Topic: Nursing Interventions to Decrease Complications of Diabetes
并发症代写 Diabetes is one of the most common chronic conditions that has plagued the society with more. And more people beginning to get…
Diabetes is one of the most common chronic conditions that has plagued the society with more. And more people beginning to get diagnosed with it. If, it is not adequately controlled, then it may result in acute metabolic complications, for example DKA in type 1 (diabetic ketoacidosis) and HONK in type 2 diabetes (hyperosmolar nonketotic coma). In the early 1920s, insulin was discovered which determined its use as a therapeutic agent. This in turn, led to the miraculous recovery of those patients who were diagnosed with DKA, and hence, were saved (Bliss, 1982).
However, it became apparent that while insulin therapy helped the patients steer away from life threatening diseases, the management of the disease in the long term became a huge challenge. Therefore, it became very important to address. And find solutions for the complications of chronic diabetes that type 1 and type 2 patients faced. As is apparent, in the long term, the complications of diabetes can affect nearly all of the systems of the body, such as the nervous system, the eyes, kidneys, and such. However, through proper research it was deduced that such complications can be reduced. And even prevented when proper care is taken by the patient. The challenge is whether or not a patient is willing to learn. And educated himself or herself regarding the challenges and their prevention.
译文：糖尿病是困扰社会的最常见的慢性病之一。越来越多的人开始被诊断出患有它。如果它没有得到充分控制，那么它可能会导致急性代谢并发症，例如 1 型（糖尿病酮症酸中毒）中的 DKA 和 2 型糖尿病（高渗性非酮症昏迷）中的 HONK。在 1920 年代初期，胰岛素被发现，这决定了其作为治疗剂的用途。这反过来又导致那些被诊断患有 DKA 的患者奇迹般地康复，并因此得救（Bliss，1982）。
然而，很明显，虽然胰岛素治疗帮助患者远离危及生命的疾病，但从长远来看，疾病的管理成为一个巨大的挑战。因此，解决问题变得非常重要。并为 1 型和 2 型患者面临的慢性糖尿病并发症寻找解决方案。很明显，从长远来看，糖尿病的并发症会影响身体的几乎所有系统，例如神经系统、眼睛、肾脏等。然而，通过适当的研究，推断可以减少此类并发症。当患者采取适当的护理时，甚至可以防止。挑战在于患者是否愿意学习。并对自己进行了有关挑战及其预防的教育。 并发症代写
Literature & Review
The world is faced with a diabetic crisis, with an increase in the number of people being diagnosed with diabetes especially type 2 diabetes, the prevention of its complications. Or at least minimizing them, is an important objective for all health care providers (Jillian Hill, 2004). Let us first have a look at the different complications that a person with diabetes is likely to face.
译文：世界正面临糖尿病危机，被诊断患有糖尿病的人数增加，尤其是 2 型糖尿病，预防其并发症。或者至少将它们最小化，是所有医疗保健提供者的一个重要目标（Jillian Hill，2004）。让我们先来看看糖尿病患者可能面临的不同并发症。
There are two types of complication that can occur in diabetes patients, 1) those caused due to complication of the microvascular system (nerves and organs) and b) those that are caused by the macrovascular system damage, and c) a combination of both of the aforementioned complications. The duration of diabetes such as how long a person has had it, hypertension, hyperglycaemia, unhealthy lifestyles. And dyslipidemia are all significant factors which help complications develop in diabetic patients (Jillian Hill, 2004). Following are all of the complications discussed in detail.
译文：糖尿病患者可能发生两种类型的并发症，1) 由微血管系统（神经和器官）并发症引起的并发症和 b) 由大血管系统损伤引起的并发症，以及 c) 两者的组合上述并发症。糖尿病的持续时间，例如一个人患病的时间、高血压、高血糖、不健康的生活方式。血脂异常都是导致糖尿病患者出现并发症的重要因素（Jillian Hill，2004）。以下是详细讨论的所有并发症。
This involves all the nerves and organs such as the small blood vessels of the eyes i.e. the retina, kidneys. And nerves. This can result in diabetic retinopathy, nephropathy, and neuropathy. This microvascular complications occur due to hyperglycaemia, as deduced in a study by Pirart. These complications were less common is people with good glycaemic control.
