Hypertension Crises
Diabetes is a disease in which the body does not properly use or produce insulin. A hormone, insulin converts sugar, starches, and other food into energy needed for daily life. The exact cause of diabetes remains a mystery. Experts agree that both genetics and environmental factors such as obesity and lack of exercise appear to contribute to the disease.
Over 17 million people in the United States, or slightly more than 6% of the population, have diabetes. Although an estimated 11 million Americans have been diagnosed, 6 million people (or the equivalent of one-third with the disease) are unaware that they have diabetes.
There are three major types of diabetes. They are:
Type 1 diabetes – The condition results from the body’s inability to produce insulin, the hormone that “unlocks” or “opens” the cells of the body, allowing glucose to enter and fuel them. Between 5-10% of Americans who are diagnosed with diabetes have type 1.
Type 2 diabetes – The condition results from the body’s resistance to insulin (a condition in which the body fails to properly use insulin), combined with insulin deficiency. Approximately 90-95% (or the equivalent of 16 million) have type 2 diabetes.
Gestational diabetes – Gestational diabetes inflicts about 4% of all pregnant American women – or about 135,000 cases in the United States each year.
There is also a condition known as Pre-diabetes. This occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. It is estimated that at least 16 million Americans have pre-diabetes, in addition to the 17 million with diabetes.
Diabetes Hypertension, or high blood pressure, is often called a silent killer because it has no symptoms, except in the most severe of cases. Many people are unaware they have it. Until they suffer from a major complication, such as heart attack or stroke, they are oblivious to the condition. But just like diabetes, high blood pressure can be controlled and maintained with proper diet modification and medication.
People with both types of diabetes must also manage blood pressure and cholesterol and talk to their health provider to learn about other ways to reduce their chance for heart attacks and stroke.
Since there is a large number of Americans unaware of their condition, it is important for nurses to recognize symptoms, and provide initial consultation, helping individuals to seek proper diagnosis from a physician. Nurses must encourage the patient to seek blood testing, emphasizing the importance of early detection of this health problem. By providing counseling, nurses can help individuals yet to be diagnosed with diabetes to learn of their condition, and seek medical care.
Once a patient has been diagnosed with diabetes, it is important for the individual to learn about the disease, and how to live with it. Emotional concerns must be addressed. Part of the successful treatment and management of diabetes is modification of diet and exercise. Nurses can help the learning needs of the family, offering resources, and information. Nurses can encourage participation in support groups. They can also provide literature, and other vital information.
A part of the goal the nurse should keep in mind is behavior modification. Here the entire family can assist the patient, and the nurse should encourage the adaptation of a healthier lifestyle, which includes diet changes and increase exercise activity. Family members, not diagnosed with the disease, should receive encouragement and training on how to help the diabetic patient with a better diet and more exercise regime.
Resources available to diabetic patients are numerous. The nurse can help provide a path to the information, and encourage patient learning. One of the main areas is to understand a diabetic diet, and to modify eating habits. Nurses can recommend or refer the patient to seek the assistance of a Registered Dietician. Often these consultations are paid for by the patient’s hospitalization insurer. Nurses can verify coverage, and inform the patient of the likely coverage, and the benefit of seeking diet counseling.
The American Diabetes Association provides valuable resources, including books and brochures. There are both state and local chapters. Nurses can refer patients to these resources. The nurse can also direct the patient to these chapters, including participation in activities, such as walks or other fund raising activities that encourage exercise. Many organizations offer newsletters which also provide information.
Nurses can also direct patients to other sources of information, such as books that explain diet, offer recipes, or provide other information. They can also encourage a proactive approach to the treatment of the disease, and counsel their patients to check their blood sugars through monitoring devices. They can offer training in the use of the blood testing or glucose monitoring devices, and direct the patients to their insurers to pay for both the monitor and maintenance supplies.
Bibliography
National Diabetes Fact Sheet Brochure, issued and published by the American Diabetes Association. Downloaded from www.ada.orgon April 11, 2003.
Fuller JH, Stevens LK, Wang SL. Epidemiology of Hypertension in Diabetic Patients. The WHO Multinational Study of Vascular Disease in Diabetic patients. Journal of Cardiovascular Pharmacology 1996; 28(Suppl.4): SI-S5.
American Diabetes Association: Standards of medical care for patients with diabetes mellitus. Diabetes Care 22(Suppl 1):S32-S41, 1999.
The Diabetes Control and Complications Trial Research Group: The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus. N Eng J. Med 329:977-986, 1993.
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