n.d.; Willis, 2018). However, the normal blood glucose range is rather narrow. Blood glucose levels are regulated by an internal feedback mechanism that involves the pancreas and the liver (Willis, 2018). The following blood glucose test results indicate normal findings (Pagana et al., 2019). From the ages of two to adulthood: ● Fasting (no caloric intake for at least eight hours): 70 to 110 mg/dL or <6.1 mmol/L. ● Casual (any time of day regardless of food intake): <200 mg/ dL (11.1 mmol/L). Children <2 years of age: ● 60 to 100 mg/dL or 3.3 to 5.5 mmol/L. When normal blood glucose levels are not maintained, the impact can be devastating on an individual’s health and wellness.
To effectively provide healthcare services for persons who have diabetes, healthcare professionals must understand both normal pancreatic functioning and the pathophysiology associated with the disease. To do this, it is essential to differentiate among the different types of diabetes, all of which have different pathologies. Self-Assessment Quiz Question #2 The endocrine function of the pancreas focuses on: a. The production of enzymes essential to the process of digestion. b. The production of bile. c. Hormone secretion. d. Alpha cell production of insulin.
THE DIFFERENT TYPES OF DIABETES MELLITUS
Health care professionals and health care consumers are arguably most familiar with type 1 and type 2 diabetes. But there are other types of diabetes with which nurses must be familiar (Rebar et al., 2019). ● Type 1: The body is unable to produce adequate amounts of insulin. ● Type 2: There is resistance to insulin or abnormal insulin secretion. ● Secondary diabetes: This form of diabetes develops because of, or secondary to, another disease or condition. ● Gestational diabetes: This occurs in pregnant women who have never had diabetes. The primary focus of this educational program is on type 1 and type 2 diabetes, but the issue of other types of diabetes is also quite important. Therefore, it will be discussed before delving into type 1 and type 2 diabetes. Gestational diabetes Gestational diabetes occurs in women who have never had diabetes mellitus but have high blood glucose levels during pregnancy (Mayo Clinic, 2020c). This condition develops in a fairly high number of women. In the US, an estimated 10% of women who are pregnant develop gestational diabetes (Dansinger, 2019a). Healthcare professionals are becoming increasingly concerned about the occurrence of gestational diabetes. Thus, the following more detailed information is provided. Etiology of Gestational Diabetes As a result of hormonal changes associated with pregnancy, nearly all women experience some amount of impaired glucose intolerance. Although blood sugar may be higher than normal, it is not high enough to be diagnosed as diabetes mellitus. During the third trimester of pregnancy, these hormonal changes put women at higher risk for gestational diabetes. Hormonal changes can interfere with the appropriate action of insulin, which leads to insulin resistance (American Diabetes Association, 2021d; Dansinger, 2019a). During pregnancy, certain placental hormones help to shift nutrients from the mother to the fetus. Other placental hormones help prevent hypoglycemia in the pregnant woman. As pregnancy advances, such hormones can lead to progressive impaired glucose intolerance (elevated blood glucose levels). Usually, the woman’s pancreas is able to compensate for these elevated levels by producing about three times the normal amount of insulin. If the pancreas is not able to produce adequate amounts of insulin, blood glucose levels rise, and gestational diabetes occurs (Dansinger, 2019a). Risk Factors for Development of Gestational Diabetes Several factors increase the risk for the development of gestational diabetes (Dansinger, 2019a; Mayo Clinic, 2020c): ● Being overweight or obese ● Being a member of a high-risk ethnic group such as Hispanic, Black, Native American, African American, Pacific Islander, Alaska native, Native American, or Asian ● Being older than 25 years of age
The term secondary diabetes refers to specific types of diabetes because of other causes (ADA, 2021b). Some of the most common causes of secondary diabetes include (Khardori, 2021c; Rebar et al., 2019): ● Physical or emotional stress, which may cause prolonged increases in levels of the stress hormone cortisol, epinephrine, glucagon, and growth hormone (GH). These increases, in turn, raise the blood glucose level and place more demands on the pancreas. ● Use of adrenal corticosteroids, hormonal contraceptives, and other types of drugs that antagonize the effects of insulin. ● Diseases of the pancreas that destroy pancreatic beta cells, such as pancreatic cancer, pancreatitis, and cystic fibrosis. ● Hormonal syndromes that interfere with the secretion of insulin, such as pheochromocytoma. ● Hormonal syndromes that cause peripheral insulin resistance, such as Cushing syndrome. ● Some medications, such as estrogens, phenytoin, and glucocorticoids. ● Having impaired glucose tolerance or impaired fasting blood glucose levels. This means that blood glucose levels are high but not high enough to be diagnosed as diabetes mellitus. ● Having gestational diabetes during a previous pregnancy ● Having a family history of gestational diabetes ● Having polycystic ovary syndrome or other condition that is associated with insulin abnormalities ● Previously giving birth to a baby that weighed over 9 pounds ● Previously giving birth to a stillborn baby or one that had birth defects ● Having had a miscarriage ● Having hypertension, elevated cholesterol, or heart disease Complications Gestational diabetes may increase the risk of (Mayo Clinic, 2020c): ● Development of diabetes in the future ● Need for a surgical delivery (C-section) Diagnosis of Gestational Diabetes The ADA (2021b) has published the following recommendations for gestational diabetes mellitus screening. ● Hypertension ● Preeclampsia ● Test for undiagnosed prediabetes and diabetes at the first prenatal visit in those with risk factors using standard diagnostic criteria. ● Test for gestational diabetes mellitus at 24-28 weeks of gestation in pregnant women not previously found to have diabetes. ● Test women with gestational diabetes mellitus for prediabetes or diabetes at 4-12 weeks postpartum, using the 75-g oral glucose tolerance test and clinically appropriate nonpregnancy diagnostic criteria. ● Women with a history of gestational diabetes mellitus should have lifelong screening for the development of diabetes or prediabetes at least every three years. ● Women with a history of gestational diabetes mellitus found to have prediabetes should receive intensive lifestyle interventions and/or metformin to prevent diabetes.
Book Code: ANCCUS2423
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