifestyle of an individual. One of the noteworthy problems is that this condition cannot be cured, and one should get used to such eating behaviors. Psychological aspects are especially crucial and should be considered because many struggles with the realization that they have to deal with it for the rest of their lives.
However, it is essential that one can make slight changes to the diet when some products become too repetitive, and the necessity to consume them may lead to depression, anxiety, and other severe mental conditions. Beliefs play a significant role, and they have an enormous influence on the products that are chosen by individuals for the diet. The fact that this diet is not short-term is also quite significant, and the taste preferences of a person have an enormous impact. It is also interesting that some people still do not like to consume fruits and vegetables, even when considering the fact that they have proven to be excellent for health. Ethnic food should also be viewed as a significant factor because some of the meals are not healthy, but they are consumed as a part of the tradition. Overall, it is paramount to keep track of ingredients in meals that are consumed throughout the day
Important Change Agents
New technologies in the food industry had an enormous influence on the diet because they helped to make sure that some of the products are healthy for those who suffer from diabetes and do not lose their quality over time. New transportation options were also essential because they allow the products to be delivered and packaged much faster. The use of some technologies is necessary to make sure that foods retain their qualities. Improvement of food processing systems was also quite crucial.
However, it should be said that there are negative influences of the technology because some products that were previously not available have led to the increased prominence of this condition. Numerous dietary supplements that are sold as pharmaceuticals are available. However, their effectiveness is often questionable, and there is little evidence that would suggest that they can be useful as a part of this diet. Governments are often fighting with such products, and try to prohibit the production of most dangerous ones with some success. However, it should be said that there are still some dangerous ones on the market.
Innovation
Numerous innovative foods have been introduced over the years. It is not an easy task to consume necessary amounts of plants, and juices help to address this issue. There are also improvements in packaging that were needed to keep the products fresh much longer. The regiment has been improved over the years, and currently, there are numerous alternatives to the traditional one. A vegetarian diet can be viewed as one of the options for diabetes diet because the reduction of intake of meat has various benefits and reduces possible risks that are associated with this disease. High protein diets are quite popular nowadays because it helps with weight loss. It is instrumental thanks to the fact that it increases satiety, which is one of the most critical factors that affect food intake. The higher risk of cardiovascular diseases should be considered because it is a significant side effect. It should be said that there are studies that indicate that such a diet may cause the harmful effects of lipids.
Research has shown that plants should be valued over animals as a source of protein to increase the effectiveness of the treatment (Evangelista et al., 2009). One of the studies that focused on high-protein diets has shown that it can be used as an effective method of treatment of type two diabetes, and the need for pharmacologic interference will be limited (Nuttall, Schweim, Hoover, & Gannon, 2007). It is also interesting that a recent study has shown a vegan diet that was focused on low fats was more efficient when it comes to the improvement of glycemia than standard diabetes diet (Barnard et al., 2009). Also, it is essential to say that there is no necessity to follow such regiments, but it should be beneficial for the health of a person. It is vital that recommendations for this diet are now evidence-based. Overall, there have been numerous innovations over the years that have had a dramatic influence on this regiment.
Resources
It is indispensable to develop a diabetes diet plan. A professional should guide one through the process, and the preferences of a patient should be taken into account. Products that cause allergic reactions should be avoided at all costs. It is paramount to address the fact that a professional should monitor the process because some individuals can show resistance to the regimen (Kavookjian et al., 2005). It is also essential to consider the fact that there is a possibility that there are some comorbidities that should be taken into account during the development of a diet plan. Allergic reactions to specific products are also possible and should be evaluated. It is also quite paramount to note that this diet has an immense influence on social activities. Some may not be able to share meals and drinks with their friends and relatives. However, the importance of this regiment should be acknowledged and not disregarded. The timing of meals is essential, and several options can help with this task.
Also, the opinions of others and recommendations should be considered. Nutritional counseling would be quite helpful for most individuals that need to be educated about this diet (Polak, Dill, Abrahamson, Pojednic, & Phillips, 2014). It is necessary to acknowledge the fact that numerous books that are focused on such diets are currently available. Still, their content is often questionable, and one should consult with a specialist before attempting self-treatment. Only trusted sources of information should be considered because possible complications are hazardous. Some foods are suggested to be the healthiest for those who suffer from this condition. Also, it is tough to maintain a diet regiment, and it is one of the most significant issues that are present. Moreover, psychological barriers should not be disregarded. Overall, it is necessary to address both psychological and physiological aspects before the start of the diet. Overall, several resources are needed to start this diet.
Contemporary uses
Production Methods
Food production systems have been dramatically improved and modernized over the years because the industry has acknowledged the need for such products. However, it is necessary to say that some of the products that are suggested for those with diabetes are not healthy. Fructose that is used in their production is associated with increased risks of development of cardiovascular conditions. It is imperative to note that recent research has shown that it does not have a noticeable effect on insulin (Cozma et al., 2012). However, further investigation of its effectiveness may be required. It is necessary to note that most diet foods do not contain a reduced amount of vitamins, as believed by many (Oakes, 2004).
Numerous dietary supplements contain multivitamins, magnesium, vitamin C, chromium, and others. Also, many pre-made meals are available on the market. They are made with consideration of unique aspects of this condition and are cooked very fast in microwaves. Products that are interesting and innovative also can be seen. Some of them may be used to increase the amount of glucose in the blood, and they are viewed as an alternative to drugs. Most fruits and vegetables are grown on healthy soil because it has a drastic effect on the overall quality of the product. Fresh ingredients should be mostly preferred because vitamins are an essential part of this particular diet. Overall, production methods have changed and have been modernized over the years, and there is a need for further improvement.
Techniques
There are always new techniques for this diet that are being developed all the time. Some tips can be used by individuals during preparation and cooking to make the process much more comfortable. It is suggested that people should try different products because some of them may become incredibly stale, and it is known that people view taste as one of the most critical aspects. Flavorings can be used as a way to address this problem, but it is essential to choose the products that are appropriate for the diet plan.
The intake of sodium should be reduced for those that suffer from this condition. It is also suggested that people that are affected by diabetes eat at home because it is hard to measure the ingredients in restaurant meals. Most of them contain surprising amounts of sodium. They are also often high in fats and calories. Cooking at home allows one to have better control of ingredients. It is imperative to avoid foods that are known to contain an increased amount of sodium, and some alternatives are available. Dried basil, cinnamon, cumin, and other spices may be used to flavor foods. Herbs are also recommended in most cases.
Artificial ingredients should not be used most of the time because it is known that some of them are not healthy. Fresh dill and parsley are especially useful and significantly improve the taste of most dishes. Also, ingredients should always be checked because some of them are mislabelled. Some tips may help one to maintain the regime and do not forget about the diet. It is also interesting that numerous websites sell foods that are related to diabetes, and some of them are supported by organizations. Online sales and wrongful advertisement are used to aim at customers that may look for cheaper options, but it is necessary to consider the fact that it is better to purchase products from trusted sources. This market is developing at an incredibly fast pace because of the popularisation of online purchases. Also, sections that are aimed at people who suffer from this condition are present in most supermarkets, and a broad range of products are offered. Overall, many techniques can be used. Are they quite innovative?
Resources
The products that are a part of this diet have also changed over the years. People prefer the ones that are easy and fast to cook, and the food industry acknowledges this fact. The products have become much tastier than they used to be, and they are healthier thanks to the advancement of methods of production. Also, the ones that contain gluten are generally avoided because of a recent discovery of dangerous aspects of this protein. Most people understand the importance of this diet, and they make the process of product selection very seriously. Web sites with reviews also have an immense influence on the behavior of buyers. There are guidelines for the production of such foods that should be followed. Overall, customers pay more attention to the quality and ingredients of the products before making a purchase, then they used to, and some companies use it to their advantage. This aspect is used as a core of promotion and advertisement.
The enterprises that are producing products that were not safe have understood that the population had a better understanding of this issue and started to make changes to the ingredients. They are versions of the products that are lower in sugar or those that a completely sugar-free. Some of them are quite expensive, and most individuals cannot afford them. Many organizations also suggest limiting the consumption of these products because they are hard to regulate. Some of them are quite useful and healthy, but they should be selected wisely. It must be said that an increase in demand has played a vital role. It is also paramount that such foods are also available in most countries all over the world. However, there are still some issues that are present and should be addressed because diabetes is a severe disease and global threat.
