According to the CDC, diabetes is the most expensive chronic condition in the US. A summary of these expenses includes (CDC, 2021c): ● The total annual cost of diabetes is $327 billion. An additional $90 billion is spent on reduced productivity. ● One dollar out of every four dollars in US healthcare costs is spent on caring for people with diabetes. ● The total economic cost of diabetes rose 60% from 2007 to 2017. ● Sixty-one percent of diabetes costs are for people 65 years of age or older. These costs are mainly paid by Medicare. ● An estimated 48% to 64% of lifetime medical costs for a person with diabetes are for complications related to diabetes, such as heart disease and stroke. Medical costs are not the only costs related to diabetes. The stress of chronic illness can impact interpersonal relationships. It can impact the person’s ability to work, which may have significant economic impact on the family income. Financial burdens are inter- related with psychological issues that impact persons dealing with diabetes. Medical bills, loss of work time, and inability to actively participate in work and social activities can all have s significant adverse impact on patients, their families, and their employers. Dealing with a chronic illness can lead to significant stress, which can adversely impact ability to function effectively at work, home, and school and interfere with interpersonal relationships. Therefore, the costs of diabetes include monetary, societal, and interpersonal factors. The impact on society includes overextended health services, increased public assistance programs for financially stressed families, and the societal burden of mental health care and rehabilitation for those with complications resulting from diabetes (CDC, 2021c; O’Connell, 2019). The cost of medications used in the treatment of diabetes continues to increase at alarming rates. The price of insulin, for example, has increased 1,200% since 1996 (Kumok, 2021). It is not possible to comprehend the pathophysiology of diabetes without an understanding of normal pancreatic functioning. The pancreas is a triangular shaped organ, about six to 10 inches long, located in the curve of the duodenum (the first portion of the small intestine from the stomach to the jejunum). The pancreas plays critical roles in both the digestive process and the process that regulates blood sugar (The Pancreas Center, n.d.; Willis, 2018). The pancreas is surrounded by various other organs: the small intestine, liver, and spleen. It has three sections. The wide part, Exocrine function of the pancreas The pancreas contains exocrine glands, which produce enzymes that are essential to the process of digestion (The Pancreas Center, n.d.). Acinar cells make up most of the pancreas and are responsible for the regulation of the exocrine functions of the gland (Willis, 2018). Below is a summary of the exocrine function of the pancreas (The Pancreas Center, n.d.): ● Food enters the stomach. Endocrine function of the pancreas The endocrine function of the pancreas focuses on hormone secretion. The endocrine cells of the pancreas are islet cells, or islets of Langerhans. These islet cells exist as clusters of cells that are scattered among the acinar cells. They consist of alpha, beta, and delta cells, which produce the following essential hormones (Johns Hopkins Medicine, n.d.a.; The Pancreas Center, n.d.; Willis, 2018): ● Glucagon: Glucagon is produced by the alpha cells. It raises blood glucose levels by causing the breakdown of glycogen to glucose. ● Insulin: Insulin is produced by beta cells. Insulin’s primary function is to reduce blood glucose levels by triggering the conversion of glucose to glycogen. ● Somatostatin: Delta cells are responsible for the production of somatostatin. Somatostatin inhibits the release of growth hormone (GH), corticotrophin, and some other hormones.
The estimated economic cost of glucose-lowering drugs is $57.6 billion per year in the U.S. in 2015–2017 (15–20% of the estimated annual cost for all prescription drugs in the U.S.). The cost of such drugs can cause a financial burden and have a devastating impact on people without health insurance and people whose insurance imposes high deductibles—the people least able to afford the high cost of diabetes drugs. This means that the high cost of diabetes drugs has important implications for both public policy and social justice (Taylor, 2020a). Members of an Insulin Access and Affordability Working Group (Cefalu, (2018) made the following recommendations to help lower the cost of insulin. These recommendations may also be applied to other drugs used in the treatment of diabetes. Examples include (Cefalu, (2018): ● Providers, pharmacies, and insurers should discuss the cost of insulin preparations (and other drugs) with patients to help them understand the advantages, disadvantages, and financial impact of potential insulin preparations and those of other diabetes medications. ● Providers should prescribe the lowest-priced medications that effectively and safely achieve treatment goals. ● Researchers should study the comparative effectiveness and cost-effectiveness of the various insulins. ● Organizations such as the (ADA) should: ○ Advocate for access to affordable medications for all people who have diabetes. ○ Develop and regularly update clinical guidelines or standards of care based on scientific evidence for prescribing medications. ○ Make information about the advantages, disadvantages, and financial implications of medications easily available to people with diabetes. referred to as the head of the pancreas, is positioned toward the center of the abdomen. The middle section is called the neck and the body of the pancreas. The thin end of the organ is referred to as the tail and extends to the left side (Johns Hopkins Medicine, n.d.; The Pancreas Center, n.d.; Willis, 2018). The pancreas is surrounded by several major blood vessels: the superior mesenteric artery, the superior mesenteric vein, the portal vein, and the celiac axis, which supply blood to the pancreas and many other abdominal organs (The Pancreas Center, n.d.). ● Pancreatic juices flow into a system of ducts that terminate in the primary pancreatic duct. ● The pancreatic duct joins with the common bile duct to form the ampulla of Vater located in the duodenum. ● The common bile duct produces bile. Pancreatic juices and bile flow into the duodenum and facilitate the digestion of fats, carbohydrates, and proteins. Under normal conditions, a small amount of insulin is constantly secreted by the pancreas. Insulin secretion increases in response to increases in blood glucose levels. Insulin triggers the conversion of glucose to glycogen. Glycogen is stored primarily in the liver and in skeletal muscle (Johns Hopkins Medicine, n.d.; The Pancreas Center, n.d.; Willis, 2018). When blood glucose levels are low such as between meals or during or immediately following exercise, alpha cells are stimulated to release glucagon. Glucagon causes the liver to release glycogen, which is then converted to glucose. Glucose travels through the blood stream to the cells of the body where it is converted to energy to maintain body functioning (Johns Hopkins Medicine, n.d.a.; The Pancreas Center, n.d.; Willis, 2018). Maintaining normal blood glucose levels is essential to the ability of key organs—including the brain, liver, and kidneys—to function properly (Johns Hopkins Medicine, n.d; The Pancreas Center,
NORMAL ANATOMY AND PHYSIOLOGY OF THE PANCREAS
Book Code: ANCCUS2423
Page 57
EliteLearning.com/Nursing
Powered by FlippingBook