译文：这涉及所有神经和器官，例如眼睛的小血管，即视网膜、肾脏。还有神经。这可能导致糖尿病视网膜病变、肾病和神经病变。正如 Pirart 的一项研究推断，这种微血管并发症是由高血糖引起的。这些并发症较少见的是血糖控制良好的人。
When the blood vessels that are present at the back of the eye are damaged, it can lead to blindness. Diabetic retinopathy is one of the most common causes of blindness. This is why it is essential to have annual eye screening through diluted pupils. So that the symptoms can be deduced at an early stage. And the progression can be controlled (NICE, 2002). In the early stage, the retina shows the blood vessels clotting up which can cause dilation of other vessels as well, which results in microaneurism. Most often, treatment is not required at this stage, unless the same occurs in the macula region, which is the central part of the retina.
The best treatment that is suggested is laser therapy which can prevent blindness from occurring in the eyes by sealing the vascular leakage points from damaged blood vessels. While this will npt restore the sight, it can definitely help in prevention of utter blindness.
建议的最佳治疗方法是激光疗法，它可以通过封闭受损血管的血管渗漏点来防止眼睛失明。虽然这将 npt 恢复视力，但它绝对有助于预防完全失明。
Diabetes affects the kidneys severely as well. Diabetic renal disease is one of the major causes of mortality in people who have type 1 diabetes. While it is rare in type 2 diabetes, it is still quite a prevalent issue. If the blood pressure is controlled aggressively. And glycaemia is also monitored and controlled, then the nephropathy can slow down. ACE (Angiotensin – converting Enzyme) helps in reducing the pressure in the kidney. And reduces loss of urinary albumin.
糖尿病也会严重影响肾脏。糖尿病肾病是 1 型糖尿病患者死亡的主要原因之一。虽然它在 2 型糖尿病中很少见，但它仍然是一个非常普遍的问题。如果血压得到积极控制。并且血糖也被监测和控制，然后肾病可以减缓。 ACE（血管紧张素转化酶）有助于降低肾脏压力。并减少尿白蛋白的损失。
This is the most common complication of diabetes and it is highly difficult to provide treatment for it. Because once this complication appears then nothing can be done except manage it. It is a result of the macrovascular system getting damaged which is primarily responsible for supplying blood to the autonomic and peripheral nerves. The nerves are damaged, which causes burning in the hands. And feet, i.e. the limbs of the patient, and reduces sensation of the body, and may even lead to pain and paraesthesia.
However, it is very difficult to manage the painful peripheral neuropathy. Nocturnal burning pain as mentioned earlier is often accompanied with this condition. And hence tricyclic antidepressants are very helpful in easing the pain. Motor neuropathy can cause atrophy of the muscles such as gait changes. And hammer toes, which can sometimes lead to the formation of calluses and ulcers. Autonomic neuropathy sometimes leads to dry cracked skin which is usually a result of a reduction in sweating. And arteriovenous shunting, which results in an abnormal blood flow within the foot.
Diabetic foot disease is the most common cause of non-traumatic amputation in the UK – someone with diabetes is at 15 times greater risk than someone who does not have diabetes (Williams and Pickup, 1999). However, the number of patients requiring amputations has been increasing over the past decade.
糖尿病足病是英国非创伤性截肢的最常见原因——糖尿病患者的风险是非糖尿病患者的 15 倍（Williams 和 Pickup，1999）。然而，在过去十年中，需要截肢的患者人数一直在增加。
The large blood vessels are affected in macrobascular damage, which are linked to the heart, legs. And brain, and may lead to coronary heart disease, stroke, myocardial infarction, and peripheral vascular disease. Hypertension, dyslipidaemia and smoking may cause this more easily then hyperglycaemia. This is one of the most common causes of death among patients with Type 2 diabetes (Campbell, 2001).
大血管受到大血管损伤的影响，这些损伤与心脏、腿部有关。 和大脑，并可能导致冠心病、中风、心肌梗塞和周围血管疾病。 高血压、血脂异常和吸烟可能比高血糖更容易引起这种情况。 这是 2 型糖尿病患者最常见的死亡原因之一 (Campbell, 2001)。
Who develops complications?
The complications related to diabetes can occur in patients having type 1 diabetes as well as those with type 2 diabetes (Audit Commission, 2000). Type 2 diabetes results in a complex condition which can lead to more problems if care is not taken. At times, patients with Type 2 diabetes are suffering from it far longer than they know. And it is deduced later on that they have Type 2 diabetes. 37% of diagnosed patients showed signs of retinopathy in a study on diabetes held in the United Kingdom (UKPDS, 1994).