Future trends
Technology
The introduction of new technologies is going to be crucial for diabetes management. Smartphones are nearly everywhere and help individuals not to forget about their diet. However, it can be improved even further. Smartwatches can be used as one of the examples. The fact that they are always on the hand of a person is crucial. Such devices can provide a broad range of services that are associated with diabetes diet in addition to notifications. Google Glass is also a revolutionary technology that could help to address the current problems of diabetes diet management. Overall, the possibilities are limitless. Also, it is imperative to consider the fact that the effect of this diet should always be observed. Modern technologies can be used to address this problem. Also, it may be much more comfortable with the introduction of new devices and gadgets.
This is a massive industry because the number of people that suffer from this condition is astounding, and scientists are always looking for new ways in which current issues that are present can be addressed. Also, several products will likely be discovered that would revolutionize this particular diet. The food industry is developing at a breakneck pace, and the overall goal is to satisfy the needs of customers. There is a need for new technologies that would help fix current problems that are associated with this diet. Free tools should be promoted because a study has indicated that they were met with approval and were viewed as generally helpful (Peterson, 2014).
Some of these applications can record food habits, and it is beneficial (Arsand, Tatara, Ostengen, & Hartvigsen, 2010). An app that would scan a barcode and show information about the ingredients of a product would be innovative and may help millions of people that are on this diet. It is necessary to note that numerous technologies have been introduced to keep track of calories (Illner et al., 2012). The fact that they are so easy to use is crucial. The process of the evaluation is incredibly fast, and it cannot be overlooked. The development of diet smartphone applications was especially critical, and they are becoming increasingly popular each year.
They help with shopping and can be configured according to the preferences of the user. Numerous applications that come with a range of services can be downloaded and installed for free, and there are paid alternatives that also have their advantages. The memo feature is especially critical because many individuals struggle with remembering that they are on a diet. Notifications to take a meal are also quite useful and liked by users.
The fact that all the information about the food can be stored and viewed later should not be overlooked because it is necessary to keep track of the progress to make sure that the process is successful. The effectiveness of such applications should not be disregarded, and health care systems should consider the implementation of such software as a part of the treatment of this disease. Some systems can automatically transfer the necessary data about the consumption of food to professionals, and they can monitor the process (Cruz-Cunha, M., & Moreira, 2011). However, it should be said that some of them have issues with usability because access to wireless transmission is necessary. Overall, numerous possibilities for the development of new technologies are present, and they would help to solve current issues.
Social Influences
Social interactions have an immense impact on the behavior of people that follow the diet regiment. Mass media is one of the reasons that weight loss is viewed by many as a necessary part of the diet. Images and pictures that are displayed on the screen are considered to be normal, and anything that slightly differs is viewed as not attractive. It is necessary to address the fact that women are affected by this problem the most because it is hard to meet the standards. After all, they are set very high. Recent research has shown that there is a connection between this disease and obesity, and aspects that influence dietary choices should be studied (Anders & Schroeter, 2015).
It could lead to an improvement in understanding of the necessity of following dietary guidelines. It is crucial to note that weight loss is considered one of the most critical factors because it is necessary to limit the possibility of the development of other severe conditions and comorbidities are especially dangerous. It is also essential to understand that such diets have a significant influence on the mood of a person.
Eating healthier often reflects positively on the overall behavior, and individuals feel better. However, it should be said that some may feel stressed about depressed because they cannot consume the food that they like. Some options on the market help to address this issue. There are alternatives to such foods that are quite similar, and it would be hard to tell the difference between their tastes. It is necessary to take measurements during each meal, and it may cause some discomfort for individuals, especially if they are surrounded by others. However, it is crucial to understand that this condition is quite severe, and full support should be offered to people that suffer from it. The level of satiety is crucial because it is essential for an individual to feel less hungry with reduced consumption of calories, and the diabetes diet is quite efficient from this point of view (Jönsson, Granfeldt, Lindeberg, & Hallberg, 2013).
It is also paramount that people on this diet are often anxious about the fact that there is a need to limit certain foods. However, it can be an excellent way to try out different products that have incredible flavors. Overall, it is paramount to consider that the behavior of the people that are affected by this disease is often influenced by the opinions of others, and it has an enormous impact on the diet.
Conclusion
In conclusion, numerous factors make this diet much more different from others. It is crucial to note that it is a necessity for some individuals, and it is accompanied by a need for lifestyle changes. Some products on this market can be used to help to address the issue of counting calories and other factors. It is imperative to understand that the effectiveness of the diet differs, and it should be individualized. Preferences of a person should also be taken into account (Deed et al., 2015). The most significant aspect that affects this diet is the nature of this condition, and it affects the product line-up. Overall, the goal of this diet is to provide an individual with the daily amount of vitamins without affecting sugar levels. It is essential to say that there is no optimal diet for the treatment of this disease, and it should be individual for all the patients (Krebs & Parry-Strong, 2013).
The importance of self-management should not be disregarded, and it can be promoted with personal and online interactions with professionals. The governments should focus on these issues and take necessary measures to educate the population about this condition and the significance of this regiment. However, it should be said that the diet dramatically differs in most regions of the world because of such factors as social class. It is caused by the fact that some products are costly, and many individuals prefer alternatives that are much cheaper (Pozzilli & Fallucca, 2014). Some issues that are associated with knowledge about management of this condition are currently present, and it is paramount to provide education to make sure that the population has an understanding of this problem. Nevertheless, new technologies are always being developed, and some of them would be able to address this fact.
References
Anders, S., & Schroeter, C. (2015). Diabetes, diet-health behavior, and obesity. Frontiers in Endocrinology, 6(1), 1-8.
Arsand, E., Tatara, N., Ostengen, G., & Hartvigsen, G. (2010). Mobile phone-based self-management tools for type 2 diabetes: the few touch application. Journal of Diabetes Science and Technology, 4(2), 328-336.
Barnard, N., Cohen, J., Jenkins, D., Turner-McGrievy, G., Gloede, L., Green, A., & Ferdowsian, H. (2009). A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. American Journal of Clinical Nutrition, 89(5), 1588S-1596S.
Cozma, A., Sievenpiper, J., de Souza, R., Chiavaroli, L., Ha, V., Wang, D.,…Jenkins, D. (2012). Effect of fructose on glycemic control in diabetes. Diabetes Care, 35(7), 1611-1620.
Cruz-Cunha, M., & Moreira, F. (2011). Handbook of research on mobility and computing. Hershey, PA: Information Science Reference.
Deed, G., Barlow, J., Kawol, D., Kilov, G., Sharma, A., & Hwa, L. Y. (2015). Diet and diabetes. Australian Family Physician, 44(5), 288-292.
Evangelista, L., Heber, D., Li, Z., Bowerman, S., Hamilton, M., & Fonarow, G. (2009). Reduced body weight and adiposity with a high-protein diet improves functional status, lipid profiles, glycemic control, and quality of life in patients with heart failure. The Journal of Cardiovascular Nursing, 24(3), 207-215.
Illner, A., Freisling, H., Boeing, H., Huybrechts, I., Crispim, S., & Slimani, N. (2012). Review and evaluation of innovative technologies for measuring diet in nutritional epidemiology. International Journal of Epidemiology, 41(4), 1187-1203.
Jönsson, T., Granfeldt, Y., Lindeberg, S., & Hallberg, A. (2013). Subjective satiety and other experiences of a paleolithic diet compared to a diabetes diet in patients with type 2 diabetes. Nutrition Journal, 12(1), 105.
Kavookjian, J., Berger, B., Grimley, D., Villaume, W., Anderson, H., & Barker, K. (2005). Patient decision making: Strategies for diabetes diet adherence intervention. Research in Social and Administrative Pharmacy, 1(3), 389-407.
Krebs, M., & Parry-Strong, A. (2013). Is There an Optimal Diet for Patients With Type 2 Diabetes? British Journal of Diabetes and Vascular Disease, 13(2), 60-66.
Marsh, K., Barclay, A., Colagiuri, S., & Brand-Miller, J. (2011). Glycemic index and glycemic load of carbohydrates in the diabetes diet. Current Diabetes Reports, 11(2), 120-127.
