World Diabetes Day: Nurses’ Roles in Diabetes Management

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Diabetes is a chronic endocrine disease that affects body homeostasis, leading to imbalance in the level of blood sugar level. It arises as a deviation from the production and utilisation of hormones insulin and glucagon.

It can also be said to be a deviation from normal body physiology that affects the metabolism and absorption of food nutrients that serve as precursor for glucose in the body. It eventually leads to a chronic condition marked by high levels of glucose circulating in the blood. It is caused either by two factors – inability of the body to produce adequate amount of insulin (a hormone produced by the pancreas to control blood glucose levels); or inability of the body to utilise insulin effectively for its physiologic functions. It could also be a combination of both conditions.

Diabetes can be said to be a disease that deprives the body mechanism the ability to produce or respond to the presence and functions of the hormone insulin, thereby causing physiological impairment.  The end result of this abnormal metabolism of carbohydrates is elevated levels of glucose in the blood.

The term “diabetes mellitus” comes from both Greek and Latin languages. In the middle of the 16th century, diabetes was derived from diabainein, a Greek word, meaning “go through”. The word “mellitus” is the Latin for “sweet”. The burden of this non-communicable disease is so enormous that it accounts for many deaths and decreases in productivity, thereby affecting national development.  It was initially regarded as the disease of the affluent and the developed worlds but today the incidence does not know any bounds.

Comrade (Nurse) Abdrafiu Alani Adeniji

Types of diabetes

Although there are many types of diabetes, there are two major types of the condition: Type 1 and Type 2. According to the Diabetes Organisation of the United Kingdom, Type 1 diabetes is hereditary and people with the condition cannot produce at all. In Type 2 diabetes, the insulin produced either can’t work effectively, or no insulin is being produced at an adequate amount.

Other types include gestational diabetes, which is common among women of childbearing age. In this condition, women may develop diabetes during pregnancy.  There is also pancreatogenic diabetes, which arises secondarily due to pancreatic diseases affecting exocrine and digestive functions of the pancreas.

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A very common form of pancreatic disorder is chronic pancreatitis that increases the vulnerability of an individual to diabetes. Empirical evidence has it that between 25 per cent and 80 per cent of victims of chronic pancreatitis eventually develop full blown diabetes. Statistics from centres dealing in non-communicable diseases put the occurrence of diabetes mellitus in 5-10 per cent cases in the western world to be a result of the secondary effect of chronic pancreatitis.

Another type of diabetes mellitus is Latent Autoimmune Diabetes in Adults (LADA). There is also diabetes insipidus. There is no relationship with glucose metabolism in diabetes insipidus. Rather, the pathology of diabetes insipidus is due to secretion of and even reaction to the pituitary hormone known as vasopressin impairment. It is manifested in the production of a very large quantity of diluted urine, leading to much thirst and dehydration.

Occurrence of diabetes insipidus is put at less than 10 thousand cases per annum in Nigeria. However, in sub-Saharan African, Nigeria has the highest prevalence rate of diabetes mellitus, with 3.9 million people being affected annually.

The International Diabetic Foundation put the prevalence of DM in Nigeria at 1.7 per cent of the population age group of 20 – 69 years. However, when considering age group extended to 20 – 79 years, it shows that about 4.99 per cent of Nigerians are living with DM. The crude mortality rate of type 2 diabetes is within 0.97 to 106 per 100,000 population in Nigeria, with a case fatality rate of 22.0 percent.

 

Impact and symptoms

In all types of diabetes, there is disruption of glucose metabolism and absorption, thereby not being maximally useful for the body cell nutrition. The unmetabolised glucose molecules do not get into body system properly. Thus, it begins to build up in the blood. The accumulated glucose molecules therefore circulate within the blood circulatory system and constituting issues for the healthy tissues and organs. This leads to frequent urination and thirst, as well as impaired kidney and eye functions, high blood pressure, and other systemic malfunctions.

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The common symptoms of diabetes include:

  • Frequent micturition, especially at night
  • Thirstiness
  • Feeling of tiredness than usual
  • Weight loss
  • Itching, especially in the genitals, and thrush
  • Delay in the process of wound healing, sometimes leading to chronic wound
  • Blurred vision from impact of sugar on optic nerves; impaired sight, glaucoma and even blindness.
  • High blood pressure
  • Renal failures
  • Cardiopathic disorders
  • Loss of libido, especially in men
  • Susceptibility to infection
  • Numbness of peripheral nerves and general and systemic disorders, especially with uncontrolled diabetes.
  • The socio-economic impact also leads to low productivity, decreased family income and indeed poverty in the nation.

 

Management of diabetes by nurses

The prompt case detection and management of diabetes mellitus is very fundamental, especially with the intervening factor of COVID–19, which is a great threat to those having a history of DM or are vulnerable to DM. DM serving as a co-morbid condition with COVID–19 portends great danger and increases the chances of case fatality.

Treatment of diabetic condition is divided into health promotion; prevention; treatment and rehabilitation of those affected.

In the management of diabetes, the nurse plays a vital role, based on the three bound roles of independent, interdependent and dependent duties and responsibilities. The nurse plays very important roles in case definition and collaborates with other healthcare team members to address the health need of a patient with DM.

With the spread and accessibilities of nurses, they are often the only professional that the patient sees first. The masses, as individuals, families, groups and communities should be counselled and educated to live healthily and utilise nutrition, physical exercises, adequate rest, and avoidance of unhealthy life patterns to enhance healthiness. The unhealthy habits of late night diners, abuse of certain substances like hard drugs, alcohol and cigarette – all these are still under the core competences of professional nurses.

The need to educate, mobilise and assist the masses in doing regular checks in our health institutions is one of the responsibilities of professional nurses. The susceptible person has to be counselled to know what to be done to remain healthy. The essence of early detection and prompt care will go a long way to promote healthiness and restoration of healthy living in both the healthy and the vulnerable population. The early detection, prompt access to treatment will determine the prognoses of the management of diabetes mellitus.

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There is the need for a well-structured and equipped health system that will guarantee easy and available opportunity for every individual to test for healthiness. The presence of safe, standardised, qualitative, accessible, timely and affordable healthcare services is very essential to the maintenance of healthiness. The government, professional associations, civil society allied, youth and women organisations, traditional and religious institutions, in collaboration with government and non-governmental organisations must work towards provision and utilisation of useful information and knowledge to manage self in case of occurrence of DM.

Backbone of competence

Professional nurses and midwives have competences to handle diabetes management and related services because of their depth of knowledge of the disease pathology and the manifestation of DM, as well as the sequence of disease symptomatology and progression. From the nature of the Nigeria nursing training and clinical expertise, they have capacity to address the clinical needs of a diabetic person. As the closest to the masses, nurses must be prepared to assist an individual, sick or well, in the performances of those activities contributing to health or recovery from ill-health.

Chemotherapy is vital to addressing the challenges of the diabetes mellitus. It is pertinent to mention that self-medication and lack of expertise to drive the process of treatment of the disease portends a great danger to the management and control of diabetes. There are consultants in the area of endocrinology and internal medicines but in short supply. There are also specialised nurses in the area of the care of diabetes. The combined efforts of the professionals will mitigate the incidence of diabetes.

(Continues next edition)

By Comrade (Nurse) Abdrafiu Alani Adeniji, mni.,

(President, National Association of Nigeria Nurses and Midwives)

 

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