Diabetic Nephropathy


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diabetic nephropathy Informative essay on Diabetes

An Informative Essay On Diabetes Mellitus

Diabetes is the seventh leading cause of death listed in the United States. Diabetes is the leading cause of blindness. "In 1996 diabetes contributed to more than 162,000 deaths"(Lewis 1367).
     "Diabetes mellitus is not a single disease but a group of disorders with glucose intolerance in common" (McCance 674). Diabetes mellitus is a metabolic disorder characterized by hyperglycemia (increased blood sugar) and results from defective insulin production, secretion, and utilization. There are many forms of diabetes. "Diabetes increases the risk of heart and blood vessel disease, amputation, infections, kidney damage, eye problems (including blindness), and nerve malfunction" (Husain). I will briefly define the different forms of diabetes and then I will discuss diabetes mellitus in general.
1.     Insulin dependent diabetes mellitus (IDDM) or type 1 is when the pancreas will produce little or no insulin, therefore requiring injections of insulin to control diabetes and prevent ketoacidosis. All patients with this type of diabetes need insulin to survive (Deakins 34). Five to ten percent of all diabetic patients have IDDM. Usual presentation is rapid with classical symptoms of polydipsia (increased thirst), polyphagia (increased hunger), polyuria (increased urination), and weight loss. IDDM is most commonly seen in patients under thirty, but can be seen in older adults.
2.     Non-insulin dependent diabetes mellitus (NIDDM) or type 2 is caused by a defect in insulin manufacture and release from the beta cell or insulin resistance in the peripheral tissues. Approximately ninety percent of diabetic patients have NIDDM. Genetics play a big role in the etiology of NIDDM and is often associated with obesity. Usually presentation is slow and often insidious with symptoms of fatigue, weight gain, poor wound healing, and recurrent infection. Primarily occurs in adults over thirty.
3.     Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance, which occurs during pregnancy. Occurs in approximately three percent of pregnancies, and usually disappears after pregnancy. Women with GDM are at higher risk for having diabetes in the future. GDM is associated with increased risk of morbidity. Women should be screened for GDM between the 24th and the 28th weeks of gestation.
4.     Diabetic ketoacidosis is a serious condition, which occurs primarily in IDDM during times of severe insulin deficiency or illness producing severe hyperglycemia (increased sugars in the blood), ketonuria (acetone bodies in urine), dehydration, and acidosis (PH balance of less than 7.35).
According to McCance the diagnosis of diabetes is based on (1) more than one fasting plasma glucose level greater than 140mg/dl, (2) elevated plasma glucose levels in response to an oral glucose test, and random plasma glucose levels above 200mg/dl combined with classic symptoms of polydipsia, polyphagia, and polyuria (674).
      The pancreas is located partially behind the stomach in the abdomen. The pancreas is a mixed gland composed of endocrine and exocrine gland cells. These cells are called acinar cells. Acinar cells, forming the bulk of the gland, produce an enzyme-rich juice that is ducted into the small intestine during food digestion.
     Scattered among the acinar cells are approximately a million pancreatic islets (islets of Langerhans), minute cell clusters that produce pancreatic hormones. The islets contain two major populations of hormone-producing cells, the glucagen-synthesizing alpha cells and the more numerous insulin-producing beta cells. Insulin and glucagons are intimately but independently involved in the regulation of the blood glucose levels. Their effects are opposite: Insulin is a hypoglycemic hormone (lowers blood sugar), whereas glucagon is a hyperglycemic hormone (increases blood glucose.) Islet cells also synthesize other peptides in small amounts. These include somatostatin (secreted by the delta cells), which inhibits the release of insulin and glucagons; pancreatic polypeptide secreted by the F cells, which plays a role in regulating the exocrine function of the pancreas; and amylin, a hormone cosecreted with insulin by the beta cells that appears to antagonize some of the insulin's effects. That should explain the basic anatomy and physiology of the pancreas.
     Diabetes can affect the entire body. Two-thirds of adults with diabetes have high blood pressure, or hypertension. This condition is serious because it leads to an increased risk of stroke, heart disease, kidney and eye problems.
     The disease may cause similar changes in the blood vessels of the kidneys. This condition, called diabetic nephropathy, may lead to kidney failure. The nerves ... more