Mazur, A. (2011). Why were “starvation diets” promoted for diabetes in the pre-insulin period? Nutrition Journal, 10(1), 23.
Nuttall, F., Schweim, K., Hoover, H., & Gannon, M. (2007). Effect of the LoBAG30 diet on blood glucose control in people with type 2 diabetes. BJN, 99(3), 511-519.
Oakes, M. (2004). Suspicious minds: perceived vitamin content of ordinary and diet foods with added fat, sugar or salt. Appetite, 43(1), 105-108.
Peterson, A. (2014). Improving type 1 diabetes management with mobile tools: a systematic eview. Journal of Diabetes Science and Technology, 8(4), 859-864.
Polak, R., Dill, D., Abrahamson, M., Pojednic, R., & Phillips, E. (2014). Innovation in diabetes care: improving consumption of healthy food through a “chef coaching” program: a case report. Global Adv Health Med, 3(6), 42-48.
Pozzilli, P., & Fallucca, F. (2014). Diet and diabetes: a cornerstone for therapy. Diabetes/Metabolism: Research and Reviews (Elect), 30(1), 1-3.
Diabetes is a disease that affects a person’s sugar levels, keeping it higher or lower than usual. Type 1 Diabetes does so by attacking the insulin production of an organism (Diabetes Type 1, 2016). Insulin is a hormone that enables the cells of the body to absorb the sugar. Unlike other types of diabetes, Type 1 is the most understudied. It is relatively rare, too – only two to five percent of the afflicted population is diagnosed with this kind of disease (Maahs, West, Lawrence, & Mayer-Davis, 2011).
The scientists do not know the exact reason why it is happening, but popular theories suggest that a predisposition towards it tends to be hereditary. It means that genetics are largely involved. This paper is dedicated to researching the subject of Type 1 Diabetes, as it is important to raise awareness of such a disease in order to help mitigate their effects on the afflicted populace. Right now, due to the relative rarity of the disease, the populace is largely uninformed about this kind of illness.
Although Type 1 Diabetes can appear at any age, it seems to afflict young people more often. Groups under 20 years of age are most commonly at risk (Diabetes Type 1, 2016). It is the reason Type 1 is known as juvenile diabetes, and it can affect the life of a growing child quite a bit and in many ways. The importance of knowledge about the disease cannot be understated – while currently, there is no way to prevent the disease from happening; it is required to know how to mitigate the effects.
The target audience would be the children and young adults, who are more likely to be affected. Parents must also be made aware of the conditions, symptoms, and ways of dealing with them. After all, they are the ones who are going to be administering the treatment to their children and make sure it is followed.
Being diagnosed with Type 1 would affect a person’s lifestyle in both physical and psychological ways. It reduces stamina, causes eye blur, induces limb numbness and stomach aches, weight loss, urination, headaches, and all sorts of other symptoms that could cause a lot of problems to a young organism (Type 1 Diabetes, 2015). If not properly managed, it could keep a child away from many social activities, such as sports and active games. Neglecting the body’s inability to control its sugar levels could also be dangerous to one’s life. The psychological aspect of children having to live with the disease for the entire life must also be addressed – it could affect them greatly and cause serious self-esteem issues (Naranjo & Hood, 2013).
Being diagnosed with a case of diabetes is not a death sentence – many can live long and healthy lives with it if they are informed of the disease and know how to manage their sugar. For the most part, it is controllable with a healthy low-carbon diet, physical activities, and insulin injections (Type 1 Diabetes. How is it Treated? 2016).
The latter is necessary since Type 1 affects the body’s ability to produce insulin (Insulin Basics, 2015). It is something that could not be countered with exercises or a healthy diet. Scientists around the world are actively working to find the cause of Type 1 diabetes and come up with a cure. Until then, the only thing we could do is raise general awareness of the population to the problem, and promote healthy solutions to minimize their effects on peoples’ lives.
Maahs, D.M., West, N.A., Lawrence, J.M., & Mayer-Davis, E.J. (2011). Epidemiology of Type 1 Diabetes. Endocrinology and Metabolism Clinics of North America, 39(3), 481-497.
Naranjo, D., & Hood, K. (2013). Psychological Challenges for Children Living with Diabetes. Web.
It is not an exaggeration to say that diabetes as a medical condition has reached epidemic levels in recent years. According to the International Diabetes Federation, the world suffers from the consequences of more than 400 million diabetics in different parts of the globe (I.D.F., 2017). There is a need to improve the treatment and care of diabetic patients. There is also a greater need to develop intervention strategies and mechanisms to predict and prevent the onset of the said dreaded disease. Due to the growing health threat, it is no longer practical to rely mainly on conventional treatment and management methods to prevent and cure the said medical condition. To win the battle against diabetes, it is important to consider the benefits of developing future technologies that are divided into the following technological categories: preventive, diagnostic, treatment, lifestyle management, and mitigation. In the end, the bottom line reveals the emergence of advanced systems based on robotics and nanotechnology that radically alter the healthcare delivery process. Thus, it is crucial to develop a guiding policy that effectively guides the implementation of advanced technologies while at the same time acknowledging the critical importance of humans as part of the healthcare delivery process.
Keeping Human Functions Intact in Certain Aspects of Treatment and Management in the Context of Applying Future Technologies
In the year 2035, the emergence of cutting edge technologies will not diminish certain key functional areas that are currently being dominated by humans. Human beings must maintain certain critical roles when it comes to providing quality healthcare for patients suffering from diabetes. Humans comprising the group of healthcare workers and healthcare delivery experts must maintain functions that are grouped into three categories. First, humans are the source of technical innovations, the brains behind the future technologies that were described earlier (Tellspec, 2017). Second, humans are the final arbiters when it comes to interpreting the results of data acquisition and data analysis that were previously performed by computers, robots, and smart gadgets. In other words, they form the last line of decision-makers that may override the suggestion of computers if they feel that there is something wrong with the way the machine interpreted the incoming data. Third, people can provide the human element needed in treating and managing life-threatening illnesses, such as the ability to empathize, to assure anxious patients, and to ensure the effective dissemination of information regarding new medical procedures.
Based on the contributions and identified functions of humans in the future healthcare delivery process, it is important to retain all three functional areas: a source of innovation; final decision-makers when it comes to interpreting data from computers and smart gadgets; and ensuring the human element in the treatment process, because they are going to assure anxious patients and they are going to make them feel that there is someone that cares enough to make early recovery a major goal of the treatment process. With regards to the first functional area, there is a need for continuous improvements to create new designs and the effective deployment of the products and equipment described earlier. With regards to the second functional area, it is important to retain a human being’s ability to see the big picture and make sense of the whole process, the ability that computers and robots do not have, especially those programmed to perform specific tasks. Also, when it comes to the emotional and psychological needs of diabetic patients, these are the requirements that are beyond the capabilities of computers and robots.
Also, to satisfy certain human needs, it is difficult to imagine a world without nurses leading the way in the area of health education. Advanced technologies are useless if patients are not eager or feel safe to use them. It is the job of nurses to educate patients on the advantages of using the device and provide them with safety-related information. Furthermore, the implementation of advanced technologies requires informed consent. Consider, for instance, “predictive technologies” that are designed to read a person’s genes. In 2035, patients will be more sophisticated than those in 2017, and they will know more about gene mapping than the current generation of diabetics. They are going to know more about ethical considerations in handling DNA and similar genetic materials that are taken out of a patient’s body. Without a doubt, “predictive technologies” radically alter the nature of the battle against diabetes. On the other hand, it opens up the healthcare community to potential problems, especially if there is no framework in place to ensure the secrecy of genetic information collected through the use of new devices.
Guiding Policy Governing the Scope in Using Future Technologies
The application of advanced technologies requires six stages of implementation:
the identification of conventional treatment methodologies that are inadequate and obsolete;
educating healthcare specialists, support staff, and patients regarding the need to replace the old with the new;
educating various stakeholders on the appropriate application of advanced technologies;
monitoring and collecting feedback from stakeholders and key personnel;
modifying the deployment or implementation process based on the feedback that came from various sources;
providing a set of rules and guidelines on how to make necessary adjustments when cutting edge technologies will be integrated to replace the advanced technologies that are available in 2035.
Therefore, the administrator must prepare the organization to handle rapid changes in the area of technological innovation.
