Diabetes and Diabetic Nurse Education and Practice

Diabetes is diagnosed by many tests such as:

Random blood sugar test: This is the primary screening test for type 1diabetes. A blood sample is taken at a random time. Regardless of when your child last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL), or 11.1 mill moles per liter (mmol/L), or higher suggests diabetes.

Glycated hemoglobin (A1C) test: This test indicates your child's average blood sugar level for the past two to three months. Specifically, the test measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). An A1C level of 6.5 percent or higher on two separate tests indicates diabetes.

Fasting blood sugar test: A blood sample is taken after your child fasts overnight. A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher indicates type 1 diabetes.

These additional tests include:

 Blood tests to check for antibodies that are common in type 1 diabetes

Urine tests to check for the presence of ketones, which also suggests type 1 diabetes rather than type 2 After the diagnosis Patient will need regular follow-up appointments to ensure good diabetes management and to check his or her A1C levels. The American Diabetes Association recommends an A1C of 7.5 or lower for all children. Doctor also will periodically use blood and urine tests to check patient :

• Thyroid function
• Kidney function
• Assess your child's blood pressure and growth
• Check the sites where your child tests blood sugar and delivers insulin
• Patient will need regular eye examinations. Patient also might be screened for celiac disease at the time of diagnosis of diabetes and at intervals afterward, depending on your child's age and symptoms.

Clinical Endocrinology and metabolism is a field of medicine; more precisely a sub-specialty of internal medicine, which mainly deals with the investigation and management of sicknesses related to hormones. The human endocrine system involves number of glands. These glands harvest and release hormones which monitor many important function of our body. When the hormone exits the gland they reach the bloodstream and are moved to organs and tissues in every part of the body. Endocrinology also concentrates on the endocrine glands and tissues that secrete hormones. The human endocrine system comprises of several glands. These glands harvest and secrete hormones which regulate the body's metabolism, growth, sexual development and function. Hormonal imbalance in our body henceforth leads to diabetes

Geriatric Diabetes is a chronic, progressive disease that can have serious implications for the well-being of both patients and their families. They may have vision and dexterity problems that interfere with their ability to take their medication. Many may have lost spouses and friends and live on their own, which can contribute to depression and poor eating habits. If older patients are experiencing hypoglycemia, they can be at risk for falls which can further compromise their independence, making diabetes care harder. They evaluates the physical, social and emotional/cognitive status of patients and identifies specific barriers patients and families have in performing diabetes self-management skills.

Each patient undergoes a comprehensive evaluation that includes assessments of:

• Medication use
• Hypoglycemia severity & frequency
• Problem solving skills
• Nutritional intake
• Social background & support system

Gestational diabetes is developed during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects the usage of glucose by cells. High blood sugar can be caused by gestational diabetes and this can affect the pregnancy and the health of baby. Gestational diabetes can be controlled by women by eating healthy foods, exercising and taking medication if necessary. Controlling blood sugar can prevent a difficult birth and can keep both the mother and baby healthy. In gestational diabetes, blood sugar returns to normal soon after delivery. But a person having gestational diabetes can have a risk for type 2 diabetes.

• Excessive birth weight
• Early (preterm) birth and respiratory distress syndrome
• Low blood sugar (hypoglycemia)
• Type 2 diabetes
• High blood pressure and preeclampsia
• Ophthalmologic problem in Diabetes

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 the 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.

• Visual Impairment
• Cataracts
• Glaucoma
• Retinal detachment
• Diabetic Retinopathy
• Background retinopathy
• Proliferative retinopathy
• Diabetic maculopathy

The risk of CVD mortality in type 2 diabetic patients is more than double compared with that in age-matched subjects. Stroke events and all manifestations of CHD, myocardial infarction (MI), sudden death, and angina pectoris is at least twofold more common in patients with type 2 diabetes than in non-diabetic individuals. A high proportion of patients with type 2 diabetes die after an acute MI within 1 year, and a considerable number of patients die outside the hospital. Relative risk for CHD events is higher in female patients with type 2 diabetes than in male patients with type 2 diabetes. The reason for the sex difference is largely unknown but could be at least in part explained by a heavier risk-factor burden and a greater effect of blood pressure and atherogenic dyslipidemia on the risk of CVD in diabetic women than in diabetic men.

