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juvenile_diabetes_clc_pp1.pptxJuvenile Diabetes
Patricia Akuamoah – Boateng, Joy Ejim, Natasha Johnson, Alissa Kochaver
January 27, 2017
Grand Canyon University
NRS-434VN, Prof. Sandi Coufal
Juvenile Diabetes (Type 1 diabetes) by Patricia Akuamoah – Boateng, Joy Ejim, Natasha Johnson, & Alissa Kochaver. January 27, 2017.
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Clinical Description/ Definition
Auto immune disease
No known prevention
Pancreas produce little or no insulin.
Juvenile diabetes is a chronic disease in which pancreas produces little or no insulin, a hormone needed to allow glucose to enter cells to produce energy (Mayo Clinic Staff, 2014). It is believed to be an auto immune disease where the body attacks its own insulin-producing cells, causing the pancreas to produce little or no insulin (Mayo Clinic Staff, 2014).
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Pathophysiology
Insulin
Autoimmune
Pancreas does not produce insulin
Insulin is a hormone produced by the pancreas. The body uses insulin to unlock the cells in the body, allowing glucose to enter the cell and provide energy for cellular function. In diabetic patients, there is an autoimmune response that attacks the insulin-producing cells in the pancreas. When no insulin is produced, the lack of insulin in the blood causes inadequate glucose uptake by the cells. Subsequently, glucose remains in the blood leading to high sugar level (Mandal, 2015).
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Impact on Health Care and Nursing
Estimated cost
Medical
Reduced productivity
Individual cost
Nursing Care
How does it compare?
According to the American Diabetes Association (2015), the total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity. This is a 41% increase from 2007 (American Diabetes Association, 2015). The majority of this cost (43%) was hospital inpatient care. Per individual, diabetic patients incur about $13,700 worth of medical bills related to diabetes (American Diabetes Association, 2015).
When compared with usual care, nurse-directed diabetes care resulted in significantly fewer urgent care/emergency room visits and hospitalizations for preventable diabetes-related causes (Davidson, Ansari, & Karlan, 2007).
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Impact on Childhood
Growth and development
Mortality rate
Stress
Embarrassment
Overwhelming
Juvenile diabetes can have a significant impact on the growing child. Studies have shown that JD affects the growth and development of children, where children with the disease tend to be shorter in stature than those without it (Brown,1994). There is a higher mortality rate among children with diabetes. Some children and their parents may not be able to manage the complexity of the disease, resulting in the child’s death (Skrivarhaug et al., 2006). Psychological impacts of juvenile diabetes (such as frequent doctor visits, frequent finger pokes and injections, taking medications, meticulous diet planning, and comorbidities) may be overwhelming to a child and cause increased stress, embarrassment, and low self-esteem (American Diabetes Association, 2017).
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Into Adulthood…
No cure
Management and treatment
Juvenile diabetes/Type 1 diabetes is usually diagnosed in childhood or early adulthood (Juvenile Diabetes Research Foundation, 2017). There is no cure for the disease, but it can be treated and managed. Because we have the knowledge and capabilities to treat it, people are living well into adulthood with juvenile diabetes. This is why it is rarely ever called “juvenile diabetes anymore, rather, it is now more well-known as Type 1 diabetes.
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Demographic and Health Statistics
Prevalence
Undiagnosed
New Cases
Deaths
Race/Ethnicity
Prevalence: 1.25 million Americans with Type 1 diabetes in 2012 (American Diabetes Association, 2016).
Undiagnosed: 8.1 million (American Diabetes Association, 2016).
New Cases: 1.4 million each year (American Diabetes Association, 2016).
Deaths: Diabetes is the 7th leading cause of death in the United States, with 303,122 deaths each year (American Diabetes Association, 2016).
Race/Ethnicity: 7.6% of non-Hispanic whites, 9.0% of Asian-Americans, 12.8% of Hispanics, 13.2% of non-Hispanic blacks, and 15.9% of American Indians/Alaskan Natives (American Diabetes Association, 2016).