With regards to the first stage of the policy framework on how to properly deploy and implement future technologies, it is of critical importance to persuade doctors, nurses, patients, and support staff of the need to upgrade to new technologies. In some cases and concerning certain products and treatment methods, little persuasion is required. For example, these conventional methods rely on outdated technologies that merely allow for the treatment and management of the disease and not the ability to predict up to a certain level that a particular person has a high risk of developing diabetes.
As a result, the person prone to acquiring the dreaded health condition starts suffering from the consequences of the said medical problem without personal knowledge of having acquired the disease. One can argue that early diagnosis could have prevented some of the life-threatening consequences of this particular health issue. Aside from the inadequacies of conventional treatment strategies, the remaining outdated systems do not guarantee the patient’s safety and satisfaction levels, because according to the American Diabetes Association, the procedure known as pricking the diabetic’s finger to draw blood, and for the daily testing of blood sugar levels is one of the most painful aspects of the said medical condition (A.D.A., 2017). These ideas cover the first and second stages of the deployment policy.
When it comes to the third stage of implementation guidelines, it is not enough to list innovative solutions to diabetes-related issues. At this stage, the most critical requirement is to understand how these different types of technologies are going to work as one integrated system. Even if medical equipment companies can develop a painless way to analyze blood samples without the use of needles, the quest to improve the diabetes treatment and management procedure is halfway done. Aside from enhancing treatment methodologies, there is also a need to monitor the patient’s health after making a diagnosis or after the patient’s hospital discharge. Thus, these advanced technologies are not going to be applied in isolation, but in tandem. The first goal is to pinpoint individuals with predisposing factors, while the second is effective prevention. The next one is early detection. Finally, the last goal is efficient management to ensure early recovery.
The administrator in charge of drawing up an all-encompassing policy must create a plan that demonstrates how future technologies may affect the treatment and management of the symptoms, complications, and other health consequences of diabetes. Previous studies regarding the emergence of cutting-edge technologies related to diabetic treatment and care highlighted at least five major components comprising an effective treatment and prevention process, and these are listed as follows: predictive, diagnostic, treatment, monitoring, and management technologies for people suffering from diabetes. The policy calls for the use of “predictive technologies” similar to the one being developed by deCode genetics (Lyssenko & Laakso, 2017).
The newly developed policy also requires the availability of diagnostic technologies to form the second component in the constellation of treatment strategies associated with diabetes. A good example is Oxford University’s Oxford Medical Diagnostic Breath Ketone Device (Hall, 2017). Furthermore, implementing guidelines require the integration of advanced treatment technologies to form the third major component of the prescribed treatment and management procedures in tertiary health care facilities. One of the best examples is an inhalable insulin product known as Afrezza (Afrezza, 2017). The newly-minted policy framework also demands the inclusion of monitoring technologies to form the fourth critical component in the fight against diabetes. A good example of future technologies answering the need for better monitoring strategies is the Smart Contact Lenses and a similar device developed by Abbot Pharmaceuticals (Bertalan, 2017; “FreeStyle Libre Flash Glucose Monitoring System,” 2017). These two devices are technological breakthroughs in terms of the ease of use and speed of data acquisitions.
Finally, the last component is made up of management technologies. Shortly, it will no longer be enough to diagnose, treat, and monitor diabetic patients. It will be imperative to have a system or mechanism in place that eliminates the need for frequent clinic visits. The future availability of the Diabetes Remote Care Management System or DRMS provides a solution to monitor patients without the need for face-to-face interaction with a nurse or a health professional (Fonseca, 2017). Also, it enables health workers to attend to more serious cases of diabetic-related complications and not drain resources attending to patients with minor issues.
An overview of the guiding policy reveals the need to make room for the integration of newer technologies that will replace those that are going to be available in 2035. Several years after the successful implementation of different technologies mentioned earlier, a new breed of predictive devices and monitoring systems will emerge featuring robotics and nanotechnology (DiSanto, Subramanian, & Gu, 2015). Thus, it is prudent to enhance the guiding policy to include the scope of using new technology. There is a potential problem linked to the overreliance on the computer and robotics-based system to handle all aspects of the healthcare delivery process. It must not come to that point. As discussed earlier, certain critical tasks and functions are best served when handled by humans and not machines.
Due to the need to limit the scope of technological application, the following guidelines are added. First, there is a need to maintain the strictest level of privacy. Second, the administrator must acknowledge the immense value of informed consent. Finally, the importance of mandatory follow-ups and the requirement of a second opinion must be stressed. The type of technologies described earlier offered the speed of access to the patient’s medical information, but without a clear framework to ensure the privacy of patients, this information can easily leak out and fall into the wrong hands. Also, it is vital to establish protocols that pave the way for informed consent. Patients must understand the scope and nature of the cutting-edge technologies that form part of the treatment process. Finally, they need to see a real doctor to get a second opinion and to comply with follow-up requirements. These steps ensure the safety of diabetic patients.
Conclusion and Recommendations
In creating a policy that governs the scope in using future technologies, it is critically important to utilize the five components that makeup preventing and managing the consequences of diabetes. Therefore, technology plays a critical role when it comes to the early detection and prevention, effective diagnosis, effective treatment, accurate monitoring, and cost-efficient management of the disease. It has to be made clear that although robotics technology was included in the discussion on the management of diabetics that are far away from a tertiary healthcare facility, it is not prudent to simplify the contribution of robotics technology in terms of remote management of the said patients.
Robotics technology, when applied properly and incorporated into appropriate engineering design, can lead to the emergence of a multi-purpose device that handles all aspects of the prevention, diagnosis, treatment, and management of a diabetic’s healthcare needs. Therefore, the ultimate future technology is the application of robotics and nanotechnology as cost-efficient methods in early detection and continuous care. After describing the availability of cutting-edge technologies that were created to resolve current issues linked to diabetes, a process that utilizes the best available future technologies to address healthcare needs in the year 2035 was mapped out. It was revealed that robotics and nanotechnology will play a vital role. Robotics technology can pave the way for the emergence of a multi-purpose system or mechanism that answers all the requirements when it comes to the early detection, prevention, treatment, and remote management of the healthcare delivery needs of diabetic patients. Nevertheless, it is also important to retain key human functions to ensure safety, a faster recovery process, and more importantly to sustain the development of innovative products and solutions.
References
A.D.A. (2017). Diabetes basics. Web.
Afrezza. (2017). How Afrezza works. Web.
Bertalan, M. (2017). Digital contact lenses can transform diabetes care. Web.
DiSanto, R., Subramanian, V., & Gu, Z. (2015). Recent advances in nanotechnology for diabetes treatment. Wiley Interdisciplinary Reviews: Nanomedicine And Nanobiotechnology, 7(4), 548-564.
The best medication choice for T. S. based on her history of uncontrolled diabetes would be Vraylar or Abilify. According to Chwastiak et al. (2015), people with psychotic disorders experience “substantial health disparities concerning diabetes” (p. 465). Therefore, the pharmacological treatment should assess possible complications associated with the condition. Antipsychotics may cause weight gain in such cases, for instance, clozapine was shown to have such an impact on individuals. Foley et al. (2015) state that “a positive synergy between antipsychotic drug effects and a pre-existing liability to diabetes mellitus” exists (p. 1092).
The family history of diabetes has a substantial role in prescribing treatment, as it determines response to the prescribed medications. According to Foley et al. (2015), state that mellitus was observed in patients prescribed with clozapine, quetiapine, aripiprazole, risperidone, or olanzapine, without occurrences of diabetes within his or her family. Currently, no clear identification of the family’s medical and psychiatric history was provided by this patient.
Vraylar can be prescribed as an alternative medication for T. S. According to Watts (2015), it was recently approved for use and has shown fewer side effects when compared to Risperdal. The risk profile for Vraylar and Abilify was found to be similar. Watts (2015) states that in clinical trials 76 adverse outcomes were registered for Vraylar, compared to 150 for Abilify. At the same time, out of patients who were prescribed with Risperdal, 177 had adverse reactions. Based on this data, it appears that safer alternatives for psychotic disorders treatment exist. Therefore, it is advised to consider an option of prescribing either Vraylar or Abilify for treatment of schizophrenia in the case of T. S.
