From the Guidelines
Diabetes is a chronic condition where the body either doesn't produce enough insulin or cannot effectively use the insulin it produces, resulting in elevated blood sugar levels, and its management involves a combination of lifestyle modifications and medications, with the goal of preventing or delaying complications and optimizing quality of life. Management of diabetes involves understanding its definition, pathophysiology, signs and symptoms, diagnosis, and treatment options. According to the most recent evidence 1, the goals of treatment for diabetes are to prevent or delay complications and optimize quality of life.
Definition and Pathophysiology
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both, as defined by 1. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Several pathogenic processes are involved in the development of diabetes, ranging from autoimmune destruction of the β-cells of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin action.
Signs and Symptoms
Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision, as noted in 1. Impairment of growth and susceptibility to certain infections may also accompany chronic hyperglycemia. Acute, life-threatening consequences of uncontrolled diabetes are hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome.
Diagnosis
A diagnosis of diabetes can be made based on fasting blood glucose levels, plasma-blood glucose levels after an oral glucose tolerance test, or the presence of clinical symptoms with plasma glucose levels, as outlined in 1.
Treatment
The treatment plan should be individualized and take into account the patient's preferences, values, and goals, with a focus on lifestyle modifications and medications to achieve optimal glycemic control. For type 1 diabetes, insulin therapy is essential, with options including rapid-acting insulins, long-acting insulins, or insulin pumps delivering continuous doses. Type 2 diabetes management often begins with metformin, potentially adding medications like SGLT-2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, or sulfonylureas. Lifestyle modifications are crucial for all diabetes patients, including regular physical activity, a balanced diet limiting refined carbohydrates, regular blood glucose monitoring, and maintaining a healthy weight.
Anaesthesia Considerations
For patients with diabetes undergoing surgery, perioperative management is critical, including the management of hyperglycemia and the use of insulin and oral glucose-lowering drugs, as discussed in 1. The use of injectable non-insulin treatments, such as GLP1 receptor agonists, should also be considered in the preoperative period.
Quality of Life and Morbidity
The management of diabetes should prioritize the prevention or delay of complications and the optimization of quality of life, as emphasized in 1 and 1. Regular medical check-ups are necessary to monitor for complications affecting the eyes, kidneys, nerves, and cardiovascular system. The use of empowering language in diabetes care and education can help to inform and motivate patients, while language that shames can hinder progress, as noted in 1.
Key aspects of diabetes management include:
- Individualized treatment plans based on patient preferences, values, and goals
- Lifestyle modifications, including regular physical activity and a balanced diet
- Medications, such as insulin, metformin, and other glucose-lowering agents
- Regular blood glucose monitoring and maintenance of a healthy weight
- Perioperative management for patients undergoing surgery
- Ongoing assessment, education, and treatment planning to support self-management efforts and improve disease outcomes.
From the Research
Definition of Diabetes
- Diabetes mellitus is a chronic heterogeneous metabolic disorder with complex pathogenesis, characterized by elevated blood glucose levels or hyperglycemia 2.
- It is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both 3.
- Type 2 diabetes is a common metabolic disorder characterized by chronic hyperglycaemia, associated with a reduced life expectancy owing to a greater risk of heart disease, stroke, peripheral neuropathy, renal disease, blindness, and amputation 4.
Pathophysiology of Diabetes
- Hyperglycemia manifests in various forms with a varied presentation and results in carbohydrate, fat, and protein metabolic dysfunctions 2.
- The chronic hyperglycemia of diabetes mellitus is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels 3.
- Type 2 Diabetes Mellitus (T2DM) is characterized by chronically elevated blood glucose (hyperglycemia) and elevated blood insulin (hyperinsulinemia) 5.
Signs and Symptoms of Diabetes
- The main types of diabetes include Type 1 and Type 2, with common symptoms such as hyperglycemia, polyuria, polydipsia, and polyphagia 6.
- Type 2 diabetes is associated with a reduced life expectancy owing to a greater risk of heart disease, stroke, peripheral neuropathy, renal disease, blindness, and amputation 4.
Diagnosis of Diabetes
- Hyperglycemia serves as the primary biomarker for the diagnosis of diabetes 2.
- An elevated fasting plasma glucose, an abnormal glucose tolerance test, obesity, and evidence of impaired insulin action are the best predictors of increased diabetes risk and progression to diabetes 4.
Treatment of Diabetes
- Good diabetic control depends on diligence in blood glucose monitoring, frequent adjustment of medications, adherence to a regular diet and exercise plan, and treatment of comorbid conditions such as hypertension and hyperlipidemia 3.
- Treatments for T2DM that lead to improvements in glycemic control and reductions in blood insulin levels are sensible based on a pathophysiologic perspective, and carbohydrate-restricted diets have been used effectively to treat obesity and T2DM 5.
Anaesthesia Considerations
- There is no direct evidence provided in the given studies regarding anaesthesia considerations in patients with diabetes.
- However, it is essential to consider the patient's overall health, including their diabetes management, when administering anaesthesia to ensure safe and effective care.
Management of Diabetes
- Nurses have a crucial role in monitoring, educating, and supporting people with diabetes, as well as their families and significant others 6.
- The management of diabetes is complicated and requires a comprehensive approach, including lifestyle modifications, medication management, and regular monitoring of blood glucose levels 3.