Diabetes and Self-Care Ability of High School Diabetics

The diabetes menace has become on of the central health challenges that ail our contemporary society. The trends have change significantly over the last 50 years and now the high school population that suffers form diabetes has vastly increased. This is informed by the predisposing factors that the children are exposed to at their younger age and the fewer physical activities like sports that they engage in before the high school stage. The dietary habits of most young children is yet another factor that leads to the development of diabetic conditions among the children with the easiest foods that they indulge in on a daily basis being high sugar low-carb diets. These being the prevailing facts, there is need to have an intervention plan which will help the high school students who suffer from diabetes to better handle the condition. This is a plan that is aimed at ensuring that the students lead a near normal life and are informed about their condition such that they do not have to limit their lifestyle for fear of having diabetic attacks and yet far away from a doctor. It is an intervention plan that will also help both those suffering from diabetes and those living with them know the kind of simple physical activities and social activities that they can engage in to ensure they lead healthy lifestyles that do not predispose them to obesity which is closely related to diabetes.

Abstract

The diabetes intervention plan herein involves a two pronged approach which looks at the social cultural lifestyle of the individual, as well as the medical intervention that is suitable for the diabetic students. The intervention focuses on the high school students since this is the age group that can me entrusted with medical equipment and drugs and be trained on how to administer it to self successfully. This age is considered as one that has the basic skills that can be built on and be left to be sufficient at their own implementation of the training that they receive. The intervention is meant to be multifaceted in the results that it will achieve in that the individual students with diabetes will gain in getting to know how to handle their condition, and the general public, here the students of the selected high school, will have the requisite knowledge on how to handle diabetes and whet they need to do to avoid developing diabetes as well.

This proposed intervention plan will be in three basic categories; the implementation plan, evaluation plan and dissemination plan. The implementation plat will essentially look into how the students can be equipped to handle their conditions and the physical activities and the schedule that they can adopt to better manage their diabetic conditions. The evaluation plan will highlight how the researcher will monitor the success or lack of it in the implemented intervention plan. This evaluation will give the directions on what need to be changed in order to make the intervention plan work best. Dissemination plan will highlight how the intervention plane is envisioned to be passed down to the students and the main stakeholders who will assist in ensuring the plan comes in actualization.

Problem statement

Diabetes has been one of the biggest challenges faced by the health sector in the recent decades. There have been soaring numbers of fast foods across the nation and with them the subsequent rise in the number of diabetic population and in specific the high school students who hardly have any time to cook or access healthy foods hence opting for the fast foods during their breakfast hours and lunch break. The change in the feeding habits is significantly informed and shaped by the change in trends and lifestyle where eating in fast foods is seen as both a fashionable trend and convenient despite the outright health challenges that come with it like the predisposition to obesity and diabetes due to wrong diet. Ferguson, T., Tulloch-Reis, M., Wilks, R. (2010) note that the last 50 years have seen the highest number of Western fast foods mushroom across the world and with it the significant rise in the number of diabetes cases, especially among the women.

Unfortunately, most of the diabetic students in high school still depend on the nearest doctors to attend to them in situations where they encounter diabetic attacks and regular check ups of simple things like the sugar levels in the blood. It is also unfortunate that most of the high school students, due to the cultural foods they are accustomed to from the young age, they do not know what categories of foods are healthy for them as diabetics hence indulge in almost any unhealthy foods they get without knowing the consequences. There is general lack of knowledge on the foods that are healthy and the quantities that need to be taken in line with the advice of the dieticians. This is yet another area where the plan intends to outline and highlight so that the students are able to initiate healthy eating programs for the good of their own health.

Thirdly and finally for this paper, there is the problem of social lifestyle and its connection to the menace of diabetes among the high school students. The docile lifestyle has facilitated the increase in numbers of obese students, which is a predisposing factor to diabetes. The plan will seek to inculcate the culture of active leisure as opposed to the prevailing dormant or docile leisure. The plan will suggest several ways that the students can strengthen their social ties through active leisure and also develop personal exercise schedules that suit their programs and academic schedules.

In light of these facts aforementioned, there is need to have a well structured and easy to understand approach towards empowering the high school students to take care of themselves in the event that they happen to develop diabetes. The plan needs to cover the three problem areas identified above and also be comprehensive enough yet simple enough to follow and implement for the students. The plan also needs to be one that can be monitored by the people whom the students interact with frequently, in this case the teachers in order to ensue the intervention is efficient and safe for the students. The ease of application of this intervention and the safety among the teenagers will be the two pivotal points that will give the intervention the advantage and acceptability among the students.

The intervention above is grounded on the self-care theory developed by Dorothea Orem. The proposed approach that will guide the formulation of this intervention and which is best and suitable for high school students is the Self-care theory which was formulated by Dorothea Orem who was determined to see improvement in quality of nursing in general hospitals. It is upon the basis of this theory and the assumptions therein that the assessment of the knowledge that students have and the application of the knowledge of diabetes management will be based.

There are basic assumptions or tenets that guide and shape the self-care theory; one significant one is that people should be self-reliant and responsible for their own care as well as those of the family members who may be in need of the health care. The theory also recognizes that people are different and unique for that matter. Self-care theory also indicates that nursing is an action that involves interaction between two or more persons to help improve the health of the patient. It also states that the knowledge of potential health problems is essential for the promotion of self-care behaviors or measures by the individual. The last but significant tenet is that the self-care and dependent care are both behaviors learned within a social cultural context (Alice P., 2015). These are the tenets that are essential and guiding in this proposed knowledge evaluation plan. With this approach or theory guiding the formulation and implementation of the intervention plan, there is likelihood of obtaining higher rates of success in the end result that is desirable for the program.

