UNIT – I

Introduction
 Introduction to Diabetes as Non-communicable disease burden - global &
national - Review
 Diabetes risk factors, preventive measures & risk reduction measures
Role of nurse in national programs relevant to Diabetes prevention, control and care

[Link] TO DIABETES AS NON COMMUNICABLE DISEASE

BURDEN - GLOBAL & NATIONAL - REVIEW

The earliest known record of diabetes was written on 3rd Dynasty Egyptian Papyrus
by Physician ‘Hesy- Ra’. He started recurring urination as a sign of this illness. The
Indian physician Sushruta in the 6th century B.C. noticed the sweet nature of urine in
such patients and termed the condition [Link] per Indian Council of
Medical Research – India Diabetes (ICMR INDIAB) study published in 2023, the
prevalence of diabetes is 10.1 crores. Responding to the increasing burden of
diabetes around the world, the World Health Organization has launched the Global
Diabetes [Link] WHO Global Diabetes Compact has the vision of reducing
the risk of diabetes, and ensuring that all people who are diagnosed with diabetes
have access to equitable, comprehensive, affordable and quality treatment and care.
The work undertaken as part of the Compact will also support the prevention of type
2 diabetes from obesity, unhealthy diet and physical inactivity.

Diabetes is one of the top five leading causes of death in most developed countries.
The World Health Organisation (WHO) predict that the current diabetic population of
177 million (estimate 2000) people will increase to 370 million by the year 2030.
Diabetes has become a major health issue in South-East Asia. India has the largest
diabetic population and one of the highest diabetes prevalence rates in the world.
The prevalence rates for type 2 diabetes in India are still increasing sharply with the
number of sufferers predicted to rise from 19.4 million in 1995 to 80.9 million in 2030.

Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and
lower limb amputation.A healthy diet, regular physical activity, maintaining a normal
body weight and avoiding tobacco use are ways to prevent or delay the onset of type
2 diabetes. Diabetes can be treated and its consequences avoided or delayed with
diet, physical activity, medication and regular screening and treatment for
complications.

DIABETES is a group of metabolic disease characterized by hyperglycemia resulting

from defect in insulin secretion, insulin action or both. Globally: 382 million people
had diabetes in 2013, by 2035 this number will rise to 592 million. India: 65.1 million
people had diabetes in 2013, by 2035 this number will increase by 70.6%. The adult
pancreas is a transversely oriented retroperitoneal organ extending from the “C” loop
of the duodenum to the hilum of the spleen.

Exocrine secretions :

Pancreatic juice enzymes promote the digestion of carbohydrates, proteins and fats.
Endocrine secretion:

Insulin and glucagon-enter portal vein-transported directly to the liver-

regulate metabolism of carbohydrates, proteins, and fats.

 15-20% alpha cells synthesize and secrete GLUCAGON .

 70-80% beta cells synthesize and secrete INSULIN
 1-8% delta cells synthesize and secrete STOMATOSTATIN and GASTRIN
 1-2% F-cells Secrete PANCREATIC POLYPEPTIDE which decreases the
absorption of food from the GIT
 Polypeptide hormone Produced by Beta cells of islets of Langerhans of
pancreas.
 Insulin is a protein made of 2 chains-alpha and beta.
 Anabolic hormone
Regulation of insulin secretion:

Factors stimulate insulin secretion: Glucose, Amino acids, Gastrointestinal

hormones.

Factors inhibit insulin secretion: Epinephrine

Action of Insulin :

 Stimulate activity of glycolytic enzymes

 Reduces the activity of the enzymes of gluconeogenesis
 Increased synthesis of glycogen
 Increased uptake of glucose by resting skeletal muscles
 Reduction of blood glucose level
 Reduction of lipolysis and stimulation of lipid synthesis

Pancreas secretes 40-50 units of insulin daily in two steps : Secreted at low levels
during fasting, increased level after eating, an early burst of insulin occurs within 10
minutes of eating, the proceeds with increasing release as long as hyperglycemia is
present

CLASSIFICATION BY AMERICAN DIABETIC ASSOCIATION 2009

 Type-1 diabetes  Type-2 Diabetes  GDM  Secondary DM

Diabetes is a chronic disease that occurs either when the pancreas does not
produce enough insulin or when the body cannot effectively use the insulin it
produces. Insulin is a hormone that regulates blood glucose. Hyperglycaemia, also
called raised blood glucose or raised blood sugar, is a common effect of uncontrolled
diabetes and over time leads to serious damage to many of the body's systems,
especially the nerves and blood vessels.

