Statistics of Diabetes Mellitus in UAE and Morocco

Diabetes mellitus is a collection of chronic metabolic problems induced by a sustained high blood sugar level. Increased thirst, frequent urination, and increased hunger are all recognized symptoms of elevated blood sugar. Diabetes mellitus can cause acute consequences in the body, such as hyperosmolar coma or even death, if left untreated for an extended length of time. It can also cause long-term complications such as chronic kidney failure, heart disease, vision damage, and foot ulcers. Diabetes is mostly caused when the pancreas fails to produce enough insulin for the body, either totally or partially. Additionally, it can be caused when the cells of the body fail to respond appropriately to the insulin being produced by the pancreas. It is established that there are 3 major types of diabetes mellitus. They include the type I diabetes mellitus, type II diabetes mellitus, and gestational diabetes. The type I diabetes mellitus is caused when the pancreases fail to produce enough insulin for the body. It is thus referred to as the insulin-dependent diabetes mellitus (Atkinson, Eisenbarth, & Michels, 2014). Type II diabetes mellitus is caused when the cells of the body fail to respond effectively to the insulin produced by the body. It is thus referred to as non-insulin-dependent diabetes mellitus. The gestational diabetes mellitus only occurs to pregnant women who have not had early cases of diabetes mellitus before the pregnancy (Pagana, 2013).

Statistics of Diabetes Mellitus in UAE and Morocco

The International Diabetes Federation estimates that 415 million people in the in the world suffers from diabetes mellitus. Of these population, 35.4 million people from the Middle East and North Africa, UAE included, have diabetes mellitus. This number is expected to shoot to 72.1 million by the year 2040. In 2015 alone, cases of diabetes mellitus reported in UAE stood at over 1 million in number. UAE as at 2015 had a total adult population of 7,442,000. Of this number, 1,384,000 million deaths were caused by diabetes mellitus. The prevalence of diabetes mellitus in UAE is estimated to be 14.6%. UAE spends about USD 2,155.9 per person suffering from diabetes mellitus yearly. 387,200.000 is the number of adult population with undiagnosed cases of diabetes mellitus in UAE (International Diabetes Federation, 2015).

Morocco, a member country of the Middle East and Northern Africa territory, was estimated to have an adult population of 21,662,000 in 2015. Of the total adult population, 9,473,000 adult deaths are caused by diabetes mellitus. The prevalence of diabetes mellitus stood at 7.7% in the year 2015. The country spends an average of USD 281.0 per person struck with diabetes mellitus. Additionally, the total reporting of adults with diabetes mellitus in Morocco in 2015 was 1,671,400. Moreover, 688,200 adults are not diagnosed with diabetes mellitus (International Diabetes Federation, 2015).

The Pathophysiological Basis of Diabetes Mellitus

Lack of balance in production and demand of insulin hormone results in diabetes. Ingestion of food follows with the breakdown of the food into carbohydrates and sugar components. The body then breaks these components into glucose which is an energy source for the body. The insulin hormone is manufactured in the beta cells of the pancreas. This hormone helps in regulating the level of sugar in the blood. Excessive amounts of glucose in the blood lead to the stimulation of cells by the insulin hormone to absorb the glucose for energy purposes. Increased levels of insulin lead to absorption and storage of glucose by the liver a process known as glycolysis. Reduced levels of insulin hormone lead to the breakdown of carbohydrates for the release of glucose a process known as gluconeogenesis. It also leads to the breakdown of glucose stored in the form of glycogen; a process called glycogenolysis and release of glucose by breaking down lipids, a process called lipolysis. Proteolysis is the process by which low insulin levels results in the breakdown of proteins to release glucose to be used for energy production (Mandal, 2016).

Pathophysiology of Type I Diabetes Mellitus

In this type of diabetes, there is an autoimmune destruction of pancreatic cells. It is important to note that the destruction of these cells leads to the destruction of insulin production and this leads to the derangement of the various metabolic processes in the body. Additionally, apart from the reduction in insulin production, some of the pancreatic cells begin to function abnormally and secret excess glucagon. Hyperglycemia is meant to reduce the levels of glucagon in the body, however, in patients with this type of diabetes, hyperglycemia is ineffective in suppressing the excessive production of glucagon (Ozougwu, Obimba, Belonwu, & Unakalamba, 2013).