Proposed solutions

Bearing the nature of the problem of diabetes, this intervention plan will have a three tier approach to comprehensively handle the diabetes among the teenagers; the medical aspect, the dietary aspect and the physical activities/social lifestyle aspect.

Medical solution intervention plan

The diabetic students who agree to participate in the program will be located various days for the medical training and a team of qualified medics who are well versed on issue of diabetes will be conducting the training. The medics will spend at least three days with the students who will be in groups of 10 students per session. This low number of students per group is meant to ensure comprehensive contact and understanding of the medical facts and self initiated intervention. The medical approach will basically be meant to sensitize the students on what they need to watch out for symptoms of an impending diabetic attack. With the knowledge of the signs, they will then be trained on how they can initiate a personal remedy within the school without necessarily having to be rushed to the hospital.

The medics will educate them on the procedure and the medicine that they need to always have with them to help them out of attacks. The students will also be educated on the regular medical procedures that they need to carry out like measuring of the blood sugar levels, the BMI ratios and such factors. The medical team will also ensure that the proposed or prescribed medication approach will be on an individual basis after a medical procedure and test is conducted since each person has different levels of blood sugar and different people develop different types of diabetes.

Once the medical team has conducted a comprehensive evaluation of each student and diagnosis of their diabetes, a customized medical pack will be issued to each student and the instructions on how to use it will be issued. The students will be made to conduct a mock self-medication procedure with the supervision of the medics to ensure that they understood the entire procedure. This is a safety measure to ensure that the students are safe once they are left on their own.

The medics will further advise the school administration on the importance of having self-care for the diabetic students and the need to support such an intervention plan within the school. The concerned teacher will be also trained to help him in assisting the students refurbish their medical supplies in their personal medical kit on a regular basis depending on the use that the individual student puts the medicine into. It is also essential that the medical team revisits the institution at bleats twice a year to review how the implemented plan runs and also to know the effectiveness and the challenges that the intervention has faced. This will help not only in correcting the areas that have missed the intended goals, but also to reinforce the positive areas that have achieved the intended end goal.

The medical training sessions will be annually conducted, with the first training being for the entire population hence will be expected to take longer, but the subsequent trainings will basically be for the new students joining the institution hence will take relatively shorter period to conduct. The medical training will be in close conjunction with the medical department of the institution to ensure that the intervention plan is widely acceptable and well understood by all the stakeholders. The school administration will be duly informed of each step of the training and intended outcomes that the trainers are targeting.

This measure is in line with the third tenet of Orem’s self-care theory; the health deviation self-care which entails seeking medical attention when one falls ill, being aware of the pathologic effects of conditions, carrying out the medical prescriptions, adjusting oneself in line with the prevailing state of health and learning to live with the pathologic conditions.

Dietary training for the diabetic

Probably this is the biggest contributor to the issue of diabetes among the youth across the globe. The feeding habits that are catching up across the world have given little space and priority to the healthy foods as was the case before, instead the junk food with their mass fat deposits and high levels of processed sugars in them have significantly predisposed the young consumers to obesity which is known to be a causing factor to diabetes, when eaten over a long time as a routine. Unfortunately, Western lifestyle that is catching up in most parts of the world, lesser exercises, sugar filled meals, sodium and cholesterol are the order of the day that increase the obesity and subsequently diabetes rates in the U.S.A. plus other consequent conditions that come with obesity (Sidiga A.W. & Maha B.A., 2010 ). Worse still, the lack of knowledge and information among the teenagers also works to further expose them to diabetes. They don’t seem to know the health risks that are involved in eating fat rich foods as well as the possible health complications that they may have. The intervention plan will therefore look into the diet of the students and sensitize them on the best possible meals to take in order to keep diabetes away or to effectively manage the condition.

The intervention plan will hence focus on the diet that the students suffering from diabetes need to observe. With the help of a dietician, the students will be taught what is contained in some of the most commonly available foods in the fast foods and stores around the community and school. They will also be trained on what actually constitutes a healthy meal for a diabetic person. The students will also be practically shown how to averagely calculate the nutritional values that they will be taking in hence be able to independently estimate the kind of foods that they need to eat and the quantities.

The dietary training will also not be randomized in application but will have an individualized aspect in it where each student will be diagnosed and a personal diet schedule and plan drafted out for them in order to manage both diabetes and obesity, if they happen to be obese. The plan will include a wide variety of locally available foods as possible so that the student will not feel missing out on the cultural trends, but the balance in terms of the intake quantities ill need to be of the ratios that are healthy for the individual diabetic student.

In order for this specific dietary program to effectively work as an intervention measure, there will be need to persistently remind the students of the importance to have a continuous implementation of the diet as guided and the benefits of eating healthy foods. This is one of the most important aspects of the intervention and yet the most challenging in terms of implementation since it will involve change of culture and digressing from a lifestyle they had been used to over a good number of years.

This measure is palatable to the Second tenet of Orem’s self-care theory towards achieving good health as an individual. The second tenet under the self-care theory is the developmental self-care requisites which is mainly based on the development of the students, including adjusting feeding habits to the body changes that they experience in high school in order to lead a healthy life. The intervention plan will involve making the students, especially the females, aware of the body changes during adolescent and also sensitizing them on what these changes may imply in terms of their predisposition to diabetes.