[Link] RISK FACTORS, PREVENTIVE MEASURES & RISK

REDUCTION MEASURES

DIABETES RISK FACTORS:

Non-modifiable risk factors for Type 2 diabetes: Risk factors that increase your
risk for developing prediabetes and Type 2 diabetes that can’t be changed are:

 Family history: Some factors that increase the risk of diabetes are inherited from
our parents or close biological relatives. If the person have a blood relative with
diabetes, their risk for developing it is significantly increased.

 Race or ethnic background: there is a greater cance of diabetes for African-

American, Asian- American, Latino/Hispanic-American, Native American or of
Pacific- Islander descent.

 Age: The older we are, the higher the risk for prediabetes and Type 2 diabetes.
Type 2 diabetes generally occurs in middle-aged adults, most frequently after age
40. But health care professionals are diagnosing more and more children and
adolescents with Type 2 diabetes.

 Gestational diabetes: During pregnancy,there is increased risk of developing

diabetes.

MODIFIABLE RISK FACTORS

Weight: Being overweight or obese increases the risk of developing diabetes.

Losing 5% to 10% of your body weight—in addition to getting regular physical activity
—can significantly reduce the risk of developing diabetes. The risk decreases even
more as they lose more weight. For most people, a body mass index calculator will
provide a good target weight for their height.

 Physical activity: Physical inactivity is a key modifiable risk factor for prediabetes
and Type 2 diabetes. Regular physical activity helps lower insulin resistance. This
means the body can use its own insulin more effectively. Even a brisk 30-minute
walk at least five days a week has been shown to significantly reduce the risk of
diabetes and heart disease.

For the overall cardiovascular health, aim for:

- At least 150 minutes per week of moderate-intensity aerobic physical

activity;
Or
- 75 minutes per week of vigorous-intensity aerobic physical activity (or a
combination of the two);
And
- muscle-strengthening at least two days per week.
 Blood pressure: In addition to causing damage to the cardiovascular system,
untreated high blood pressure has been linked to complications from diabetes.
People with diabetes and HBP should maintain a blood pressure of less than 130/80
mm Hg. Normal blood pressure is below 120/80 mm Hg. Learn more about high
blood pressure and how to control it.

 Cholesterol (lipid) levels: Diabetes is associated with atherosclerosis (hardening

of the arteries) and blood vessel disease. Low HDL “good” cholesterol and/or high
triglycerides can increase the risk for Type 2 diabetes and cardiovascular disease.
Following a healthy eating plan, getting regular physical activity and reaching and
maintaining a healthy weight can help improve abnormal lipid levels. Sometimes,
medications are also needed.

 Smoking: If you smoke, there are a number of tools, medications and online
resources that you can use to help you quit. Talk to your health care team about the
best options for you.

 Diet: It’s important to eat healthy foods in the right amounts. Diet is one of the
most important modifiable risk factors for prediabetes and Type 2 [Link]
American Heart Association recommends an eating plan that includes fruits and
vegetables, whole grains, skinless poultry, fish, legumes, non-tropical vegetable oils
and unsalted nuts and seeds. A healthy diet should also replace saturated fats with
monounsaturated and polyunsaturated fats, avoid trans fats, reduce cholesterol and
sodium (salt) and limit red and processed meats, refined carbohydrates and
sweetened beverages.

 Alcohol: Heavy use of alcohol can cause inflammation in the pancreas and limit
its ability to produce enough insulin. Alcohol can cause liver damage and adds more
sugar and starch to the diet that must either be used or stored as fat.