The absence of insulin or low production is a disaster to the body. Most patients with type I diabetes mellitus have impaired body tissues due to the multiple biochemical mechanisms that take place within them. Lack of insulin in the body also leads to an increased level of fatty acids in blood plasma of the body as well as increased level of lipolysis. This increment of levels reduces the metabolism of glucose in the peripheral cells of the body tissues hence accounting for the impairment of body tissues. It is also acknowledged that insulin deficiency and the decreased glucose utilization within the body results in a number of genes which are responsible for making the target tissues respond positively to insulin in the body, for example, the glucokinase cells of the liver not to be expressed.

Pathophysiology of Type II Diabetes Mellitus

Patients with this type of diabetes mellitus have traces of insulin in their bodies, and this is completely different from the patients who have the type I diabetes mellitus. This type of diabetes is detected through the oral glucose tolerance test. According to the oral glucose tolerance test, patients are categorized as: those with impaired glucose tolerance, those with normal glucose tolerance, those with diabetes because of minimal fasting and those with diabetes as a result of over fasting (Ozougwu, Obimba, Belonwu, & Unakalamba, 2013).

Patients with impaired glucose tolerance usually develop hyperglycemia despite having a considerable amount of insulin in their bodies. This means that the cells of their bodies are resistant to the insulin being produced in their bodies. Impaired glucose tolerance progresses to type II diabetes mellitus. The level of insulin within the bodies of the patients is reduced. It is true to state that insulin deficiency, as well as resistance, are very common in patients that have the type II diabetes. The primary cause of this type of diabetes is resistance to insulin. However, it is argued that insulin deficiency alone is not enough to cause the development of the type II diabetes. The secretion of insufficient insulin is also a major contributing factor. It has been established that a hormone receptor referred to as the nuclear hormone receptor in the family of proteins is in the etiology of type II diabetes (Mandal, 2016).

Pathophysiology of gestational diabetes

Excessive counter-insulin hormones of pregnancy results in the emergence of gestational diabetes. Counter insulin hormones results in resistance to the insulin hormone hence raised blood sugar of the mother. Defective receptors of insulin also result in this form of diabetes. There are various pathophysiological symptoms behind this form of diabetes. They include polydipsia which means increased thirst, polyuria associated with excessive urination, loss of weight, hunger due to polyuria, poor healing of wounds, damage to the eye, kidney and nerves and much more (Mandal, 2016).

The glucose present within the body of a pregnant woman crosses via the placenta and reaches the fetus. Therefore, if this type of diabetes is left untreated, the fetus can be exposed to a lot of glucose, and in turn, the fetus will also end up producing a lot of insulin. Note that insulin is one of the components in the body that stimulates growth. The fetus will, therefore, grow at a faster rate than usual and when born the baby will be highly susceptible to low glucose levels. It is true to state that this type of diabetes raises the risk of birth complications, for example, macrosomia also referred to as the big baby, stillbirth, premature birth, placental abruption, and trauma during birth.

Nursing Assessments and Management for Diabetes Mellitus Patients

Diabetes mellitus requires effective treatment. This calls for adequate quality assessment and management of the patient. The main objective of assessment and management is to harmonize the blood glucose level of the patient. Also, the assessment and management should aim to decrease insulin complications through exercise and eating a balanced diet. The nurse needs to come up with programs that comply with the treatment during assessment and management of the patient. Nursing interventions include but not limited to: Hyperglycemia assessment. This condition arises where there are excess glucose and inadequate or limited amounts of insulin hormone. Another intervention is assessing the levels of blood sugar before meals and at bedtime (Smeldzer, 2010). During this time, the blood sugar level ought to be between 140-180 mg/dl. Also, monitoring the patient’s glycosylated hemoglobin (HbA1c) is a recommended assessment because it measures the patient’s sugar level over the last two to three months and the desirable levels should be between 6.5 to 7%. Another assessment criteria are looking for anxiety, speech slurring, and tremors in the patient. These are signs of hypoglycemia and should be treated with 50% dextrose. Furthermore, the nurse can assess the pulse rate of the patient, sensation, and color as this helps in neuropathy and peripheral perfusion monitoring (Vera, 2017).

Additionally, assessment should integrate aspects like physical activity pattern assessment, assessing the knowledge of the patient on understanding the prescribed diet. This is particularly important because physical activity helps in lowering sugar level and if one does not adhere to dietary guidelines, it can lead to hypoglycemia or hyperglycemia (Vera, 2017).