Active lifestyle/leisure

In the U.S., many of the teenagers are seen to prefer docile leisure as opposed to active leisure. Most would rather stick to their computers playing games, or PlayStation or even just sit back the whole weekend watching movies than finding time to participate in active exercises. The sedentary lifestyle is directly associated to the possibility of an individual developing obesity due to accumulation of fats within the body. Obesity is known to come alongside other complications like shortness of breath, high blood pressure, lowered sex drive and of bigger concern diabetes. Diabetes is one of the most prominent complications that are caused by obesity in the U.S. than any other disease. It is worrying that even the young children under the age of 5 years, according to the Centre for Disease Control and Prevention (CDC) (2010), statistics have an ever increasing graph for diabetes. A disease that was once considered a disease of old age. Further shocking statistics from CDC has it that people with BMI of above 27 constitute 80% of the Type 2 of diabetes.

The diabetic students in this intervention plan will be advised by a qualified physical exercise professional on the types of active leisure and the procedure that they need to follow into the lifestyle of active leisure. The trainer will give them the practical approach and simple enough approach that they can individually do while at home even during the holidays. The students will be required to pick a schedule that suits the class program they reenrolled in. this will be the best way to ensure the exercise schedule goes trough since it will not be hindering the actualization of other equally important activities. The implementation of the physical exercise plan is aimed at making the social life of the students better in as much as it will be helping in the burning of calories, loss of weight and general healthy lifestyle.

This intervention is in line with the first tenet of Orem’s self-care theory. The first tenet of self-care theory indicates that one needs to get equipped with universal self-care requisites like life processes and maintenance of individual integrity and of the body, these include intake of water, air and food. It emphasizes on provision of care that is associated with elimination process, the balance of the physical activities, the social life and the emotional balance, avoidance of hazards to life and promotion of normal functioning. The plan will therefore help the individual students know the predisposing factors to diabetes and the steps that need to be taken to help avoid diabetes. Then it will draft a schedule of activities and the things to check out in instances the student already has diabetes. The plan will further give an array of activities that the students need to engage in to avoid being at risk of diabetes, the type of diet suitable and the social activities that are helpful in maintaining a healthy body.

Implementation of the solutions proposed

The diabetes intervention plan is an important plan that will see the lives and health of many students significantly impacted on. In order for this to materialize, the above drafted plan needs to have a clear implementation plan with the right stakeholders onboard.

The school administration will need to give their consent for the program to be implemented in their respective schools as will be identified by the intervention team. This means the team will have to get the consent of the administration of the school in advance in the form of a written letter of authority, with the terms and conditions well spelt out. This will only be possible after the intervention team shall have properly briefed the administration of the intention of the program.

Then with the consent of the administration, the team will set up a medical consultation tent within the school and pin up notices in school inviting the willing participant to the intervention program. The enrolling into the program will be purely on voluntary basis and the written consent form of the student will be obtained. The students will then be briefed on the objective of the entire exercise and what it would entail, their continued participation in the program will be purely voluntary and any candidate who feels like withdrawing from the program at any give stage of the plan will be allowed to do so without undue duress to stay on. Each participant will be informed of all the medical, physical and psychological procedures that may be involved in the program and any individual with questions will be effectively handled within the pre-admission stage. This is one of the most significant stages since the entire intervention program will strive to avoid ethical issues of bias and uninformed consent.

Once those who would like to participate have been settled upon, the students will be divided randomly into groups of 10 students per group through picking of mixed up numbers which will randomly locate them to groups of ten. The groups will then be allocated the time and venue of meeting the medical, dieticians and the physical trainer in the subsequent weeks. The participants will discuss with the moderators the proposed schedules and settle for the most suitable schedule as a group of ten. It is paramount to note that most of the decisions and activities that will be engaged in here will be widely participatory.

Evaluation plan of the intervention

The intervention, once implemented will need to be monitored and evaluated in order to have a clear sense of the direction and effect that the intervention has on the diabetic students. The evaluation will act to give developmental feedback on the progress of the program as well as to inform the changes that may be needed. The evaluation will also be important for the stakeholders who will be funding the program so that they can be duly informed that the project is well on course as the intended schedule and outcome. The evolution will also act as learning points which will be noted down and the falls avoided in the next projects that will be implemented in the future (CDC, 20018).

The evaluation will basically be in two formats; the first will be the stakeholder questions and criteria, and the second one is the external project evaluation. The internal or stakeholder evaluation schedule will enable the people directly involved in the project to find out the milestones that the project has achieved after the given period. The external evaluation measure will ensure that the objectivity that may be lacking in the internal evaluation is captured and the professional view and approach to the project is introduced into the lifespan of the project. A consulting firm that deals in project monitoring and evaluation will be contracted to carry out a comprehensive evaluation of the lifespan of the project and a detailed report presented to the stakeholders. The evaluation by the internal stakeholders will involve a collaborative effort by the sponsors of the project and the people entrusted with implementing the project. Questionnaire and interview schedules will be drafted and sessions with the beneficiaries of the project will be conducted. There will be 30 students from each class picked randomly and given questionnaires which they will fill and hand in within a week. Interviews will be important to capture the respondents’ opinions as well as body language which may give more information that the spoken work. It will also offer the opportunity for the interviewers to pose prodding questions in line with the answers that the respondents will be giving. An evaluation plan that will involve both the diabetic students who have undergone the sensitization and equipping as per the plan above as well as the non-diabetic students will be involved. There will be two major methods that will be used to evaluate the effectiveness of this intervention; the use of face-to-face interviews as well as the use of questionnaires. A representative sample of 30 students from each grade will be used in evaluation process. From the class selected, 15 students will be randomly picked among those with diabetes, and another 15 randomly from those without diabetes. This will be replicated in at least three other classes in order to acquire a representative number. The research assistants will first interview the participants and there after they will be given questionnaires to carry home and fill in accordingly. This double take will also help in finding the consistency in the information given since most of the questions will be a repeat of the interview but slightly changed.

