Diabetes is a disease which stays with the patient life-long except in some cases where the diabetes is gestational which occurs during pregnancy and often goes back to normal after the delivery. Typically there are two types of diabetes which are type 1 and type 2 diabetes but less common are gestational diabetes and other types which contain features of both type 1 and type 2 diabetes (Cowle et al., 2006). The management of diabetes mostly depends on the patient himself/herself because in diabetes it is all about self-care. But of course the guidance comes from the nurses and doctors and they need to educate the patients in order to control their condition. In order to prevent (in cases where there are chances of diabetes occurrence) or control (in cases where the person already has diabetes) diabetes it is very essential to take care of patient's weight, blood pressure, blood sugar and blood lipids (National Diabetes Fact Sheet, 2007).
Morbidity and Mortality
Diabetes is one of the top five causes of death around the world. Approximately 247 million people all over the world have been diagnosed with diabetes. Whereas, 8% of Americans are affected by diabetes but at the same time one third of these people do not even know that they have diabetes (ADA, 2010). However, the mortality of diabetes is not evenly distributed among people; instead it has been found that women, ethnic minorities, older people and people in low-middle class are affected by it more than others (Brown et al. 2004).
There is an increased risk for people with an increase in central obesity for heart diseases and diabetes. Increased caution is required for lean people with type 2 diabetes at every age, as type 1 diabetes can occur in older people and with a slower onset than is normally seen in the young (Davis et al., 2007).
Types of Diabetes
Diabetes may be type 1, type 2 and gestational diabetes (American Diabetes Association, 2010).
In type 1 diabetes the insulin produced by the pancreas is either very less or nil due to which sugar is not absorbed in the cells and thus the sugar remains in the blood stream. Type 1 diabetes is also known as insulin-dependent diabetes. Type 1 diabetes is an autoimmune disease which means that the immune system of the body is sometimes the cause of the disease. This type of diabetes is often left undetected (Roglic & Unwin, 2010).
Type 2 diabetes is far more common than type 1 diabetes. It is also referred to noninsulin-dependent diabetes. As the name suggests, in this type of diabetes the patient does not necessarily need insulin shots. This type is usually developed in adults rather than juveniles.
Another type of diabetes is Gestational diabetes which develops in the course of pregnancy, mostly in the last trimester. This normally happens because of the hormonal changes taking place during pregnancy. This type of diabetes is normally temporary. 2% to 5% of the pregnant women experience this type of diabetes (National Diabetes Fact Sheet, 2007). Once a woman develops gestational diabetes during pregnancy, it normally goes back to normal after delivery of the baby. However, woman having gestational diabetes are more likely to develop it again, especially type 2 diabetes later on. Majority of the pregnant women are screened for gestational pregnancy.
It is not fully understood why different types of diabetes develop in people, however, only certain factors based on evidence have proved to be causes of diabetes (Shaw et al., 2010).
Both types of diabetes, 1 & 2 can be transferred genetically. If someone in the immediate family has diabetes, there are greater chances that person is prone to have diabetes (Aekplakorn et al., 2007).
Obesity is one of the major causes of diabetes. The fatty tissues especially around the abdomen cause the muscles and tissue cell to be resistant to the insulin produced by the pancreas. Inactivity People who are less physically active are prone to developing diabetes because excessive sugar in their blood is not utilized. Secondly, the fats in the body are not burnt. Physical activity helps in controlling weight (Aekplakorn et al., 2007).
Age is one of the causes of diabetes. The reason is that with age, the person becomes less active. Less blood sugar and fats are utilized resulting in more sugar in the blood stream (Concannon, Rich, Nepom, 2009).
Race or ethnicity is one of the factors of developing diabetes. Although it is not known why this is so. But researches have shown that some races have a greater tendency of diabetes than other like, Hispanics, blacks American Indians are known to have greater expectancy of diabetes (Aekplakorn et al., 2007).
There are a number of diagnostic tests for detecting diabetes, which are:
Finger-Prick Blood Sugar Screening
Screening tests are simple, economical and sometimes even free by the health care providers. This test takes only a few minutes. A dingle drop of blood is pricked from the tip of the finger and is placed on a strip. This strip is injected into a small device which finds out the level of blood sugar in the sample provided and displays the value on its screen. If the value exceeds 126 mg/dL, then fasting blood sugar test is required to be done (AACE, 2007).
Random Blood Sugar Test
This test is normally carried out during a routine physical exam. The blood sample is taken from a vein of a person and is sent to the laboratory for a number of laboratory tests. Even if one has just consumed and his/her blood sugar is at its highest, the blood sugar should not be exceed 200 mg/dL. But of the result exceeds this limit then the physician asks the patient to go for fasting blood sugar test (Troisi et al., 2000).
Fasting Blood Sugar Test
The level of blood sugar is normally maximum after eating a meal and lowermost after an overnight fast. But normally it is preferred by the doctors to go for overnight fasting which is normally about 8 hours. Blood sample is taken and is evaluated. Normal fasting blood sugar is between 70 mg/Dl to 110mg/Dl. If the level of blood sugar exceeds 126mg/Dl, then the person is diagnosed with diabetes. However, if the results are normal then it is advisable to get the test done after every 3 years. In case a person has marginal diabetes, that is, the blood sugar level is between -- 111 to 125 mg/dL -- he/she then it is recommended that the individual must get a fasting blood sugar test done every year (Troisi et al., 2000). Most doctors do not screen for diabetes during routine visits, though they generally request a fasting or random blood sugar test as part of a more comprehensive examination.
Glucose Tolerance Test
This test is not very common because it is comparatively more expensive than other methods. This test is done after overnight fasting. 75g of sugar is taken by the patient in a liquid form. The blood sugar is checked before taking the liquid and after taking it. If a person is diabetic, his/her level of blood sugar increases more than estimated. If the blood sugar at the 2-hour blood test is 200 mg/dL or above, the person has diabetes (Saiidek et al., 2008). In order to get accurate results it is very important that the person getting the test done is physically active, not taking any kind of medication, takes healthy diet and has no medical condition or problem. This test is usually carried out to test for gestational diabetes in pregnant women.
Glycated Hemoglobin Test
The World Health Organization (WHO) diagnostic criteria 6 were ratified in 2000 and are still in use today; although it is likely that glycosylated hemoglobin (HbA1c) will be adopted in future. In the absence of symptoms, the test should be repeated to confirm the condition.
However, there are some groups in whom HbA1c will not be a reliable diagnostic tool and it is likely that the WHO method will be retained for them. They include: pregnant women; people with renal failure, haemoglobinopathy and anemia; and, possibly, frail elderly patients (American Diabetes Association, 2010).
HbA1c targets figure highly in the Quality and Outcomes Framework (QOF) of the General Medical Services contract, gaining the maximum number of points awarded. The QOF is not about performance management, but incentivizing and rewarding good practice. The rewards to the practice are highest by achieving goals in HbA1c, blood pressure and cholesterol, but holistic care is paramount (Molinaro, 2007). Agreeing plans with patients to achieve goals can also significantly improve their future quality of life. Diabetes itself accounts for the highest number of points awarded for any condition; if we add heart disease, renal disease and depression, among others, all of which are more common in diabetes, its seriousness becomes evident (Kahn et al., 2006).