Recent Medical and Nursing Management Strategies for Diabetes Mellitus

Management strategies for type I diabetes mellitus

Lifelong therapy of insulin is needed for patients with type I diabetes mellitus. These patients mostly require at least two insulin injections every day. Recent medical and nursing strategies for diabetes type I mellitus includes but not limited to: Ensuring a tight glycemic control. Tight glycemic control is beneficial as it reduces microvascular complications rate and the overall cardiovascular and mortality rates. Tight glycemic controls maintain the HbA1c at 8% and have high chances of improving the diabetic patient. Another recent strategy is the use of Self-Monitoring of Glucose. Patients can use machines that help in allowing rational optimization of and adjustment in the doses of insulin levels. Two to four measurements should be taken daily including the fasting levels. Such patients can also test for ketones in urine by use of commercially available urine reagent strips. These patients should do so when experiencing polyuria, vomiting or nausea, symptoms of cold or flu.

Another strategy is the use of Continuous Glucose Monitors (CGMs). These devices measure interstitial glucose in every one to five minutes by use of subcutaneous sensors. Use of these devices helps the patient to prevent glucose variability since the glucose will not fall rapidly. The artificial pancreas is also one of the latest development in managing diabetes. These pancreases have closed-looped systems that improve the glycemic control for those having diabetes type II mellitus. This pancreas is configured with a smart phone to receive data from the CGM. Another strategy for diabetes type I mellitus is the use of Insulin Therapy. These therapies can be short, rapid or intermediate and long action (Romesh, 2016).

Management of diabetes type II mellitus include setting appropriate goals, seeking medications like pharmacologic therapies (Skidmore, 2014), doing laboratory assessments, regular complications monitoring, exercise and dietary modifications and appropriately self-monitoring glucose (Potter, 2010)

Management of Diabetes Mellitus in UAE and Morocco in comparison to above

High levels of undiagnosed diabetes mellitus both in UAE and Morocco is an opportunity for application of the recent nursing interventions. Current nursing interventions in UAE includes screening for diabetes. Screening targets people with pre-diabetes hence giving them an insight of their diabetic status. Tests like oral glucose tolerance tests are currently being done in both UAE and Morocco. They are also applying the modern tests like HbA1c screening and fasting glucose (Hawamdeh, Almakhzoomy, & Hayajneh, 2013). Another strategy applied in UAE is a prevention of diabetes via lifestyle interventions. There are appropriate diet consumption and frequent performance of exercises. Also, they have taken up disease management strategies such as insulin therapies and other medications aimed at lowering sugar levels for diabetic patients.

Conclusion

Diabetes mellitus is a phenomenal world epidemic. It results in serious metabolic complications and even several deaths worldwide. We can conclude that both types I, II and gestational diabetes mellitus are equally dangerous and serious interventions should be taken up to facilitate management and treatment of patients suffering from this disease. Most of the recent interventions for management of diabetes mellitus is a universally applied across the world. It is true that countries like Morocco and UAE are embracing these recent interventions.

References

Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetes. The Lancet, 383(9911), 69-82.

Hawamdeh, S., Almakhzoomy, I., & Hayajneh, Y. (2013). Screening and correlates of depression and HbA1c in United Arab Emirates (UAE) women with diabetes. Perspectives in Psychiatric Care, 49(4), 262-268.

Ozougwu, J. C., Obimba, K. C., Belonwu, C. D., & Unakalamba, C. B. (2013). The pathogenesisand pathophysiology of type 1 and type 2 diabetes mellitus. Journal of Physiology and Pathophysiology, 4(4), 46-57.

Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.

Mandal, M. D. (2016, June 20). Diabetes Pathophysiology. Retrieved February 21, 2017, from http://www.news-medical.net/health/Diabetes-Pathophysiology.aspx

Potter, P. & Perry, A. (2010). Clinical Nursing Skills & Techniques (8th ed). Philadelphia: Elsevier

Pagana, K. & Pagana, T. (2013). Mosby’s Diagnostic and Laboratory Test Reference (11th ed.). St. Luis Missouri: Elsevier

Skidmore, L. (2014). Mosby’s 2014 Nursing Drug Reference (27th ed.).Texas: Elsevier

Diabetes Mellitus - National Library of Medicine - PubMed Health. (n.d.). Retrieved February 21, 2017, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024704/

Vera, R. M. (2017, February 06). 13 Diabetes Mellitus Nursing Care Plans. Retrieved February 21, 2017, from https://nurseslabs.com/diabetes-mellitus-nursing-care-plans/

Rhomesh Khadori, George T, Griffting (2016). Type 1 and 2 Diabetes Mellitus Treatment & Management. Retrieved February 21, 2017, from http://emedicine.medscape.com/article/117739-treatment#d1