Endocrinology and Metabolic Disorders

Endocrinology is one of the body’s two chief communication systems. A system in which a group of secretory cells secretes a potent chemical transmitter substance which is called as a hormone, into the blood. The transmitter is then carried by the blood to the target cells where a reaction is provoked. It differs from the other systems. The Endocrine system is essential for the maintenance of homeostasis.

The most common form of diabetes is type 1 diabetes, type 2 diabetes, pre-diabetes, gestational diabetes. Type 1 diabetes is also known as insulin-dependent diabetes, and type 1 diabetes is due to autoimmune b-cell destruction, typically leading to a lack of insulin. Whereas type 2 diabetes is non-insulin-dependent diabetes. Type 2 diabetes is due to a progressive loss of b-cell insulin secretion commonly on the background of insulin resistance. Gestational diabetes mellitus (GDM) is triggered by pregnancy and is often diagnosed in middle or late pregnancy. Specific types of diabetes due to other effects, e.g., monogenic diabetes syndromes which is a neonatal diabetes and maturity-onset diabetes of the young (MODY), diseases of the exocrine pancreas; such as cystic fibrosis and pancreatitis, and drug- or chemical-induced diabetes by using glucocorticoid use, in the treatment of HIV/AIDS, or after organ transplantation.

Complications associated with diabetes are often acute or chronic. Acute complications, though short-termed, can often present immediate danger and thus needs to be treated at the earliest possible. These short-term complications are mainly characterized by the hypoglycemic or hyperglycemic state of the body in which it is unable to function properly. Acute complications chiefly consist of diabetic ketoacidosis, diabetic coma and so on. These complications if promptly treated, usually results in full recovery, however, might prove fatal in case of delayed treatment

Diabetics are more prone to developing dental complications than those who have proper control over their blood glucose level. There are a host of dental and gum diseases associated with diabetes including gingivitis, periodontitis (mild and severe), fungal infections, dry mouth, loose teeth and so on. Prolonged levels of blood glucose can lead to developing or worsening of dental infections. Keeping a check on the blood glucose level, maintaining proper oral and dental hygiene can help mitigate such complications.

Also known as diabetic kidney disease (DKD), diabetic nephropathy is the chronic loss of kidney function primarily because of high blood glucose level. About 40% of the individuals affected with Diabetes Mellitus, eventually develop DKD. Diabetic Nephropathy is characterized by the loss of protein in the urine (proteinuria or albuminuria) and by a decline in the estimated Glomerular Filtration Rate of the kidneys. It is one of the most common causes of End-Stage Kidney Disease (ESKD) which can ultimately lead to kidney failure. A proper diet, healthy lifestyle, regular checking of blood glucose and lowering blood pressure can help prevent diabetic nephropathy and protect kidney function

Diabetic neuropathy or nerve damage which is brought about by diabetes is a severe form of diabetic complications. High blood glucose levels often damage the small blood vessels which supply essential nutrients thereby causing neuropathy. Diabetic neuropathy mostly affects the nerves in the legs and feet. Apart from neuropathy, diabetes has also been linked to various other disorders of the brain including Alzheimer's disease, Memory loss, Gastric Problem, Mental Health, etc. Though a serious complication, the progress of diabetic neuropathy can be slowed down with tight blood sugar control and a healthy lifestyle.

Diabetes can also cause a group of eye conditions which are collectively called Diabetic eye disease. The most common form of the disease is diabetic retinopathy which is associated with damage to the tiny blood vessels in the retina. This condition can progress through four stages and eventually result in retinal detachment or permanent vision loss. Other forms of diabetic eye disease include Glaucoma, Cataracts, Blindness, etc. For early detection and treatment of such disease, it is necessary for affected individuals to undergo retinopathy screening and taking proper care of oneself.

Having diabetes greatly enhances the risk of developing heart disease and having a greater chance of a heart attack or a stroke. High blood pressure or high cholesterol which is often associated with diabetes is the main causative factors of cardiovascular diseases. Apart from these, several other serious vascular complications also arise because of diabetes viz. Angina, Deep vein thrombosis, endothelial dysfunction, Peripheral arterial disease, etc.  Identifying symptoms, maintaining a healthy weight, proper diet and medications and cutting down on smoking can help keep these otherwise serious complications under control.

Often, raised blood glucose can damage the sensation in the feet, affecting blood circulation to the area without which there usually tends to be delay in healing of the cuts and sores. When these symptoms are kept untreated, various complications are likely to arise like foot ulcers, foot infections and foot deformation and might also lead to amputation. Hence, it is extremely essential to take proper care of the foot, undergo regular foot checkups and keep diabetes under control.

Diabetes is a group of metabolic disorders characterized by high blood sugar levels over a prolonged period mainly due to insulin deficiency or resistance. Symptoms of high blood sugar include frequent urination, increased thirst, increased hunger, and weight loss. If left untreated, diabetes can cause many complications. Acute complications can comprise diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications consist of cardiovascular disease (CVD), stroke, chronic kidney disease, foot ulcers, and damage to the eyes.

High levels of sugars or glucose in the blood lead to such a chronic condition called diabetes mellitus. High glucose in the blood may cause eye damage, nerve damage, and kidney damage, loss of sensation in sexual organs (sexual dysfunction). Diabetes increases the risk of various cardiovascular diseases such as coronary artery disease, heart attack, heart stroke and narrowing of arteries which reduces the blood flow through the arteries. In addition to this, people with diabetes have more chances to develop infections that may lead to allergies. Diabetes is the main cause for cardiovascular diseases, kidney failure, and blindness. Diabetes can also cause foot ulcers and hearing problems, people with diabetes have hearing impairment commonly.

The most common type of diabetes which occurs in children is type 1 diabetes. It is a common chronic childhood diseases, occurring in 1 in 350 children by age 18; the incidence has recently been increasing, particularly in children less than 5 yr. Although type 1 can occur at any age, it naturally expresses between age 4 yr and 6 yr or between 10 yr and 14 yr. Type 2 diabetes, once rare in children, has been increasing in frequency in parallel with the increase in childhood obesity (in children). It typically manifests after puberty, with the highest rate between age 15 yr and 19 yr (in adolescents)

Heart disease is a complication that may affect people having diabetes if their condition is not managed well for a long period of time. High blood pressure (Hyperglycemia), which characterizes diabetes, in combination with free fatty acids within the blood can alter the character of blood vessels, and this can lead to heart disease. Vascular disorders include coronary artery disease (CAD), retinopathy (damage to the vision) and nephropathy, peripheral vascular disease (PVD), and heart stroke. Diabetes also affects the heart muscle which causes both systolic and diastolic heart failure.

One of the most significant features of diabetes management is the self-management of diabetes which can be effectively achieved, and complications prevented with the help and support of the nursing team. Diabetes specialist nurses play an essential role in screening diabetic persons, detecting early onset of diabetes, considering nutritional needs of the patient, promoting self-management, providing prevention advice, spreading awareness on diabetes and providing health education. It is very necessary for nurses to be well educated, trained and skilled sufficiently to be able to proficiently deliver care, support self-management and provide advice to diabetic persons