• High Blood Pressure
• Heart Disease
• High Blood Glucose
• Damage of Blood Vessels
• Atherosclerosis and Hypertension
• Shortness of Breath
• Diabetic Neuropathy

Diabetes specialist nurses play a crucial role in screening diabetic persons, detecting early onset of diabetes, assessing nutritional needs of the patient, promoting self-management, providing prevention advice, spreading awareness on diabetes and also providing health coaching. In this context, it is extremely necessary for nurses to be well educated, trained and skilled adequately to be able to proficiently deliver care, support self-management and provide advice to diabetic persons.

• Diabetic Nursing Education
• Diabetic Nursing Management
• Diabetic Nursing Care
• Diabetic Nursing Assessment
• Nursing Priorities
• Nursing Interventions
• Discharge and Home Care Guidelines

Innovations in Diabetes Research:

• Vaccination
• Engineered Beta Cells
• Artificial Pancreas
• Islet Neogenesis
• New Anti-Diabetic Drugs
• Intensive Combination Therapies
• Development of Diabetic Diet

Molecular Biomarkers can be demarcated as a characteristic that is accurately measured and gauged as an pointer of normal biological procedures, pathogenic procedures, or pharmacologic responses to a pharmaceutical intervention. Biomarkers play a vital part in leading clinical trials and treating patients. Advances in molecular diagnostics help medical professionals make knowledgeable, scientifically valid decisions. More well-organized discovery and usage of biomarkers in the growth of antidiabetes drugs will depend on accelerating our understanding of the pathogenesis of diabetes and specifically its macrovascular complications.  Procedural improvements from other fields, especially cancer, are beginning to show the way towards better models of diabetes pathogenesis and molecular biomarker discovery.

A primary role for nurses is that of a diabetes self-management educator who provides information to patients with pre-diabetes and diabetes in an effort to help patients make informed decisions about prevention and managing their condition. With a focus on helping people make lifestyle changes that contribute to improved health, the duties of a diabetes educator include:

• Working with patients to assess their needs and to develop a plan that includes educational interventions and self-management support strategies appropriate for the patient
• Providing education that helps the patient accomplish self-management goals
• Evaluating patients periodically to determine if they are meeting their goals or if they need other interventions and future reassessments
• Developing, with the cooperation of the patient, a personalized follow-up plan for ongoing self-management support
• Documenting the assessment and education plan, as well as interventions and outcomes
• Diabetes nurse educators provide services in hospitals, physician offices, pharmacies, patients’ homes, and other settings. Advanced practice registered nurses typically serve under a primary specialization in their patient population focus, allowing them to further specialize as adult, gerontological, or pediatric diabetes educators.

Certificate programs and Nursing continuing education in diabetes management is available for both nurses with an undergraduate degree and for advanced practice nurses who already hold MSNs. These post-baccalaureate and post-graduate certificate programs typically cover the following areas:

• Pathophysiology, classification, and diagnosis of diabetes mellitus
• Complications associated with diabetes
• Oral medications and insulin therapy

Non-drug therapies for diabetes, including exercise, nutrition, and other lifestyle and behavioral modifications

While some MSN programs with a diabetes nursing specialization are available, it is much more common for nurses interested in advanced practice to pursue graduate-level education in a primary patient population focused specialization, such as one designed for adult, pediatric, or family nurse practitioners or clinical nurse specialists. Advanced practice registered nurses interested in diabetic care may take diabetes-related classes during their graduate program, and could arrange to have diabetic care included in the clinical experience component of their education.

Registered Nurses are eligible for certification as Certified Diabetes Educators (CDE) through the National Certification Board for Diabetes Educators. In addition to holding a current, active RN license, nurses must have a minimum of two years of professional experience as an RN. They must also have no fewer than 1,000 hours of experience in diabetes self-management education, with a minimum of 400 hours of experience during the year just before applying for certification, as well as 15 clock hours of continuing education related to diabetes within the two years before applying. The certification exam is given twice a year, in the spring and fall, for a one-month period, through AMP Assessment Centers.