NURS 6501 WeeK 9 : Diabetes Essay
A collection of hormone producing glands make-up the endocrine system. The endocrine system’s hormones are involved in regulating growth and development, metabolism, mood, sexual function, sleep, and other functions as well (Zimmermann, 2016). When there is an alteration of the endocrine system hormone levels become elevated, or are too low, usually indicating changes in the bodies fluid balance, infection, or physiologic stress (Huether, & McCance, 2017). The topic of this paper is diabetes mellitus (DM) and diabetes insipidus (DI). Understanding of DM and DI entails the understanding of the endocrine system and the feedback mechanisms for insulin, glucagon, and somatostatin work to maintain glucose stores in the body.NURS 6501 WeeK 9 : Diabetes Essay
Pathophysiology of Diabetes Mellitus
Huether and McCance (2017), describe diabetes mellitus as a “group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both” (p. 471) and classifies DM into four categories. Three of the four categories include type 1, type 2, and gestational. DM is diagnosed from one of the several tests performed on two separate occasions including glycosylated hemoglobin (HbA1c), fasting plasma glucose, 2-hour plasma glucose levels during oral glucose tolerance testing, or by random glucose levels in an individual with symptoms (Huether, & McCance, 2017, p. 471).
Diabetes mellitus is a heterogeneous disorder characterized by the presence of hyperglycemia and is a result of insulin dysfunction of the endocrine pancreas (Hammer, & McPhee, 2014). Insulin is important in DM, as its function is to transport glucose into cells where it becomes energy in the form of glycogen (Huether, & McCance, 2017). Insulin also partakes in fat storage and protein synthesis (Huether, & McCance, 2017).). Insulin also partakes in fat storage and protein synthesis (Huether, & McCance, 2017).
When describing the pathophysiology of DM, one must understand that the pancreas has four types of islet cells from the islets of Langerhans, each secreting a different product. Insulin comes from the Insulin-secreting β cells, and glucagon is secreted from glucagon-secreting α cells, and glucagon acts to increase blood glucose levels (Hammer, & McPhee, 2014). Knowledge about the islet cells of the pancreas is important because the different types of DM have distinctive alterations involving the pancreas.
DM type1 can either be idiopathic or caused by a progressive autoimmune T-cell-mediated disease. In autoimmune DM the beta cells of the pancreas are destroyed from lymphocyte and macrophage infiltration as an inflammatory response occurs, resulting in the decline of insulin synthesis.NURS 6501 WeeK 9 : Diabetes Essay Hyperglycemia develops due to the reduction of insulin synthesis (Huether, & McCance, 2017). Conversely, in DM type II adipokines, an increase in free fatty acids, inflammatory cytokines, decreased activity of ghrelin, results in insulin resistance. Insulin resistance increases the demand for insulin and causes hyperinsulinemia, or the tissue effect without hyperglycemia (Huether, & McCance, 2017). Insulin resistance and the increased demand for insulin synthesis, as well as the diminished activity of amylin, lead to a decrease in beta-cell mass and function causing hypoinsulinemia (Huether, & McCance, 2017). Dm type II is associated with inadequate insulin production, insulin resistance, and chronic hyperglycemia.
Pathophysiology of Diabetes Insipidus
Diabetes insipidus (DI) is related to an insufficiency of antidiuretic hormone (ADH) causing a partial or total inability to concentrate urine. Insufficient ADH activity leads to leads to high volumes of dilute urine causing increased plasma osmolality which results in frequent thirst (polydipsia) and frequent urination (polyuria, Huether, & McCance, 2017). In DI dehydration can develop quickly without fluid replacement and when a person cannot conserve more water than lost in the urine, serum hypernatremia and hyperosmolality occur. There are three forms of DI. The first is neurogenic and is caused by lesions on the hypothalamus, pituitary stalk, or posterior pituitary, disrupting ADH synthesis, transport or release (Huether & McCance, 2017). The other form nephrogenic DI is triggered by inadequate response of the renal tubules to ADH (Huether & McCance, 2017). In neurogenic drugs such as amphotericin B, carbonate, colchicines, demeclocycline, lithium, loop diuretics and general anesthesia, are factors known to cause kidney damage because it can inhibit the generation of cAMP in the tubules (Huether & McCance, 2017). The second is Central diabetes insipidus, and it is caused by inadequate antidiuretic hormone (ADH). Gestational DI is rare and caused by vasopressin as increase which usually causes mild symptoms that do not require treatment (Huether & McCance, 2017).