The collected data will then be analyzed and then resultant information will be given to the stakeholders in form of easy to understand information, explaining the extents of success and the short coming noted therein.

Dissemination plan

Once the evaluation is done, the results and findings will need to be conveyed to the relevant school departments as well as parents of the teenagers who will be directly responsible for helping in implementation of the intervention plan. For the departmental heads and administration at school, there will be PowerPoint presentations prepared as well as printed results handed over to the departments for their review and continued implementation. There will also be emails sent out to the parents so that they are equipped with the relevant information and details pertaining diabetes management. The participating students in the research will also be given copies of the findings of the entire process so that they know the impact of their actions and its effectiveness in helping making the diabetes menace more bearable in the school and even beyond.

Literature review

Being a complex ailment, diabetes affects people numerous varying ways. The complexity of the disease indicates that the best way for managing it takes different varied forms and approaches and involves understanding the different social and psychological factors, medical measures as well as the physical ones, that interplay in both the development and the treatment of the disease. For example, it is common when somebody is first diagnosed with diabetes to be given information about what they can eat when they eat out at chain restaurants. This is important because it recognizes that culture and habit can play a role in the treatment — it takes time to break habits that have built up over the course of a lifetime. Nobody thinks that it is good for Type 2 diabetes patients to eat fast food, but the reality is that they probably will for a while until the habit can be broken, so the strategy is thus to mitigate the damage that the person might be doing to him/herself.

What therefore is diabetes? This disease is described by Australian Government, Department of Health and Ageing, (2012) as “a chronic disease characterized by high levels of glucose in the blood.” In the functioning of the body, blood sugar is controlled by insulin that is introduced into the blood stream and body system. Insulin is a hormone produced by the pancreas. Diabetes then comes about as a result of the pancreas, which should be responsible for generating sufficient quantities of insulin, fails to generate enough of it. Diabetes can also occur when the human body develops resistance to insulin hence fails to utilize it as required, in some instances both of these cases above do occur, occasioning diabetes on the human body.

There are three main categories of diabetes commonly referred to; Type 1 diabetes where the body immune system attacks the cells of the pancreas responsible for production of insulin. Type 2 diabetes that is activated by lifestyle and eating habits and the third is the gestational diabetes that occurs mainly during pregnancy (Diabetes Australia, 2013).

According to America Diabetes Association 25.8 million adults and children have been diagnosed with diabetes in the United States. There are approximately 2 million new cases of diagnosis that are done each year and approximately 79 million are considered to be in the pre-diabetes state. These masses of people have the risk of several alterations which include heart diseases, neuropathy, stroke, kidney failure and even blindness.

Pathophysiology of diabetes insipidus

In order to properly grasp the pathophysiology of diabetes, one should have the basic information of the metabolism of carbohydrates and how insulin functions. Diabetes insipidus is occasioned by the basic pathophysiological defect which is the autoimmune destruction of the beta cells found in the pancreas. With the beta cells are deformed of destroyed, the body is absolutely deficient of insulin and the body loses the ability to produce any more insulin from the pancreas. Environmental events such as viral infections can possibly trigger the autoimmune destruction of the beta cells. Genetically determined factors for susceptibility might increase of the autoimmune destruction. Due to the inability to produce insulin diabetes mellitus patients totally depend on insulin which is administered exogenously in order for them to survive (Mealey, 2010).

Normally, the electrolyte and volume homeostasis is a complex mechanism that creates a balance in the requirements for the blood pressure and electrolytes sodium and potassium. Volume regulation is normally preceded by electrolyte regulation. Diabetes insipidus is related the production of ADH which is produced in the hypothalamus. ADH functions as a regulator of water levels in the body through controlling urine produced within the liver. The diabetes insipidus patients have their ADH failing to regulate the level of water in the body thus a lot of urine is produced from the body.

Pathophysiology of diabetes mellitus

The basic pathophysiological defect in diabetes mellitus is characterized by three main disorders which are; an increase in glucose production within the liver, a peripheral resistance to insulin particularly within muscle cells and an alteration in the secretion of pancreatic insulin. The high levels of blood glucose occasions the production of insulin hence patients have excessive production of insulin. There is insulin resistance and hence body cells do not respond in an appropriate way in the presence of insulin (Mealey, 2010).

The main difference between diabetes insipidus, and diabetes mellitus, is that in diabetes mellitus insulin resistance is referred to being “post-receptor.” This implies that the problem lies with the cells which respond to insulin as opposed to there being a problem in the production of insulin. The onset of diabetes mellitus is often gradual and slow and it might advance unnoticed hence undiagnosed for a significantly long time. On the other hand, the onset of diabetes insipidus is abrupt and it might be diagnosed at any age.