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diabetes

Diabetes is rapidly becoming a national epidemic. An estimated eighteen million Americans have diabetes and the number is growing, especially among children. The Centers for Disease Control and Prevention (CDC) reports that between 1990 and 1998, the incidence of diabetes rose by 70% in the population aged 30-39, by 40% among those 40-49, and by 31% in the 50-59 age group. Even more frightening is the fact that it is estimated that as many as 33% of the population with Type I diabetes and up to 55% with Type II go undiagnosed. Many patients have been hyperglycemic for at least six years before diagnosis.
Many chronic complications have been implicated with the diagnosis of diabetes. Keeping these conditions in check is vital.
Retinopathy is damage to the small blood vessels in the retina. It is important to note that there are no early warning signs for retinopathy. Annual eye exams with an ophthalmologist is imperative to catch this condition early. Retinopathy is the most frequent cause of new blindness and is related to the duration of the diabetes and also to the level of glucose control. In the nonproliferative stage there may no evidence of disease in the retinal vessels or there may be signs of beginning damage, such as yellow deposits. Microaneursyms, or intraretinal hemorrhages may be seen on exam. In this stage the treatment is blood pressure control, blood glucose control, and annual dilated eye exam. In the proliferative stage there is abnormal, fragile retinal vessel growth, vitreous hemorrhage, and vision loss. Common complaints are blurred vision, or spots and cobwebs in the visual field. Treatment for this stage is photocoagulation, which involves 1200-1600 scatter burns throughout the periphery of the eye, surgery for retinal detachment, and vitrectomy for persistent vitreous hemorrhage. The third phase of retinopathy is maculopathy, or macular edema. This involves a loss of central vision and the treatment is photocoagulation with argon laser. Retinopathy (treated or untreated) may worsen with exercise that increases intraabdominal pressure. This would include stretches, isometrics, rapid head movements, weight lifting, excessive jarring movements, and repetitive low head position movements.
Another complication associated with diabetes is nephropathy. The kidneys filtering ability lessens and allows waste to remain in the blood. There are no early warning signs. Interestingly, 95% of patients with nephropathy also have retinopathy. Diabetes is the most common cause of ESRD (End Stage Renal Disease) and accounts for 30% of all cases. Native Americans, and Hispanic Americans are at higher risk that their white counterparts. Renal failure occurs in 5-15% of patients with Type II, and 30-40% with Type I diabetes.  Renal disease is classified in stages from I-V. Stage I begins at diagnosis and there are no symptoms, although there may be renal hypertrophy and hyperfunction. Microalbumin levels are normal. Stage II usually begins after about two years. In this stage there are no symptoms, although there may be structural changes such as glomerulosclerosis. Stage III usually occurs after approximately 7-15 years and is accompanied by hypertension and a positive microalbumin level. Stage IV starts at 10-30 years after diagnosis and includes proteinuria. Stage V is ESRD and usually occurs 20-40 years after diagnosis. Dialysis is the temporary treatment until a transplant is possible for end-stage renal disease. Onset of nephropathy may be prevented or delayed by blood sugar control, tight blood pressure control, ACE inhibitors, and microalbumin screening. This screening should begin at diagnosis and then be done annually with Type II, and for Type I screening should begin around five years after diagnosis and then done annually. Other renal threats to watch for in diabetic patients are urinary tract infections, and neurogenic bladder. It is important that a urinalysis be performed at every visit with the doctor, especially for older individuals. Positive cultures should be treated with antibiotics. Neurogenic bladder symptoms include frequent voiding, nocturia, incontinence and frequent urinary tract infections. If pharmacologic therapy does not prove to be successful, intermittent straight catheterization 2-3 times a day will be necessary.
Peripheral neuropathy is the most common long-term complication of diabetes. Distal nerves of the hands and feet are the first to be affected. There are varying degrees of severity and the diagnosis usually comes late in the process after damage ... more

diabetic nephropathy

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  • Diabeties Diabeties Diabeties There are two types of diabetes: diabetes insipidus and diabetes mellitus. Diabetes insipidus is a rare metabolic disorder caused by a deficiency of the pituitary hormone, which is usually the result of damage to the pituitary gland. Diabetes insipidus is characterized by enormous amounts of urine that are produced by the body regardless of how much liquid is consumed. Diabetes mellitus results from the production of insufficient amounts of insulin by the pancreas. Without insulin the ...
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