Similarities and Differences
Both DM and DI are regulated by hormones in the endocrine system, and both alterations can potentially affect multiple body systems. The body system involved in DM are the liver and pancreas and, with DI the body systems are the hypothalamus and pituitary (Huether & McCance, 2017). DM relates to blood glucose levels and insulin resistance, and frequent monitoring of blood sugar is necessary, whereas with DI the hormone vasopressin influences the kidneys to concentrate urine, and therefore individuals must monitor for polyuria and polydipsia (Diabetes Insipidus, n.d.).
Patient Factors
DM has a strong genetic component, in both type I and II. Although in DM type II the factor is more of a combination genetic-environmental or behavioral factor involved (Huether, & McCance, 2017). In both DM type, I and II blood glucose must be monitored, therefore requiring education and re-education on the risks involved when an individual is noncompliant with controlling sugar levels. Treatment of DM includes regulating insulin levels with oral medications and insulin injections, along with lifestyle modifications including diet and exercise (Huether, & McCance, 2017). NURS 6501 WeeK 9 : Diabetes Essay
DI can be genetic in that there are mutations in the genes affecting ADH synthesis, transport, and or release. DI is also the result of structural changes of the hypothalamus and pituitary glands hypothalamus and pituitary. Structural changes can result from trauma, infections or thrombosis, which are all likely due to an individual’s behavior (Huether, & McCance, 2017).
References
Diabetes Insipidus. (n.d.). Diabetes insipidus vs mellitus. Retrieved from http://diabetesinsipidus.org/diabetes-insipidus-vs-mellitus
Hammer, G. G., & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Zimmermann, K. (2016). Endocrine system: Facts, functions, and diseases. Retrieved from https://www.livescience.com/26496-endocrine-system.html
Response #1 Jennifer
Jennifer, the Centers for Disease Control and Prevention (CDC, 2017) reports that in the United States individuals in the Appalachian and southern regions have the highest prevalence of diagnosed diabetes. 2015 data estimates 7.2% of the US population has diagnosed diabetes, 193,000 of the population are adolescents and children under the age of 20 (CDC, 2017). Ethnicity also plays a role in diabetes prevalence with American Indians and Alaskan Natives making up 15.1% and non-Hispanic blacks 12.7% of the total population with DM (CDC, 2017). In 2015 the incidence of diagnosed diabetes in adults was 1.5 million, which is 6.7 per 1,000 adults getting the diabetes diagnosis (CDC, 2017). As healthcare workers, we know there are a high incidence and prevalence of diabetes which is a comorbidity for many, many diseases.NURS 6501 WeeK 9 : Diabetes Essay
Reference
Centers for Disease Control and Prevention. (2017). National diabetes statistics report. Retrieved from http://www.diabetes.org/assets/pdfs/basics/cdc-statistics-report-2017.pdf
Jennifer Bailey
Diabetes mellitus (DM) occurs when an individual’s blood glucose is too high (NIH, 2017). Blood glucose is used for energy within the body, and insulin is made by the pancreas to regulate glucose. Having an elevated blood sugar level can cause health problems now and in the future. Symptoms of DM increased thirst, increased hunger, dry mouth, frequent urination, unexplained weight loss, weak, blurred vision, numbness or tingling in the hands or feet and frequent yeast infections (Cleveland Clinic, 2017). Treatment for DM is maintaining normal blood sugars with diet or medication therapy.
Diabetes insipidus (DI) is an uncommon disorder that causes the water within the body to be imbalanced (Mayo Clinic Staff, 2016). DI and DM are not the same. Symptoms of DI are extreme thirst, excretion of an excessive amount diluted urine, fussiness, fever, trouble sleeping, vomiting, diarrhea, and weight loss (Mayo Clinic Staff, 2016). Treatment includes maintaining normal electrolytes within the body. Replenishing with fluids such as D5W is recommended.