Factors affecting diagnosis and treatment prescription of diabetes

There are various factors that might affect the diagnosis and treatment of these two types of diabetes.one of these factors is age; when it comes to diabetes mellitus age plays a big role in the diagnosis. This is because its onset is slow and thus it might not be diagnosed early in life. Therefore since it can not be diagnosed early in life it might be difficult to treat it once diagnosis is done since it might be late. Another factor that might affect the diagnosis and treatment is genetics. Both types of diabetes can be genetic and therefore if an individual from a family is diabetic it can be easy to predict that another member of the family may become diabetic. Genetics can therefore help in the early diagnosis of diabetes and hence treatment can commence at the earliest opportunity possible (MediLexicon International Ltd., 2013).

Similarities and differences between Type 1 and Type 2 diabetes

The division of diabetes into two major categories as indicated above, shows that there are several features that triggered the distinct categorization in line with the observable differences despite the fact that they are both diabetes.

Similarities;

According to Diabetic Supplies Inc. (2013);

Both type1 and type 2 diabetes are caused by insufficiency in insulin within the body system which triggers rise in blood glucose levels to the levels that the body is not used to. The use of injection of insulin to control the disease can and does apply to both types.

Both Type 1 and Type 2 diabetes predispose the victims to development of cardiovascular diseases.

Both types can and have led to Retinopathy, which is the leading cause of blindness of patients within the between the age gap of 30-69 as indicated by Baker IDI, Heart & Diabetes Institute (2013). Retinopathy is known to be so rampant among the diabetic patients that it is averaged to affect one in every six diabetes victims.

Both types of diabetes can cause impaired kidneys. The kidney function impairment is seen to be three times more prevalent among the diabetic people as compared to the non-diabetics. Diabetes is known to be the leading cause of kidney failure.

Both types are known to predispose the patients to neuropathy which is a peripheral nerve disease, as well as blood vessels damage that may lead to foot problems, ulcers and even amputation in some cases. Diabetes is known to be 15 times more the cause of amputation among those with diabetes as compared to those without diabetes.

Both types can also cause erectile dysfunction as well as complications during birth. Both types are also known to be the cause for the premature mortality rates with an estimated 12-14 years of life lost.

In both cases, the other similarity they have is that early detection, effective treatment and continued good management can significantly lead to reduction in the diabetic related complications and even death.

Differences; according to Rheem G., (2013) below are the differences between type 1 and type 2 diabetes;

While Type 1 diabetes is basically an auto-immune disease where the cells responsible for producing insulin in the pancreas are attacked by the immune system of the body and the person has no control over this, the Type 2 diabetes is caused by exposure to risk factors as docile living conditions, poor diet and obesity.

Type 2 diabetes can be managed through change of lifestyle, yet Type 1 diabetes renders the individual dependent on lifelong injection of insulin into the body to help manage the blood glucose levels.

Type 1 diabetes occurs mostly among young adults and children, yet the Type 2 diabetes is more prevalent among grownups of 40 years and above.

The patients with Type 1 diabetes often have normal weight and on the other hand those with Type 2 are often obese or overweight.

Type 1 diabetes is occasioned by the body producing no insulin or too little to be of sufficient function for the body while in Type 2 the body produces insulin but does not sufficiently utilize it.

The onset of the Type 1 diabetes is usually observed to be sudden while that of Type 2 is gradual and develops over years to reach full scale.

Type 2 diabetes and Chronic Kidney Disease

The leading cause of Chronic Kidney Disease (CKD) is diabetes which damages the tiny blood vessels in the kidney over a number of years (National Kidney Foundation, 2007). This is a condition that is caused by both types of diabetes and not restricted to Type 2 diabetes alone.

The kidney is made up of up to one million nephrons which act as the filter units of the kidneys. Within the nephrons are the glomerulus which are tiny blood vessels. Damage to these filters is what is referred to as the CKD or diabetic nephropathy. At this state the kidney cannot filer blood as efficiently as it should. Early detection and treatment can help save the kidneys from further damages. Since Type 2 diabetes is characterized by high blood glucose levels, the sugar in the blood, passing through the kidney can cause the blood vessels within the nephrons to be clogged hence get narrower than usual. This deprives the kidney of blood hence damaging the kidney. Therefore, albumin, a type of protein, passes through the kidney and the filters ending up in the urine yet this should not be case.

Diabetes is also known to damage the nerves within the body, yet it is the nerves that are responsible for the passing of information between the brain and the various body sections, the bladder included. The nerves informs the brain when the bladder is full and hence the need to empty it. When the nerves are damaged, such information on the bladder is not passed to the brain hence continued retention of the urine within the body. This builds up pressure and this pressure from the bladder can damage the kidney. The other effect is that, when the urine stays for abnormally long time within the bladder, it may cause urinary tract infection due to the bacteria in the urine.

Diabetes is a predisposing factor to CKD since it is estimated that a third of the people with diabetes end up with CKD. However, there are other factors that can contribute to the development of the disease such as the age (65 years and onwards), high blood pressure, family history of CKD and also race such as if one is African-American, Hispanic-American, Pacific Islander or American Indian then the risks are higher than the others. It is important generally to keep the blood sugar low and to manage the blood pressure too.

The symptoms of CKD are not very specific, however, one of the most significant sign is the fluid buildup within the body. Other symptoms include poor appetite, stomach upset, loss of sleep, weakness and lack of concentration (Kidney Health Australia, 2008).

Type 2 Diabetes prevalence among African-American women

It has been an established fact that of all the minority groups, the African-Americans have or are predisposed to the most health risks. They are unfortunately combated by more disabilities, diseases and the phenomenon of early death than the other minority groups.

