Management of Type I Diabetes

MANAGEMENT OF TYPE-I DIABETES FOR THE INDEPENDENT-LIVING ELDERLY

This research addresses the management of Type-I diabetes for the independent-living elderly. For this type of patient, self-care is crucial to patient well-being.

Diabetes mellitus affects approximately five-percent of the general population (Yki-Jarvinen, 1994, pp. 91-95). It is estimated that in the population segment 45 years of age and older, more than six-percent are diagnosed with diabetes with an equal prevalence of undiagnosed cases (Javitt, Aiello, Chiang, Ferris, Canner, & Greenfield, 1994).

Diabetes mellitus is referred to as a heterogeneous syndrome. It is characterized by a lack of insulin secretion and/or an increased cellular resistance to insulin which results in hyperglycemia and metabolic disturbances. Diabetes symptoms include excessive thirst and hunger, frequent urination, blurred vision, weight loss, and recurrent infections; diabetes is often asymptomatic during early stages. Conditions associated with the disease include severe neurological, cardiovascular, ocular, and renal complications ("American Diabetes," 1996, pp. S4-S14).

There are different types of diabetes. Insulin-dependent diabetes mellitus (IDDM) usually develops before 30 years of age with an abrupt onset of symptoms requiring immediate medical treatment. Insulin-dependent diabetes also is referred to as Type-I diabetes and accounts for approximately 10 percent of

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betic nephropathy. Finally, fat intake should be minimized and closely monitored so that cholesterol (<300 mg/d) and polyunsaturated fats (six-to-eight percent of daily energy) are avoided in favor of saturated (<10 percent of daily energy) and monounsaturated fats. Additional dietary guidelines include moderation in sodium intake (<3000 mg/d), moderation in alcohol intake (one or two drinks per week), and a relatively high intake of soluble fiber (20 to 30 g/d). Type-I diabetic patients should be encouraged to undertake a self-care program with the assistance of a nurse practitioner (Wierenga, 1994, p. 34). The nurse should provide the patient with guidelines for such a self care program. These guidelines should be in the form of quality indicators. These quality indicators are as follows (Wierenga, 1994, pp. 33-40; Wierenga & Hewitt, 1994, pp. 138-142): 1. The first quality indicator (blood-glucose levels must be maintained within the 4.4 to 8.3 mmol/L range) must be measured by the diabetic patient at home through the use of either a blood-glucose monitor or BGM test strips. This quality indicator is an outcome standard. The nurse can assure that these measurements are being made by instructing the diabetic patient in

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