DM and DI are similar in that they both cause extreme thirst and frequent urination. Both can also cause weakness. Blurred vision, numbness and frequent urinations are not similar between both, just DM. When DI and DM are diagnosed on genetics play a role. With DI, it is present shortly after birth (Mayo Clinic Staff, 2016). DM is also genetic.
References
Cleveland Clinic (2017). Diabetes mellitus. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/articles/diabetes-mellitus-an-overview
Mayo Clinic Staff (2016). Diabetes insipidus. Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/home/ovc-20182403 NURS 6501 WeeK 9 : Diabetes Essay
NIH (2017). What is diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
Response #2
Suzanne, while researching diabetes insipidus (DI) further I discovered several interesting facts. Diabetes type 2 and the early stages of DI have similar symptoms, causing misdiagnosis of DI (Health Research Funding, 2015). Diagnostic testing in DI as opposed to type 2 diabetes mellitus, involves urine testing. In DI individuals have high urine output, however low osmolality, specific gravity, and hyperosmolarity and hypernatremia. Diagnosing DI is generally confirmed with a water deprivation test (Huether, &McCance, 2017). Symptoms of DI involve excessive thirst, and in severe cases, urine output can be up to 20 liters. It is important to diagnose DI correctly as it can become life-threatening, with proper treatments/therapies many individuals with DI can live a normal life.
Reference
Health Research Funding. (2015). 17 Fascinating diabetes insipidus statistics. Retrieved from http://healthresearchfunding.org/17-fascinating-diabetes-insipidus-statistics/
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Suzanne Beatty
Diabetes is a chronic disease that affects 30 million people (Center for Disease Control and Prevention, 2017). This heterogenous disorder causes a functional deficiency of insulin. Type 1 diabetes mellitus (DM) is an “autoimmune disease caused by the selective destruction of pancreatic B cells by T lymphocytes targeting ill-defined B-cells antigens.” (Hammer & McPhee, 2014) Peak onset for DM is 5-6 years and puberty (Hammer & McPhee, 2014).NURS 6501 WeeK 9 : Diabetes Essay
Type 2 diabetes has a stronger genetic component than DM and usually occurs in adulthood. The hallmark of type 2 is insulin resistance (Hammer & McPhee, 2014). The pancreas continues to release insulin, but the organs are insensitive to the insulin. The causes an increased amount of insulin needed to transport glucose from the cells to the blood stream.
Signs and symptoms of DM include polyuria, polydipsia, polyphagia and weight loss (Huether & McCance, 2017). Type 2 diabetes sign and symptoms include changes in the vision, candida infections, fatigue, pruritus, and neuropathy (Huether & McCance, 2017). Hemoglobin A1C greater to or equal to 6.5%, a random blood glucose greater than 200 with diabetic symptoms, or 2 separate fasting glucose greater than 126 mg/dl are tools to diagnose diabetes.
Altered activity of ADH is diabetes insipidus. There are two types of altered activity of ADH which are neurogenic and nephrogenic. Neurogenic DI is caused by decreased amounts of ADH related to diseases of the hypothalamus or the pituitary (Huether & McCance, 2017). Nephrogenic DI is caused by “inadequate response of the renal tubules to ADH.” (Huether & McCance, 2017) Signs and symptoms of DI are polyuria, polydipsia, and nocturia (Huether & McCance, 2017). Evaluation for DI includes hypernatremia, water deprivation test with a urine specific gravity < 1.010, urine osmolarity low, and serum osmolarity > 300 (Huether & McCance, 2017).
Polyuria and polydipsia are symptoms of DM and DI. Polyuria is caused by the bodies inability to reabsorb water in DI. Polyuria in DM is caused the amount of glucose not being filtered by the kidneys causing an osmotic diuretic effect (Hammer & McPhee, 2014).
References
Center for Disease Control and Prevention. (2017, July 23). Diabetes Home. Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/diabetes/home/index.html
Hammer, G., & McPhee, S. (2014). Pathophysiology of Disease. An Introductoduction to Clinical Medicine (7th ed.). China: McGraw Hill Education.NURS 6501 Advanced Pathophysiology Essay
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis MO: Mosby.NURS 6501 WeeK 9 : Diabetes Essay