This fact is made worse by the lack of medical attention when it is needed and still appropriate. This means that some ailments that could be handled if discovered in good time will go unnoticed at their initial stages only to be noticed at an advanced stage that treating kit may be impossible or very taxing.

Type 2 Diabetes is considered to be one of the most prevalent health conditions among the African-American population and the women in particular. It is statistically proven that among 55 years of age African-American women one in every four suffer from diabetes as highlighted by Womenshealth.gov (2010). This is the gap that is susceptible to the most serious consequences of diabetes like amputation of limbs and kidney failure.

These humanity demeaning health conditions are abetted by the poverty levels, lack of trust in medical systems, difficulty in accessing medical care, cultural differences as well as insufficiency of knowledge on the significance of regular screening.

However, the African-American women can still take charge of their lives and reduce diabetes to a considerable minimum. By one knowing the risks that they have and regular consultation with a doctor once you have known the risk factors is a sure way of keeping diabetes at bay.

In as much as some of the risk factors like genetics, age and race among others cannot be controlled, there are some preventive measures that the society can encourage its members to embrace as a reduction factor; maintenance of a healthy BMI is essential, a well balanced diet and avoiding fatty foods, making physical activity a habit and a limitation of alcohol are sure ways to minimize risks of developing diabetes (MedicineNet, 2012).

Management of Diabetes

Since diabetes is a condition that predisposes the body to other forms of diseases, it is significant for the person to know how to manage the condition, having known the type that ails them, so that he can avoid further complications.

Type 2 diabetes and how to manage it is of particular interest here, bearing the fact that it is the most prevalent type yet it is the one that can be avoided and even managed effectively to a point that it clears off.

The management of Type 2 diabetes can take two major approaches;

Diet modification- The patient needs to know that the excessive sugar in the blood is responsible for the Type 2 diabetes. Hence, the tight control of sugar levels within the diet of the individual will reduce significantly the risk of microalbuminuria. Intake of very low protein diet is another significant measure in controlling possibility of developing Type 2 diabetes. This is in recognition of the fact that a lot of protein strains the kidney and the kidney is overworked hence subsequent ineffectiveness (American Diabetes Association, 2013). People should also avoid fatty foods because they lead to weight gain which is a predisposing factor to diabetes. The patient should also be encouraged to eat high fiber carbohydrates instead of the refined ones that have no fiber.

Lifestyle changes — the docile lifestyle is a main factor to an individual gaining weight hence predisposing themselves to diabetes. Type 2 diabetes can easily be managed by regular exercises. The regular exercises ensures the control of the blood sugar as it gets metabolized in the process and also, taking into account the weight of most Type 2 diabetes victims, to prevent the possibility of cardiovascular disease (The Global Diabetes Community, 2013). The central reasoning behind the exercise and active lifestyle is that, the muscles that are active and working use up more glucose than docile muscles. The strained and exercising muscles lead to higher uptake of sugar by the muscle cells and the consequent lowering of the blood sugar.

Patient education and diabetes control

Patient education involves the health professionals and other related stakeholders imparting information and skills to patients and their caregivers so that there can be improvement of health status and also alter health behavior of patients. Those who may be involved in health education include physicians, pharmacists, registered nurses, psychologists, special interest groups, and pharmaceutical companies. Health education can also be used as a tool by managed care plans in general preventative education and health promotion. Some of the important elements that are supposed to be considered when dealing with patient education are skill building and responsibility. It is necessary for patients to know why, when and how they are required to make their lifestyle change. This process of patient education is capable of reducing healthcare costs.

Studies on cost containment show that, patient education results to a significant savings. Those patients who are educated tend to maintain better health and fewer instances of complications, and this makes them to be in need of fewer occasions of hospitalizations, visits to emergency department, as well as clinic and physician visits. While the growth of health care continues to outpace inflation in most nations globally, health policy makers have largely turned to concentrate more on cost containment.

Educating patients and involving them in their health management always results in lower costs. The savings come in the form of the healthcare having a smaller number of diagnostic testing expenditures in addition to fewer referrals. Patients who have been educated and involved in their health affairs tend to adhere more to the prescribed medical treatments with positive outcomes hence solution of the medical condition and no further need to visit the healthcare centers, (Coulter A, Ellins J., 2007). Educating the patients means that even the family members or caregivers are to be included in the ongoing education and this always improves functional status and quicker recovery.

Impacting patients with knowledge about their health and ways of managing it without having to depend on the help from the hospital or other people makes the patients themselves to feel more involved, empowered, and knowledgeable hence becomes more satisfied. Patients education have positive impact on self-management and behavior change on the part of the patients, which according to researches this have a direct impact on the health outcomes and the costs involved.

In the U.S. two-thirds of the populations are overweight or obese. According to the researches, the rising rates of obesity accounts for a considerable fraction of spending growth in America. These obese individuals have high chances of developing chronic diseases like hypertension, diabetes, heart disease, and asthma. People who have chronic conditions usually account for about 84% of the United State’s total cost of health care. A study done by Centers for Disease Control and Prevention in 2012 found that most of the chronic conditions are preventable, and in many occasion accelerated by a personal choice to be involved in unhealthy behaviors. Patients who have been well-informed and impacted with knowledge carry out more health-related behavior changes, like the ones pertaining dietary modification, exercise, and smoking cessation. Information as well as interactive tools support patients education and it plays a very important role in supporting prevention, wellness as well as management of chronic conditions.