Other essential components of the treatment plan for T. S. include monitoring of medical care for diabetes and application of collaborative care model. Chwastiak et al. (2017) state that the collaborative care model is a better option for patients with schizophrenia and diabetes when compared to usual care.
Patients participating in the study that was in the collaborative care group have shown a significant decrease in hemoglobin levels. McBain et al. (2015) state that “integrated care provision and shared information technology (IT) services between mental health and physical services, and clearly defined roles and responsibilities” improve outcomes for such patients (p. 222). Therefore, the study substantiates a more inclusive approach offered by Chwastiak et al. (2017). The treatment plan should include diabetes management, while cooperation with other medical professionals can have beneficial results for T. S.
Many types of research have highlighted the link between psychotic disorders and diabetes, which may be connected to genetics or lifestyle preferences. Thus, the primary concern in the case of T. S. is to ensure that she receives her medication and learns how to control her diabetes correctly.
Assistance from family members will be required because the patient may struggle with adherence to the treatment plan. T. S. should be taught how to manage glucose levels, while her family members should receive information regarding possible complications and interventions they may carry out. T. S is currently not safe for discharge; thus, there is a need to examine her response to the current treatments. Additionally, more information regarding family history is required for better diagnostics. A patient is at risk of not adhering to diabetes treatment, therefore she should be monitored for additional time.
References
Chwastiak, L. A., Freudenreich, O., Tek, C., McKibbin, C., Han, J., McCarron, R., & Wisse, B. (2015). Clinical management of comorbid diabetes and psychotic disorders. The Lancet Psychiatry, 2(5), 465-467. Web.
Chwastiak, L. A., Luongo, M., Russo, J., Johnson, L., Lowe, J. M., Hoffman, G., McDonell, M. G., & Wisse, B. (2017). Use of a mental health center collaborative care team to improve diabetes care and outcomes for patients with psychosis. Psychiatric Services, 69(3), 349-352. Web.
Foley, D. L., Mackinnon, A., Morgan, V. A., Watts, G. F., Castle, D. J., Waterreus, A., & Galletly, C. A. (2015). Effect of age, family history of diabetes, and antipsychotic drug treatment on risk of diabetes in people with psychosis: A population-based cross-sectional study. The Lancet Psychiatry, 2(12), 1092-1098. Web.
McBain, H., Mulligan, K., Lamontagne-Godwin, F., Jones, J., Haddad, M., Flood, C., Thomas, D., & Simpson, S. (2016). Implementation of recommended type 2 diabetes care for people with severe mental illness – a qualitative exploration with healthcare professionals. BMC Psychiatry, 16, 222. Web.
Health problems that affect entire populations are often connected to specific characteristics of communities, including people’s financial and social resources (Marmot & Allen, 2014). For example, the African American adult population in New York and the Bronx, in particular, is a community that will be analyzed further. According to government reports, one in three residents of this borough identifies as African American or Black (NYAM, 2014).
Thus, the region’s health is represented by these individuals and their health determinants. The community of the Bronx is diverse, and people living in the area have many health-related issues that need to be addressed. However, one condition stands out as both a nationwide and local concern. The community of Black adults in the Bronx is largely affected by the rising rate of diabetes.
Community and Practice
The practice setting described in this discussion is the Bronx, NY. The community of African Americans in the borough is a substantial part of the population, representing a third of all residents. The prevalence of the Black population in the Bronx is higher than that in New York City and the state (NYAM, 2014). Furthermore, the borough’s population is primarily defined by the Hispanic/Latino community, as approximately half of all residents identify with one of these labels (NYAM, 2014). Another crucial demographic factor is knowledge – in comparison to the citywide rate, the level of education of the Bronx’s residents is low.
The income in the borough is also lower than that in the city and state, with many people living below the poverty level (NYAM, 2014). On the basis of these data, one can determine the main issues that affect the health of communities in the Bronx.
Determinants of Health and Prevalent Problems
The socioeconomic constraints of the Bronx’s residents lead to high rates of uninsured households in the borough – approximately 15 % of people living in the Bronx do not have health insurance (NYAM, 2014). This number suggests that healthcare services are too expensive and virtually unattainable for thousands of adults who have low incomes and cannot pay for hospital visits, diagnostics, and medication.
This determinant of health dramatically affects the community’s well-being. Other factors include the level of education that often determines people’s income and future opportunities and race which contributes to the social and cultural environment in the area (Braveman & Gottlieb, 2014). Health problems in the Bronx include respiratory conditions affected by environmental factors, diabetes, and obesity influenced by financial and dietary limitations, tobacco use, and cardiovascular disease.
The population at Risk and a Specific Health Problem
The African American community, especially Black adults and families from households with low income, is at risk of developing diabetes. The combination of socioeconomic factors and the idea that many adults cannot afford to maintain a healthy and nutritious diet leads to the increasing rates of diabetes in the Bronx. According to the New York City Department of Health and Mental Hygiene (2013), the city continues to experience a rise in patients with diabetes.
The Bronx is one of the boroughs where diabetes had a devastating effect on the population’s health. The lack of access to health services and people’s inability to purchase expensive foods such as fresh produce exacerbates people’s existing conditions and leads to more individuals developing diabetes (New York City Department of Health and Mental Hygiene, 2015). Black people living below the poverty level cannot control their blood glucose, thus putting themselves at risk for complications.
Conclusion
Diabetes is a serious problem that affects the entire nation. In the Bronx, this condition is difficult for people to manage and control because their lack of access to health care and education limits their understanding of healthy practices. Dietary choices of African Americans are restricted due to the prevalence of poverty in the community and high prices for healthy dietary options. Diabetes progresses in individuals who do not have any resources for managing their health.
References
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129(Supplement 2), 19-31.
Marmot, M., & Allen, J. J. (2014). Social determinants of health equity. American Journal of Public Health, 104(S4, Supplement 4), S517-S519.
The purpose of this paper is to analyze the provided subjective and objective information to diagnose and develop a management plan for the patient in the case study. The paper intends to apply national diabetes guidelines to the management plan. The mastery of SOAP note writing will also be demonstrated.
Assessment
Primary Diagnosis
Type 2 diabetes mellitus (E11.9)
Pathophysiology
Type 2 diabetes is an endocrine and metabolic disorder that arises due to acquired resistance to insulin action or loss of function of pancreatic beta cells that produce insulin, which is responsible for the metabolism of glucose. Inadequate regulation of blood sugar levels causes hyperglycemia that often leads to the manifestation of the classical symptoms of diabetes mellitus, including include polyphagia, polyuria, and polydipsia (Qureshi et al., 2017).
Pertinent positive findings
The patient reports that she has experienced increased fatigue for the last 12 weeks. She has also gained weight disproportionately despite her efforts to exercise. She also experiences extreme thirst and hunger after exercise, which complicates her weight loss process. The patient also reports that she urinates frequently at night as well as during the day. Therefore, the patient presents with the classical symptoms of diabetes mellitus: polyphagia, polyuria, and polydipsia, which confirms this diagnosis (Acuna, Labinson, & McDermott, 2017).
Additionally, the laboratory tests are indicative of type 2 diabetes. For example, the urinalysis shows glycosuria, whereas the blood glucose level is elevated at 130mg/dl, which is a symptom of hyperglycemia. Hemoglobin A1C level is 6.8 %, which is a symptom of type 2 diabetes (Chatterjee, Khunti, & Davies, 2017). Normal levels of glycated hemoglobin should be 5.7% and below, whereas hemoglobin A1C between 5.7% and 6.4% show prediabetes (American Diabetes Association [ADA], 2018).
Pertinent negative findings
Urine tests are the most reliable way of detecting ketones and microalbumin. The urinalysis did not indicate the presence of ketones or protein, which are usually present in severe hyperglycemia (Fayfman, Pasquel, & Umpierrez, 2017).
Rationale for the diagnosis
ADA (2018) recommends that type 2 diabetes should be diagnosed based on the three classical symptoms of diabetes with additional backing from laboratory tests. The diagnosis was made based on the presenting symptoms (polydipsia, polyphagia, and polyuria), high fasting blood glucose levels, the presence of glucose in urine, fatigue, and unexplained weight gain despite exercise. BMI of 31.17 is an indication of obesity, which is a known risk factor for type 2 diabetes mellitus. These findings confirmed the diagnosis of type 2 diabetes.