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Impact on Adults
Mental and emotional
Physical
Sexual
Economic (Health Insurance and Health Care)
Substance Abuse
Prenatal Care and Childbearing
Occupational Considerations and Hazards
Ability to Cope with Stress
The following slides will explain these health impacts on adult clients with juvenile diabetes.
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Impact on Adults: Mental and Emotional
Depression
Brain Function
According to Lan-Pidhainy (2015), depression is 2-3 times more common among people with depression than those without the disease, and the risk increases as complications develop. Lan-Pidhainy (2015) goes on to say that diabetes can also affect brain function, and that patients with diabetes are at an increased risk for declining memory and mental multitasking (which could indicate an augmented vulnerability to dementia later in life).
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Impact on Adults: Sexual
Sexual function
Males
Females
According to Neithercott (2012), diabetes can affect sexual function in both men and women. It can cause low libido in both sexes.
Men: Diabetic nerve damage, blocked arteries causing reduced blood flow to sex organs, and out-of-whack hormones such as testosterone could all affect a man’s sexual function (Neithercott, 2012). Men can be treated with testosterone therapy to help increase sexual desire (Neithercott, 2012).
Women: Diabetic nerve damage, blocked arteries causing low blood flow to sex organs, and unbalanced hormones all affect a woman’s sex drive as well (Neithercott, 2012). But women cannot be as easily treated as men. Although treating women with testosterone may increase their libido, it may not be safe as a long-tern treatment (Neithercott, 2012).
In addition, Neithercott (2012) points out that sexual desire and sexual arousal are different, and diabetes may affect both of these in men and women alike.
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Impact on Adults: Physical
Vessels
Nerves
Over time, high levels of glucose in the blood stream can damage large and small blood vessels. This can lead to retinal damage, kidney damage, and hardening of the arteries, increasing risk for heart attack and stroke (Lan-Pidhainy, 2015).
Persistent high glucose levels can also damage nerves that control functions of various organs. This damage may lead to slow emptying of the stomach, bloating, constipation, urine retention, tachycardia, dizziness, and neuropathy (Lan-Pidhainy, 2015).
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Impact on Adults: Economic (Health Insurance and Health Care)
Past
Present
In the past , obtaining health insurance could be difficult for people with diabetes. However, healthcare reforms improved access to converge (American diabetic Association, 2014). Beginning in 2014, job-based health insurance plans and new individual plans can no longer deny coverage due to pre-existing conditions such as diabetes.
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Impact on Adult Clients
Susceptibility to Substance Abuse
Impact on Prenatal Care and Childbearing
It is not uncommon for young people with type 1 diabetes to use recreational drugs for emotional relief to escape the day to day burden of chronic disease (Leep, Greenfield, & Campbell, 2009). According to Leep, Greenfield, & Campbell (2009), more than 50% of young adult range 17-24 years with type 1 diabetes who present with diabetic ketoacidosis admitted to poly-substance abuse.
Women with type 1 diabetes are at high risk of complications and adverse childbirth outcomes (such as congenital abnormalities, macrosomia, obstetrical and neonatal complications) during both pregnancy and childbirth. Stringent monitoring of blood sugar is required in order to improve the chance of giving birth to a healthy child (Marie & Carina, 2009).
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Impact on Adult Clients
Occupational Considerations or Hazards
Ability to Cope with Stress
It used to be a common practice to restrict individual with diabetes from certain jobs or classes of employment solely due to diagnosis of diabetes or the use of insulin without regards to individual’s abilities and circumstances. But the American Diabetes Association states that “Any person with diabetes whether insulin treated or non insulin treated should be eligible for any employment for which he/she is otherwise qualified (ADA, 2011).