The duration of the diabetes determine the complications one is likely to face for example, diabetic retinopathy is uncommon in patients who have Type 1 diabetes for five years or less. But for patients who have had the condition for over twenty years, the condition is more commonly seen. 30% of these patients also show signs of persistent proteinuria, which shows that there has been renal damage (Pickup and Williams, 1999). The level of glycaemia also determines whether or not a patient will be faced with such complications, along with other underlying factors which include smoking, hypertension, dyslipidaemia and self care skills.
译文：与糖尿病相关的并发症可能发生在 1 型糖尿病患者和 2 型糖尿病患者身上（审计委员会，2000 年）。 2 型糖尿病会导致复杂的情况，如果不注意，可能会导致更多问题。有时，2 型糖尿病患者遭受的时间比他们知道的要长得多。后来推断他们患有2型糖尿病。在英国进行的一项糖尿病研究中，37% 的确诊患者显示出视网膜病变的迹象（UKPDS，1994）。
糖尿病的持续时间决定了人们可能面临的并发症，例如，糖尿病视网膜病变在患有 1 型糖尿病五年或更短时间的患者中并不常见。但对于患有此病二十多年的患者来说，这种情况更为常见。这些患者中有 30% 还表现出持续性蛋白尿的迹象，这表明存在肾损伤（Pickup 和 Williams，1999）。血糖水平还决定了患者是否会面临此类并发症，以及其他潜在因素，包括吸烟、高血压、血脂异常和自我护理技能。
The recognition of the devastating impact of complications, and the need for well-organised diabetes care to prevent them, resulted in a World Health Organization commitment to take effective action in the early 1990s (Jillian Hill, 2004). The focus nowadays of modern diabetes management is to enable the patients suffering from either type of diabetes to have a good quality of life, with ease day to day achievement of activities, and to help them minimize the risks associated with long-term complications. When the diabetes is kept within control, and in parameters then it can allow the person to live a healthy lifestyle.
译文：认识到并发症的破坏性影响，以及需要组织良好的糖尿病护理来预防并发症，导致世界卫生组织承诺在 1990 年代初期采取有效行动（Jillian Hill，2004）。 现代糖尿病管理的重点是使患有任何类型糖尿病的患者都能拥有良好的生活质量，轻松完成日常活动，并帮助他们最大限度地减少与长期并发症相关的风险。 当糖尿病得到控制并且在参数中时，它可以使人过上健康的生活方式。
The question that the study wanted to address was how effective both treatments were in reducing the complications faced by diabetic patients.问题
The objective of the study was to help determine the effectiveness of the two therapies and determine which one was more effective in reducing the chances of getting complications from diabetes.
Many researches have been conducted to determine how best to reduce the complications arising from diabetes. A large scale study with 1440 patients was conducted in 29 centers of the United States of America, to come up with a solution. Patients were randomly selected. And then distributed into groups of conventional therapy i.e. intake of insulin once or twice in a day along with monthly clinical appointments. And intensive treatment, which entailed intake of insulin three or more times in a day. Or the use of subcutaneous insulin via an infusion pump. Which was follows up by monthly clinical appointment as well along with weekly telephone calls from the nurse. These patients made sure to keep a tab on their blood glucose level and measured them in order to adjust their insulin level as. And when required to maintain a tight control on their blood glucose.
The study was conducted for over decade after which it was determined that after nine years of care, microvascular complications in diabetics were significantly reduced for those patients who opted for intensive treatment along with nephropathy, neuropathy. And retinopathy which were reduced in varying rates from 35 – 75%. Through tight control, existing complications’ progress was also slowed with early retinopathy being reduced to 50% (Diabetes Control and Complications Trial Research Group, 1993).
While it is true that glycaemic control is very important to prevent macrovascular problems. And damage, improvement in blood pressure showed that there was a significant reduction in microvascular and macrovascular complications. Having regular screening done so that early indications of these complications arising in the body could be deduced is essential to ensure that the person’s diabetes is managed correctly (Jillian Hill, 2004).