Secondary Diagnosis
Hyperlipidemia (E78.5)
Pathophysiology
Hyperlipidemia refers to the presence of high levels of lipids in the blood, which arises from the consumption of food items that are rich in fats thereby increasing the amount of lipids that are circulating in the blood (Navar-Boggan et al., 2015). Hyperlipidemia does not have any distinctive symptoms and can only be diagnosed by conducting a lipid panel.
Pertinent positive findings
Total cholesterol of 215 mg/dl (less than 200 ng/dl is desirable), LDL of 144 mg/dl (less than 100 mg/dl is optimal); VLDL 36 mg/dl (normal range is 2 to 30 mg/dl); HDL 32mg/dl (levels of 40 mg/dl is desirable), and triglycerides 229 (200 mg/dl and above is considered high) (ADA, 2018).
Pertinent negative findings
The patient had normal blood pressure values despite having elevated lipid levels. Cholesterol could accumulate in the inner walls of the blood vessels thus elevating blood pressure in the affected individuals (Rafieian-Kopaei, Setorki, Doudi, Baradaran, & Nasri, 2014). However, in the case study, the patient had normal blood pressure values. In addition, hyperlipidemia could occur due to the consumption of a high-fat diet and hypothyroidism. However, the thyroid function test as indicated by the TSH and free T4 values were within the normal range. TSH was 2.31 (normal range is 0.35 to 5), whereas the free T4 was 0.9 ng/dl (normal range 0.7 to 1.9 ng/dl).
Rationale for the diagnosis
The lipid profile showed elevated levels of cholesterol, LDL, VLDL, triglycerides, and low levels of HDL, which are the main indicators in hyperlipidemia diagnosis (Rafieian-Kopaei et al., 2014).
Differential Diagnosis
Metabolic syndrome (E88.81)
Pathophysiology. Metabolic syndrome is an array of risk factors attributed to insulin resistance. The typical symptoms include abdominal obesity, elevated fasting blood glucose, high triglyceride levels, high blood pressure, and low levels of LDL (Furukawa et al., 2017).
Rationale for the diagnosis. The patient presents with all these symptoms except high blood pressure, which is why this disorder is considered a differential diagnosis (Furukawa et al., 2017).
Adjustment disorder with depressed mood (F43.21)
Pathophysiology. Depression is a psychological disorder that is attributed to numerous causes and interaction of factors that interfere with the balance of essential neurotransmitters such as dopamine, serotonin, and norepinephrine or significant changes in the life of an individual (O’Donnell et al., 2016). The indications of depression may include fatigue, changes in appetite, mood changes, feelings of disappointment and frustration, and disturbed sleep.
Rationale. This diagnosis was chosen because Mrs. Wu experiences fatigue and weight gain despite her efforts to lose weight, which could contribute to depression. Her attempts to exercise are frustrated by her hunger and thirst pangs, particularly after exercising. She is also unhappy about the fact that she has to use the bathroom more than usual, which at times interrupts her sleep. This diagnosis may not be adequate to account for the observed signs and symptoms. However, it should be considered when treating the patient (O’Donnell et al., 2016).
Pertinent positive findings
Mrs. Wu is frustrated about her weight gain and the need to pass urine frequently, which affects her sleep. She was recently diagnosed with knee arthritis and has had to deal with pain and difficulties walking, which can be considered a significant life change (O’Donnell et al., 2016).
Pertinent negative findings
Mrs. Wu does not have a significant hormonal change. She underwent menopause 4 years ago and has currently adjusted to the hormonal modifications associated with menopause, which rules out the likelihood of hormonal involvement in depression (Albert, 2015).
Treatment Plan
Diagnostics
Spot urinary albumin-to-creatinine ratio
Rationale: For additional assessment of renal function. The test should be conducted every year together with eGFR. Diabetes mellitus, which is associated with high blood glucose levels, damages kidneys over time and causes diabetic nephropathy (ADA, 2018). Therefore, a thorough assessment of renal function should be done regularly in patients diagnosed with diabetes mellitus.
HgbA1C test
Rationale: Hemoglobin A1C test is used to measure the average blood glucose levels over 3 months to determine the effectiveness of glycemic control. The findings help clinicians to decide whether there is a need for adjustments in the patient’s treatment (ADA, 2018). This test should be conducted every three months until normal levels are attained.
Annual fasting CMP
Rationale: This test assesses fasting blood glucose and electrolyte levels. Assessment of liver functioning should be done yearly because Metformin is contraindicated in instances of decreased liver function (ADA, 2018).
Foot exam
Rationale: To evaluate foot health because diabetic foot ulcers are among the most common complications in diabetic patients. Persistently elevated blood glucose levels often lead to vascular and nervous problems, which in turn lead to peripheral neuropathy and foot ulcers (Armstrong, Boulton, & Bus, 2017). A thorough foot exam is required for the patient and should include a detailed skin inspection: checking for foot defects, neurological assessment using a 10-g monofilament and a temperature or pinprick exam. The monofilament test should be conducted yearly.
Additionally, a vascular evaluation of the feet should be done. Mrs. Wu should have a brief foot inspection at every subsequent to facilitate the prompt diagnosis of peripheral neuropathy and avoid the need for amputations in the future (ADA, 2018).
Lipid profile
Rationale: Repeat lipid profile tests should be done t least three months following the commencement of statin therapy to monitor the efficacy of the treatment. The lipid profile would also ascertain that Mrs. Wu is receiving the correct dosage of atorvastatin dosage and prompt necessary adjustments as the need arises (ADA, 2018).
Becks Depression Inventory
Rationale: Depression and diabetes mellitus are two commonly co-occurring disorders in primary care. Healthcare providers in primary settings are mainly responsible for the diagnosis and management of these two disorders. Consequently, affected patients do not get the opportunity to receive specialized care. The occurrence of depression in diabetes has a negative effect on glycemic control and is linked to the development of diabetic complications (Semenkovich, Brown, Svrakic, & Lustman, 2015).
Nonetheless, it is often untreated, which could be attributed to the fact that most symptoms of depression such as changes in appetite, excess weight loss or gain, fatigue are often associated with diabetes. Therefore, it is not easy to confirm whether these symptoms are due to diabetes or depression. Diabetes patients should undergo screening for depression to enable the commencement of well-timed intermediations.
Health maintenance
Advancing age is a risk factor for many diseases in women, including type 2 diabetes mellitus, breast cancer, and colorectal cancer. The United States Preventive Service Task Force [USPSTF] (2016) recommends that women between the ages of 50 and 74 years undergo annual mammograms. Since Mrs. Wu’s last annual mammogram was normal, she should be reminded to schedule her next appointment. ADA (2018) recommends that diabetic patients should be vaccinated against influenza, Hepatitis B, and pneumococcal diseases. The patient’s immunizations are up-to-date. However, she should be reminded to honor her upcoming vaccinations.
Medications
Type 2 diabetes mellitus
Metformin 500 mg tablets (Extended-release)
Sig: Take 1 (one) tablet twice every day with food. Disp: #30. RF: 2
Diabetic Lancets
Sig: Test blood glucose BID, more frequently as needed. Disp: 200 (2 boxes). RF: 4
Glucometer
Sig: Test blood glucose BID, more frequently as needed. Disp: 1 kit. RF: 1
Glucagon Emergency Kit
Sig: Inject 1mg IM as directed. Disp: 1 kit. RF: 2
Test strips
Sig: Test blood glucose BID, more frequently as needed. Disp: 100 (1 box). RF: 4
Multivitamin (over-the-counter)
Sig: Take 1 (one) tab daily
Mrs. Wu will receive a prescription of oral Metformin, which is the recommended first-line pharmacological treatment for type 2 diabetes in symptomatic patients with HbA1C levels less than 9% and eGFR that is greater than 99 mL/min/1.73 (ADA, 2018). Metformin works by lowering hepatic production of glucose, increasing the uptake of glucose in the small intestines, and enhancing insulin sensitivity, which ultimately boosts the uptake and utilization of peripheral glucose. An additional benefit of metformin is the capacity to reduce LDL cholesterol, which could help in weight loss and hyperlipidemia. The initial dose of extended-release metformin will be 500 mg, which can then be increased to an upper limit of 2000 mg daily until the desired blood glucose level is attained.