According to American Diabetes Association (2013), being mindful or aware of what is working and what is not working is the best way for diabetics to cope with stress. A mindful approach to coping with diabetes opens the way to using a variety of tools for preventing avoidable stress and keeping unavoidable stress at a minimum (American Diabetic Association, 2013)
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Care Plan
Hypo or Hyperglycemia
Neuropathy
Hypo or Hyperglycemia: Inform patients to check blood glucose before and after exercise and adjust exercise according to glucose levels in order to prevent hypoglycemia. Remind patients to always carry appropriate candy, food, and juices.
Neuropathy: Monitor for loss of sensation in lower extremities. Inform patients to always wear protective foot coverings as neuropathy may leave feet susceptible to unknown injuries. Remind patients to inspect feet daily.
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Screening, Promotion, Intervention, and Education for Adults
Screening
Promotion
Education
Screening: generally not recommended for T1D because there are no accepted treatment plans for pts diagnosed in asymptomatic phase
Promotion: healthy eating, lifestyle changes and modifications, no smoking, healthy diet, exercise and proper equipment for testing
Education: includes the ABC’S- A for A1C levels keep below 8, B for blood pressure (keep at normal levels as high blood pressure forces heart to work harder) and C for cholesterol (monitors the amount of fat in your blood- high levels can raise risk of heart attack and stroke). Diabetes is one of a trifecta of illnesses that contributes to heart attacks and strokes.
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Resources
Diabetes.org
Niddk.nih.gov
There are a number of resources for patients with diabetes, some have blogs for people to communicate and share medical information, exercise and diet information.
Diabetes.org funds research to prevent, cure, and manage diabetes. They also host event planning and provide objective, credible information.
Niddk.nih.gov Conducts, supports, and coordinates research on diseases affecting public health (such as diabetes).
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References
American Diabetes Association. (2015). The cost of diabetes. Retrieved from www.diabetes.org/advocacy/news-events/cost-of-diabetes.html?referrer=https://www.google.com/
American Diabetes Association. (2016). Statistics about diabetes. Retrieved from www.diabetes.org/diabetes-basics/statistics/?referrer=https://www.google.com/
American Diabetes Association. (2017). Type 1 diabetes. Retrieved from http://www.diabetes.org/diabetes-basics/type-1/
Davidson, M. B., Ansari, A., & Karlan, V. J. (2007). Diabetes care. Retrieved from http://care.diabetesjournals.org/content/30/2/224
Juvenile Diabetes Research Foundation. (2017). Type 1 diabetes facts. Retrieved from http://www.jdrf.org/about/fact-sheets/facts-about-jdrf/
Lan-Pidhainy, X. (2015). Physical, mental & social effects of diabetes. Retrieved from http://www.livestrong.com/article/57132-physical-mental-social-effects/
Lee,P., Greenfield, J R.,& Campbell. V.,(2009) Metabolic Complication Of Substance Abuse in Type 1 Diabetes : A Journal Of The British Diabetes Association Retrieved http://eds.b.ebscohost.com.lopes.idm.olc.org
Mandal, A. (2015). What is diabetes? Retrieved from http://www.news-medical.net/health/What-is-Diabetes.aspx
Marie, B., & Carina, S., (2009) Experience Of Professional Support during Pregnancy and Childbirth- A Qualitative Study of Women with Type 1 Diabetes. Retrieved from http://eds.b.ebscohost.com.lopes.idm.oclc.org
Mayo Clinic Staff. (2014). Diabetes: Causes. Retrieved from http://www.mayoclinic.org/diseases-conditions/diabetes/basics/causes/con-20033091
Neithercott, T. (2012). Sex and diabetes: What you wanted to know. Retrieved from www.diabetesforecast.org/2012/nov/sex-and-diabetes-what-you-wanted-to-know.html?referrer=https://www.google.com/American Diabetes Association, (2014) Health Insurance Protections Retrieved from http://www.diabetes .org/living with diabetes /health insurance .
Skrivarhaug, T., Bangstad, HJ., Stene, L.C., ,Sandvik, L., Hanssen, K. F., Joner, G.,(2006). Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Retrieved from http://link.springer.com/article/10.1007/s00125-005-0082-6