译文：已经进行了许多研究以确定如何最好地减少糖尿病引起的并发症。在美国的 29 个中心对 1440 名患者进行了大规模研究，以提出解决方案。患者是随机选择的。然后分配到常规治疗组中，即每天服用一次或两次胰岛素以及每月进行临床预约。和强化治疗，这需要在一天内摄入 3 次或更多次胰岛素。或者通过输液泵使用皮下胰岛素。随后通过每月的临床预约以及每周护士的电话进行跟进。这些患者确保密切关注他们的血糖水平并对其进行测量以调整他们的胰岛素水平。并在需要时严格控制他们的血糖。
该研究进行了十多年，之后确定经过九年的护理，对于那些选择强化治疗以及肾病、神经病的患者，糖尿病患者的微血管并发症显着减少。视网膜病变的减少率从 35% 到 75% 不等。通过严格控制，现有并发症的进展也得到了减缓，早期视网膜病变减少到 50%（糖尿病控制和并发症试验研究组，1993）。
确实，血糖控制对于预防大血管问题非常重要。而损伤、血压的改善表明微血管和大血管并发症显着减少。定期进行筛查以推断出这些身体并发症的早期迹象对于确保正确管理患者的糖尿病至关重要 (Jillian Hill, 2004)。
Nursing Implications & Interventions
Diabetes can affect people from all walks of life and in all ages, which means that many of the nurses will come in direct contact with the patients. Nurses need to be educated about the conditions. And what its implications are so that their interventions while interacting with the patient can be of benefit to both of them. They need to be supporting so that the people with diabetes can understand how to manage it better. And they should help them understand the importance of proper management. At the same time, the nurses need to be well adept at identifying the complications. And guiding the patients better, in case better help is available elsewhere.
This means the nurse will be responsible for arranging the necessary services that will benefit the patient. And allow them access to it while at the same time reminding them about their annual eye screening. Or refer them to specialists who may be able to better help them in managing their condition. Specialist clinics have been set up for patients suffering from erectile dysfunction, to which they can be guided by the nurse, of give them proper guidance in case if a foot ulcer is detected.
Patients need support in order to maintain a good control on their diabetes
And nurses are the key in providing them that much needed support.
There are many patients who deny any symptoms of feelings of hyperglycaemia, when they are inadequately controlling their diabetes, which makes their daily lives difficult. A good nurse will be able to identify such problems. While at the same time motivate the patient to take better care of themselves by following the prescribed usage of the medication. And at the same time maintaining a healthy lifestyle.
For those patients who already have been diagnosed with complications, then their management can be a challenge. And it is usually suggested to follow a multi-disciplinary approach. In this scenario, the patient should have an access to a medical assistance, a nurse to guide on glycaemic control, a dietitian, a podiatrist. And a orthoptist for any patient who may have a foot ulcer. District as well as Practice nurses are an integral part of providing superior care in the dressing required for foot ulcers. And support of diabetics, often times reducing the need for the patient to be admitted to a hospital (Jillian Hill, 2004).
对于那些已经被诊断出患有并发症的患者，他们的管理可能是一个挑战。通常建议遵循多学科方法。在这种情况下，患者应该能够获得医疗援助、指导血糖控制的护士、营养师和足病医生。以及任何可能患有足部溃疡的患者的矫形师。地区护士和执业护士是为足部溃疡敷料提供优质护理的重要组成部分。以及对糖尿病患者的支持，通常可以减少患者入院的需要（Jillian Hill，2004 年）。
With the passage of time, diabetes has become one of the most common diseases of this era. And the number of people who are being diagnosed with it are increasing. If this is not properly controlled then it can lead to more problems which in turn do more harm than good. The risk of complications emerging from diabetes is far greater in people who do not maintain a healthy lifestyle. And are hence, prone to the various problems and complications that have been discussed throughout the paper.
In order to lead a good life, nurses play a significant role in both educating as well as supporting the diabetics to manage the condition efficiently. And adequately so that the risk of complications can be reduced. And these conditions can be prevented or the development be delayed.
译文：随着时间的推移，糖尿病已成为这个时代最常见的疾病之一。 被诊断出患有这种疾病的人数正在增加。 如果这没有得到适当的控制，那么它可能会导致更多的问题，反过来弊大于利。 不保持健康生活方式的人患糖尿病并发症的风险要高得多。 因此，容易出现整篇论文中讨论的各种问题和并发症。 并发症代写
为了过上美好的生活，护士在教育和支持糖尿病患者有效控制病情方面发挥着重要作用。 并充分降低并发症的风险。 而这些情况是可以预防的，或者可以推迟发展。
After viewing the research it can be recommended that patients should opt for intensive care as that is far more beneficial for them. And will help in reducing the chances of getting the complications as discussed above.
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