Sometimes, the management of blood glucose levels may lead to inadvertent hypoglycemia, which may be life-threatening. Emergency glucagon kits are important for diabetics for such eventualities (ADA, 2018).
The management of blood glucose levels in diabetes involves obtaining regular measurements of blood glucose. Therefore, Mrs. Wu will require a glucometer, lancets, and test strips. Studies show that the long-term use of metformin in the management of blood glucose results in vitamin B12 deficiency, which manifests as peripheral neuropathy in approximately one-third of patients using this drug (Niafar, Hai, Porhomayon, & Nader, 2015; Aroda et al., 2016). Therefore, it is necessary to avoid this consequence by administering multivitamins to patients on metformin (ADA, 2018).
Hyperlipidemia
Atorvastatin 10mg
Sig: Take 1 (one) tab daily. Disp: #30. RF: 2
ADA (2018) recommends statins as the drug of choice in the reduction of blood cholesterol levels as well as cardioprotection in diabetic patients. Atorvastatin is the most commonly used drug for this purpose. However, its effectiveness in reducing LDL levels depends on the dose administered. At doses of 40 to 80 mg, high-intensity therapeutic effects are observed by at least 50% reductions in LDL cholesterol levels. However, at doses of 10 to mg, moderate effects are noted in the form of 30 to 50% reductions in LDL cholesterol. In this case, a 30 to 50% reduction would bring down the LDL cholesterol levels to the normal range.
Osteoarthritis
Acetaminophen 500 mg (over-the-counter)
Sig: Take 1 (one) tab every 4-6 hours prn. Do not exceed 4000mg in 24 hrs.
Arthritis is a long-term condition without a permanent cure. Therefore, its management involves the management of associated symptoms such as pain and swelling, as well as improving mobility. Nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, corticosteroids, and hyaluronic acid are commonly used to manage pain and inflammation in arthritis (Arthritis Foundation, 2018).
Acetaminophen is an endorsed first-line medication for the pharmacologic management of osteoarthritis of the knee, which may be desirable for diabetic patients on metformin because acetaminophen has minimal gastric effects. Therefore, Mrs. Wu will be asked to use acetaminophen for pain relief. Alternative medications will be considered if she no longer obtains relief when using acetaminophen.
Education Plan
Diagnoses
Type 2 diabetes
The management of type 2 diabetes mellitus encompasses a combination of pharmacological and non-pharmacological interventions. Therefore, the patient should receive education on these two aspects. Additionally, the effectiveness of these interventions depends on the patient’s adherence to the treatment regimen. Consequently, there is a need to provide Self-management education in addition to problem-solving skills for all facets of diabetes management (ADA, 2018).
However, the medical provider should consider the patient’s preferences, values, and goals when developing a diabetes management regimen. Pharmacological interventions in type 2 diabetes include taking medications as recommended, whereas non-pharmacological intermediations include healthy diets, regular exercise, and blood sugar monitoring. Mrs. Wu should be educated on checking her blood sugar levels, including how to use the prescribed test kit, lancets, and glucometer. For insulin-independent diabetes, the frequency of blood sugar checks is less than in type 1 diabetes.
The initial recommendation based on ADA (2018) is to check blood sugar at least twice a day (in the morning and before going to bed). She should also strive for HbA1C levels of 5.7% or less, fasting blood glucose of 80 to 130 mg/dL, postprandial blood glucose less than 180 mg/dL, and bedtime levels of 90 to 150 mg/dL (ADA, 2018). It is also important for the patient to be aware of the impact of stress and dehydration on her blood glucose levels and the need to check the sugar levels at those times.
Hypoglycemia is a possible complication in diabetes. Therefore, Mrs. Wu should be educated about the symptoms of hypoglycemia, for example, irritability, wobbliness, tachycardia, confusion, and hunger. She should be advised to check her blood glucose whenever she experiences these symptoms and act appropriately. For instance, blood glucose readings of 70 mg/dL or below warrant the intake of 15 to 20 g of glucose. Readings less than 54 mg/dl necessitate the use of glucagon.
Nonetheless, there is a likelihood that she may become unconscious once her blood sugar reaches these levels. Moreover, the patient should recheck her blood glucose level following 15 minutes of oral glucose or glucagon injection and act accordingly based on the previous recommendations. Once her sugar levels have been stabilized, she can eat a meal or a snack to aver another incident of hypoglycemia. It is important to educate the patient about possible triggers for hypoglycemia, for example, intense exercise, fasting, and delayed meals. Small snacks and sweets are handy in such situations.
The patient should also be educated on important aspects of foot care, for example, regular examination of her feet for any signs of injury. She should seek medical treatment promptly for treatment if she notices any injury. Diabetic retinopathy is a possible complication in diabetes. Therefore, the patient should report any alterations in vision and see an optician regularly (ADA, 2018).
The patient should receive education on the interactions between hypertension and renal function in diabetes. Hyperlipidemia also increases her risk of cardiovascular events. Even though her current blood pressure was within the normal range, she should strive to maintain it that way to reduce her risk of chronic renal disease and cardiovascular disease (ADA, 2018).
Hyperlipidemia
Mrs. Wu should be educated about the importance of lowering her cholesterol levels. Hyperlipidemia predisposes her to the development of atherosclerosis and other cardiovascular diseases. Apart from taking her medications as recommended, the patient needs to watch her diet by cutting down the consumption of fatty foods, reduce her caloric intake, and exercise regularly. She should strive to attain LDL levels less than 70 mg/dl (ADA, 2018).
Depression
Mrs. Wu was educated about the signs of depression and advised to seek medical assistance if she experienced those symptoms. She was informed that it was normal to feel overwhelmed by the new diagnosis. Additionally, she would be required to make significant modifications to her lifestyle. These factors would increase her risk for depression, which would hamper her glycemic control goals if not addressed (ADA, 2018).
Medications
Metformin. The patient was informed about the mode of action of metformin and advised to take it with food, especially in the evenings to prevent hypoglycemia. She was also informed about the side effects of the drug, which include queasiness, weight loss, and diarrhea. Therefore, she should not be alarmed by these symptoms and should continue taking the drug because gastrointestinal indications would resolve on their own (McCreight, Bailey, & Pearson, 2016).
Glucagon. Mrs. Wu was taught how to use the glucagon kit. She was also asked to educate her family and close friends on how to do the same in the event that she fell unconscious due to hypoglycemia. She was asked to have the kit with her at all times and discard it if it expires. She was also informed about the correct storage of the kit, which was at room temperature away from extreme temperatures.
Atorvastatin. Atorvastatin can cause side effects such as muscle weakness and myalgias (Ramkumar, Raghunath, & Raghunath, 2016). The patient was informed about these possibilities and asked to seek medical help promptly if she experienced them.
Acetaminophen. The patient was asked to ensure that she did not exceed the maximum daily limit of acetaminophen. Additionally, she was advised against taking other medications that contained acetaminophen, for example, over-the-counter drugs for cold and flu. An overdose of acetaminophen could cause liver toxicity (Kheradpezhouh, Ma, Morphett, Barritt, & Rychkov, 2014).
Diet
ADA (2018) recommends that diabetic patients should take the Mediterranean diet. Mrs. Wu was asked to watch her diet by reducing the consumption of foods rich in saturated and trans-fats. She should also reduce her carbohydrate portions but increase the intake of omega fatty acids and fiber. This diet would help in the glycemic control and reduction of cholesterol levels.
Exercise
The patient was advised to increase her physical activity to 30 to 60 minutes at least 4 to 6 times a week (ADA, 2018). However, given her knee arthritis, she was advised to engage in mild to moderate exercise. She was asked to check her blood glucose after exercising.
Warning signs for diagnoses and medications
Apart from the indications of hypoglycemia that have already been mention in the previous sections, the patient should also watch out for the indications of hyperglycemia. They include blurred vision, difficulties concentrating, extreme fatigue, and blood sugar that exceeds 180 mg/dl (ADA, 2018). Other warning signs include tingling and numbness of feet as well as slow healing of cuts and wounds. She was also asked to seek urgent medical help if she developed intense abdominal pain, respiratory distress, and malaise, which could be because of lactic acidosis.
Referral
Nutritionist. Mrs. Wu explains that her weight has increased despite her efforts to exercise. Therefore, she needs the help of a dietician to develop a customized diet plan that will provide her with adequate calories, help with glycemic control, reduce body weight, and reduce hyperlipidemia (Powers et al., 2017).