 Stress and well-being: Everyone feels stress, but people react differently.
Managing the stress in our lives is an important part of healthy living

 Sleep: Adults should get seven to nine hours of sleep a night. Sleep benefits your
whole body, including the heart and brain. It improves mood, memory and reasoning.
Research also has shown that too little or too much sleep is linked to a high A1C in
people with Type 2 diabetes. If person have insomnia (trouble going to sleep or
waking up too soon) or sleep apnea (problems breathing while asleep), work with
your health care team to diagnose and treat them. Learn why sleep is essential to
overall health.

Gestational Diabetes:

Risk for gestational diabetes (diabetes while pregnant) if:

 Had gestational diabetes during a previous pregnancy.

 Have given birth to a baby who weighed over 9 pounds.
 Are overweight.
 Are more than 25 years old.
 Have a family history of type 2 diabetes.
 Have a hormone disorder called polycystic ovary syndrome (PCOS)
Gestational diabetes usually goes away after give birth, but increases
risk for type 2 diabetes. Baby is more likely to have obesity as a child or teen, and to
develop type 2 diabetes later in life. Before get pregnant, may be able to prevent
gestational diabetes with lifestyle changes. These include losing weight if
overweight, eating a healthy diet, and getting regular physical activity.

[Link] OF NURSE IN NATIONAL PROGRAMS RELEVANT TO DIABETES

PREVENTION, CONTROL AND CARE

WHO aims to stimulate and support the adoption of effective measures for the
surveillance, prevention and control of diabetes and its complications, particularly in
low- and middle-income countries.
To this end, WHO:
 Provides Scientific Guidelines for The Prevention Of Major Noncommunicable
Diseases Including Diabetes;
 Develops Norms and Standards for Diabetes Diagnosis And Care;
 Builds Awareness on The Global Epidemic of Diabetes, Marking World Diabetes
Day (14 November);
 Conducts Surveillance of Diabetes And Its Risk Factors.

In May 2022 the World Health Assembly endorsed five global diabetes coverage and
treatment targets to be achieved by 2030.

DIABETES PREVENTION

The best way to stop the diabetes epidemic is [Link] Centres for Disease
Control and Prevention report that one in four people who have diabetes don't know
it. This is why it is important for nurses to provide patient education, not only to those
diagnosed with diabetes, but those who are at high risk for developing diabetes.
 Nurses can help by:

 Educating patients about risk factors, like family history, advancing age, excess
weight and a sedentary lifestyle.

 Partnering with patients to develop personal prevention strategies like limiting

sugar and carbohydrates, increasing activity, aiming toward their ideal body weight,
and setting small weight loss goals.

 Teaching patients about critical lab values and how to recognize and report signs
and symptoms of hypoglycemia or hyperglycemia.

 Providing education and counselling for patients who are borderline diabetic or
have metabolic syndrome as well as patients diagnosed with diabetes.

The Front Lines Nurses are at the forefront of diabetes care. They are often
present at diagnosis and may care for patients throughout the life of the disease.
Watch patients' lab values closely, particularly the A1C, C-reactive protein and
fasting blood glucose values. Provide information on topics related to diabetes to
both patients and caregivers.

Diabetes Education Topics Lifestyle

Disease and Management Healthy food choices

DIABETES EDUCATION TOPICS :

LIFE STYLE Disease and management

Healthy food choices Types of diabetes
Foods to eat : nuts,oatmelas Pre diabetes
Foods to avoid : sugar,white flour Metabolic syndrome
Exercise
Smoking Management
Impact of smoking on diabetes -blood glucose monitoring
Smoking cessation strategies ·Hypoglycemia signs and management ·
-Insulin administration
Diabetes Nurse Educator:

Nurses who want to specialize in diabetes education can become a Certified

Diabetes Care and Education Specialist through the National Certification Board for
Diabetes Educators, or become a diabetes nurse (although that requires an MSN).

These roles are vital to help patients:

 Identify their risk factors

 Identify if they have diabetes or prediabetes

 Work through the emotional and physical response to a

diagnosis

 Identify resources in their community

 Manage their disease throughout all stages of life to minimize

nerve damage and other symptoms .