Other studies by managed care organizations have generally indicated that patient teaching is cost-effective. Some of the summary of studies showing the cost-effectiveness of particular patient education programs included:

Chronic pain counseling in an outpatient clinic happened to reduce visits to the clinics by 36%. The cost was $101 per patient. The savings were $312 for each patient, resulting to a cost benefit ratio of 1:3:1.

Asthma group education happened to reduce emergency room admissions as well as hospitalizations. The cost for each patient was $37. The savings were $217 for each patient, resulting to a cost benefit ratio of 1:5:8.

Diabetes education within a public health department happened to reduce hospitalizations by 44%. The cost for each patient was $150. The savings were $442 for each patient, resulting to a cost benefit ratio of 1.29.

Prenatal/nutrition counseling as well as smoking cessation happened to reduce pre-term births from 6.9% up to 1.7%. The cost per patient was $93. The savings were $183, resulting to cost benefit ratio of 1:2.

Asthma pediatric education happened to reduce yearly emergency room visits from 7.4 to 1.9 for each child. The cost for each patient was $180. The savings were $687, resulting to a cost benefit ratio of 1:3:8.

(Cost-benefit ratio=cost of education for each patient divided by total saving for each patient.)

There was no studies which showed that costs went higher that savings. Averagely, each and every dollar which was invested in these as well as similar programs, between $3-4 was saved.

This indicates that the patient education is effective and every citizen has the obligation of making important health decisions that in turn affects the outcomes of healthcare. A strategy by most of our health facilities to support patient education should be among the most important plank of health policy, (Beck R.S., Daughtridge R., and Sloane P.D., 2002). Moreover, it is important to always have in mind that patients too have a significant role in understanding what causes their illness, taking appropriate action and protecting their health as well as managing chronic illness. Such roles should be recognized and supported by the stakeholders involved.

Ways of Improving Self-Management of Chronic Conditions in order to reduce the 30 day re-admission in the hospital

Generally three out of ten Europeans suffer from a long-standing illness or health problem. Many of their countries with their policy makers have now turned to look for ways in which they can apply so that they can shift their resources back to the patients and the community at large as an effort of dealing with chronic conditions more effectively thereby reducing 30 day re-admission in the hospital. More importantly they are search for ways of empowering individuals to manage their own health through providing them self-management knowledge.

Having patients educated on how to manage themselves can improve their understanding and knowledge of their continuous problematic conditions, how to cope with the condition, how to adhere to treatment recommendations, sense of self-efficacy as well as symptom levels. Some of the ways which can be applied is using computer-based self-management education and support which can assist in increasing a patient’s knowledge and self-care ability resulting to better health behavior and better outcome, (Effing T et al., 2007). Educating patients on self-management initiatives tend to work better when it becomes integrated into the health care system, but not organized separately. For the patient education initiatives to be successful, the role of health professionals will be of great importance.

In patient education, they are taught on how to practice self-management, especially to patients with chronic conditions. While practicing self-management they are supposed to recognize, treat, as well as manage their own chronic health problem, following the education received from the medical professionals. Indeed, many of the patients with chronic problems happen to cope with their conditions well, when they use the education they got, without necessarily requiring or calling help from the professional. Even individuals with long-term conditions find themselves spending far more time taking care of themselves more than remaining under care of health professionals. This is a fact that health service planning should always consider as an important factor. Failing to support self-management means that there will be large dependency on professionals which burdens them and even raises the demand for expensive health care resources, which in turn threatens to undermine the long-term sustainability of many.

To great extent, self-management is usually made up of day-to-day caring to chronic illnesses like arthritis, diabetes, and asthma. Since from the statistics many are suffering from chronic diseases, making them to manage themselves is part of the priority by United States health systems. The affected people will even prefer to manage themselves on their own without the help of health professionals. Therefore, whenever patients with chronic health problems seek for professional advice, they are supposed to be given appropriate education and support so that they can be able to improve their self-management skills.

On the other hand, sometimes you find that such patients may fail to get the requisite levels of self-reliance. In some occasions the manner in which patients and clinicians interact seems to only promote passivity as well as dependence, but not the usual self-reliance, hence weakening self-confidence of patients and undermining these patients ability to cope. As a way to cope up and shifting away from dependence on the expensive hospital sector, as well as reducing the 30 days re-admission to the hospital in attempts to deal more efficiently with chronic problems, educating patients with right skills is the right direction.

Some of the groups have realized this fact and have come up to advocate for patient education. Among them is Chronic Care Model which was developed by Ed Wagner as well as his colleagues within the United States has taken this initiatives even internationally,(Wagner EH.,1998). Engaging in empowering people to have confidence of managing their own health and offering them most effective self-management support for patients with both short-term and long-term health problems is the best way to help the patients take care of themselves.

Major objectives of self-management support are to make it possible for patients to be able to carry out three sets of tasks:

a) Having the ability to manage their illness medically (adhering to a special diet or taking medication).

b) Having the ability to managing the emotional effect of their illness.

c) Having the ability to carry out normal roles and activities

There are theoretical models where principles of self-management have been developed, mainly from the fields of behavioral and psychology science. Among the models, the one that is mostly referred to is Bandura’s self-efficacy theory. Self-efficacy includes persons’ believing in their capacity to fruitfully learn and carry out a specific behavior. When a patient feels a strong sense of self-efficacy, they feel they are in control and have the urge of continuing with new and complicated tasks, (Warsi an et al., 2004). Intervention to reduce frequency of 30 day re-admission to the hospitals should therefore focus on patient education through building confidence as well as equipping patients with the tools such as knowledge and skills so that they can set their own personal goals and develop the most effective strategies of achieving them.