Podiatrist. Diabetic foot ulcers and amputations are common problems that contribute to the morbidity and mortality of patients with diabetes. Therefore, it is important to refer the patient to a podiatrist for specialized foot care (Thompson, 2018).
Eye specialist. Since diabetes is associated with retinopathy, the patient should visit an eye specialist for regular eye checkups to prevent this occurrence (Powers et al., 2017).
Follow up
Mrs. Wu should return to the hospital after three months for a reassessment of her condition. The follow up will also evaluate the efficacy of the treatment options and the appropriateness of pharmacological interventions (ADA, 2018).
Medication Costs
The cost of 30 pills of extended-release metformin 500 mg is $13.58 at most pharmacies using the Drugs.com discount card. However, if the dose is increased to 2000 mg a day, a total of 120 tablets will be needed, which will bring the overall cost to $13.54 (Metformin prices, coupons and patient assistance programs, 2018). The price of the cheapest glucagon kit is about $144.58 (Glucagon prices, coupons and patient assistance programs, 2018). On the other hand, the cost of 30 pills of 10 mg atorvastatin in pharmacies using the Drugs.com discount card is $17.73 (Atorvastatin prices, coupons and patient assistance programs, 2018).
The cost of diabetic supplies for one month will be 2 boxes of lancets (200 pieces) at the cheapest cost of $10, glucometer at $8.99, and test strips at $126 at a rate of 12 strips a day, each costing $0.35 (Glucose meter cost, 2018). The monthly supply of acetaminophen at the maximum dose of 4000 mg a day will be approximately $3.5 for a bottle containing 250 pills at Walmart (Acetaminophen, 2018). The monthly cost of multivitamin tablets would be $12.99 for 50 tablets of multivitamins (One a day women’s menopause formula multivitamin, 2018).
The total monthly cost for the drugs and medical supplies will be $337.33, which can be reduced further if the patient takes advantage of coupons offered on various drug websites. However, the glucometer will only need to be bought once. If Mrs. Wu buys a quality glucometer and takes good care of it, she should be able to use it for a long time. Therefore, the total cost of drugs for the subsequent months will exclude the cost of the glucometer and come down to $328.34.
Furthermore, the glucagon kit is meant to be used only for emergencies. If the patient adheres to the treatment recommendations, it is possible to avoid extreme hypoglycemia thus eliminating the need to use the glucagon kit. Therefore, it is recommended that the patient buys a kit with the farthest possible expiration date to stretch its usability. In such a case, it is possible for the patient to afford her subsequent medications on a monthly budget of $192.75 or less. Depending on the patient’s insurance plan, some or all of these costs can be covered without the need to pay out of pocket.
The cost of diabetic care may prevent effective glycemic control for uninsured patients with low incomes. To prevent such occurrences, healthcare providers need to educate patients on cost-cutting strategies such as using coupons. However, in type 2 diabetes, effective glycemic control through healthy diets and regular exercise can lower the cost of diabetic care significantly.
Conclusion
Type 2 diabetes mellitus is a longstanding illness attributed to defects in insulin function. Poorly managed diabetes can result in various complications, including diabetic nephropathy, retinopathy, and neuropathy, which may cause kidney disease, eye problems, and diabetic foot ulcers. These complications contribute to morbidity and mortality in diabetes. Attaining optimal glycemic control is the goal of diabetes management, which is possible through a blend of pharmacological and nonpharmacological intermediations. Therefore, healthcare providers should empower patients through comprehensive patient education that covers all aspects of care.
Clinical Chart SOAP note
S:
Chief Complaint: increased fatigue, weight gain, polyuria, polydipsia, and polyphagia
HPI
Mrs. W, a 59-year-old Asian female presents to the clinic with complaints of increased fatigue over the last 12 weeks. She exercises regularly but still gains weight. She experiences increased hunger and thirst, especially after exercise. She also experiences increased urination during the day as well as at night for the last 3 months. Mrs. W requires weight gain advice and evaluation for fatigue.
Current Medications
Tylenol 500 mg 2 tabs in AM knee pain
Allergies: Bactrim, cats, and pollen
PMHx
No chronic illness. German measles as a child. Right knee arthritis 3 months ago
All vaccines up to date
PSHX: None
Health screening:
Colonoscopy WNL 4 years- repeat in 10 years, ASCUS pap 1998, all further Paps WNL, mammogram last year-benign
Soc Hx
Divorced, works from home as an administrative assistant, 1-2 glasses wine daily, former smoker, quit 10 years ago, no illicit drug use, exercises twice a week.
Fam Hx
Parents are deceased, child alive and well, no siblings.
ROS
General: female in no acute distress, alert, oriented and cooperative.
General: Female in no acute distress, alert, oriented and cooperative
HEENT: head normocephalic. Hair thick and distribution throughout the scalp. Eyes without exudate, sclera white. Wears contacts. Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nares patent without exudate. Oropharynx moist without erythema. Teeth in good repair, no cavities noted. Neck supple. Anterior and posterior cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.
Skin: Warm dry and intact. No lesions.
CV: S1 and S2 RRR without murmurs or rubs.
Lungs: Clear to auscultation bilaterally, respirations unlabored.
Abdomen: soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits. No CVAT.
Musculoskeletal: Full ROM both knees. Nontender to palpation bilaterally. Gait normal.
CMP: Sodium 136, Potassium 4.4, Chloride 100, CO2 29, Glucose 130, BUN 12, Creatinine 0.7, GFR est non-AA 99 mL/min/1.73, GFR est AA 101 mL/min/1.73, Calcium 9.4, Total protein 7.6, Total Bilirubin 0.5, Alkaline phosphatase 72, AST 25, ALT 29, Anion gap 8.10, Bun/Creat 17.7, Hemoglobin A1C: 6.8 %
Adjustment disorder with depressed mood (ICD-10 F43.21)
P:
Diagnostics
Spot urinary albumin-to-creatinine ratio
HgbA1C
Annual fasting CMP
Foot exam
Lipid profile
Becks Depression Inventory
Medications
Metformin 500 mg tablets (Extended-release)
Sig: Take 1 (one) tablet twice every day with food. Disp: #30. RF: 2
Diabetic Lancets
Sig: Test blood glucose BID, more frequently as needed. Disp: 200 (2 boxes). RF: 4
Glucometer
Sig: Test blood glucose BID, more frequently as needed. Disp: 1 kit. RF: 1
Glucagon Emergency Kit
Sig: Inject 1mg IM as directed. Disp: 1 kit. RF: 2
Test strips
Sig: Test blood glucose BID, more frequently as needed. Disp: 100 (1 box). RF: 4
Multivitamin (over-the-counter)
Sig: Take 1 (one) tab daily
Atorvastatin 10mg
Sig: Take 1 (one) tab daily. Disp: #30. RF: 2
Acetaminophen 500 mg (over-the-counter)
Sig: Take 1 (one) tab every 4-6 hours prn. Do not exceed 4000mg in 24 hrs.
Education
Discussed diabetes self-care, including blood glucose monitoring and glucagon administration.
Reviewed medications
Recommended diet change and exercise
Becks Depression Inventory: advised to call the hospital if signs of depression are experienced.
Referrals: Nutritionist, dietary advice
Eye specialist, eye care
Podiatrist, foot care
Follow up: Return to office in 3 months.
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Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H.,… Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40-53.
Qureshi, S. S., Amer, W., Farooq, M., Butt, N. F., Shoaib, Z., Firdous, S., & Sara. (2017). Clinical presentations of type ii diabetes. Pakistan Journal of Medical & Health Sciences, 11(1), 108-110.
Rafieian-Kopaei, M., Setorki, M., Doudi, M., Baradaran, A., & Nasri, H. (2014). Atherosclerosis: Process, indicators, risk factors and new hopes. International Journal of Preventive Medicine, 5(8), 927-946.
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Semenkovich, K., Brown, M. E., Svrakic, D. M., & Lustman, P. J. (2015). Depression in type 2 diabetes mellitus: Prevalence, impact, and treatment. Drugs, 75(6), 577-587.
Thompson, A. T. (2018). Red flags for potential diabetes-related foot disease: When you should refer to a podiatrist. South African Journal of Diabetes, 11(3), 23-25.