Several nations have had self-management through education programs successfully working in reducing the frequency of visiting health services. Australian policy levels have self-management support that has been concentrating on chronic conditions self-management programs. The programs are rolled through the National Chronic Disease Strategy as well as patient programs that have been developed through the Sharing Health Care Initiative. Even though examinations from meta-analysis have been done regarding effectiveness of self-management education programs, such review interpretations have been limited by heterogeneity in populations and intervention, as well as limited various outcomes measured. Some of the randomized controlled trials have indicated that there has been a reduction in health service utilization, like hospitalization incidences especially patients with chronic heart disease, lung disease, or stroke and reduced visits to the hospitals for patients with chronic inflammatory bowel disease, following a direct results from attending an education program, (Williams MV, Baker DW, Parker RM, et al. 1998). According to the national quality and monitoring system for chronic disease self-management education programs, about one third of those patients who attended community programs showed a significant development self-monitoring skills and techniques.

Conclusion

The self-care or self-management of the patients is a key aspect in the contemporary health care management and it is on the basis of this that the diabetic students in high schools need to be empowered to take care of themselves through triaging and mentorship programs. The two type of diabetes can be effectively managed to the level that the students lead a normal life like the other students. This is bearing the fact that the most common Type 2 Diabetes is majorly occasioned by sedentary lifestyle and a change in diet, lifestyle and medication can effectively manage it. Investing in the interventions that empower the patients to take care of self is the surest and best way of helping solve the health care cost crisis that is prevalent in many nations.

References

Alice P., (2015). Self-Care Deficit Theory. Retrieved March 17, 2016 from http://www.nursing-theory.org/theories-and-models/orem-self-care-deficit-theory.php

American Diabetes Association, (2013). Kidney Disease (Nephropathy). Retrieved March 17, 2016 from http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html

Australian Government, Department of Health and Ageing, (2012). Diabetes. Retrieved March 17, 2016 from http://www.health.gov.au/internet/main/publishing.nsf/Content/pq-diabetes

Baker IDI, Heart & Diabetes Institute (2013). Diabetes: The Silent Pandemic and its Impact on Australia. Retrieved March 17, 2016 from http://www.diabetesaustralia.com.au/Documents/DA/What%27s%20New/12.03.14%20Diabetes%20management%20booklet%20FINAL.pdf

Beck R.S., Daughtridge R., and Sloane P.D. (2002). Physician-Patient Communication in the Primary Care Office: A Systematic Review. Journal of the American Board of Family Practice 15(1): 25-38.

Centre for Disease Control and Prevention, (2010). Overweight and Obesity: Defining Overweight and Obesity. Retrieved March 17, 2016 from http://www.cdc.gov/obesity/defining.html

CDC, (2008). Using evaluation to Improve Programs: Strategic Planning. Retrieved March 17, 2016 from http://www.cdc.gov/HealthyYouth/evaluation/pdf/sp_kit/sp_toolkit.pdf

Coulter A, Ellins J. (2007). Effectiveness of strategies for informing, educating and involving patients. British Medical Journal, 335:24-27.

Diabetic Supplies Inc. (2013). Similarities in Type 1, 2 Diabetes. Retrieved March 17, 2016 from http://www.diabeticsuppliesinc.com/type2diabetic/29-similaritiestype12diabetes.html

Diabetes Australia, (2013). Diabetes — The Facts. Retrieved March 17, 2016 from http://www.diabetesaustralia.com.au/PageFiles/1615/the%20facts%20DA%20FINAL%202011.pdf

Effing T. et al. (2007). Self-Management Education for Patients with Chronic Obstructive Pulmonary Disease. Cochrane Database of Systematic Reviews, (4):CD002990.

Kidney Health Australia, (2008). Diabetic Kidney Disease. Retrieved March 17, 2016 from http://www.kidney.org.au/ForPatients/Management/DiabetesandCKD/tabid/704/Default.aspx

MedicineNet, (2012). 4 Steps to Prevent Type 2 Diabetes. Retrieved March 17, 2016 from http://www.medicinenet.com/script/main/art.asp?articlekey=52299

Mealey, B. L. (2010).Diabetes Pathophysiology. Retrieved March 17, 2016 from http://www.health.am/db/diabetes-pathophysiology/

MediLexicon International Ltd. (2013). All about Diabetes. Retrieved March 17, 2016 from http://www.medicalnewstoday.com/info/diabetes/

National Kidney Foundation, (2007). Diabetes and Chronic Kidney Disease. Retrieved March 17, 2016 from http://www.kidney.org/atoz/pdf/diabetes.pdf

Rheem G., (2013). Types 1 and 2 Diabetes: A Comparison and Contrast. Retrieved March 17, 2016 from http://amarris.homestead.com/Type_I_and_II_diabetes.htm

Sidiga A.W. & Maha B.A., (2010). Poor Diet Quality and Food Habits are Related to Impaired

Nutritional Status in 13- to 18-year-old Adolescents in Jeddah. Retrieved March 17, 2016 from http://ipac.kacst.edu.sa/eDoc/2011/191058_1.pdf

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Wagner EH. (1998). Chronic Disease Management: What will it Take to Improve Care for Chronic Illness? Effective Clinical Practice, 1(1):2-4.

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