CHAPTER ONE
INTRODUCTION
1.1 Background Of Study
The prevalence of diabetes is increasing rapidly and electrolyte disturbances are common in patients with diabetes. According to World Health Organization, over 1.4 Nigerians are diabetic in 2017. Diabetes can be defined as a disease condition in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. They are two major types of diabetes; Type 1 and Type 2 diabetes.
In Type 1 Diabetes, the body does not produce enough insulin. Diabetic patients with Type 1 are advised to follow a healthy eating plan, do adequate exercise, and take insulin, so they can lead a normal life. In Type 2 Diabetes, the body does not produce insulin for proper function. Type 2 patients need to eat healthily, be physically active, and test their blood glucose regularly. They may also need to take oral medication to control blood glucose levels. As the risk of cardiovascular disease is much higher for a diabetic, it is crucial that blood pressure and cholesterol levels are monitored regularly. Smoking might have a serious effect on cardiovascular health; diabetics are advised to stop smoking. Hypoglycemia (low blood glucose) can have a bad effect on the patient. Hyperglycemia (when blood glucose is too high) can also have a bad effect on the patient. Hyperglycemia sets the internal environment for osmotic diuresis while causing a dilution effect on electrolyte concentrations. The osmotic effect of glucose results in decreased circulating blood volume and fluid shift from the intracellular spaces causing cellular dehydration. (Nabil, 2016) Then there is Gestational diabetes. This type affects females during pregnancy. It is the leading cause of blindness, kidney failure and lower limb amputations. The most common diabetes symptoms include frequent urination, intense thirst and hunger, weight gain, unusual weight loss, fatigue, cuts and bruises that do not heal, male sexual dysfunction, numbness and tingling in hands and feet. (Goldberg, 2004)
After food consumption, the body breaks down every sugar to its simplest form (glucose) which is then carried into the bloodstream for further cellular activities. The production of glucose for body cellular activities is regulated by insulin. Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. Patients suffering from diabetes have high blood sugar because their body cannot move sugar from the blood into muscle and fat cells to be burned or stored for energy, also because their liver makes too much glucose and releases it into the blood. This is because either: their pancreas does not make enough insulin or their cells do not respond to insulin normally. When there's excess sugar (glucose) in the cell membrane, it disturbs that concentration of electrolyte in the cell and causes osmotic diuresis.
Osmotic diuresis refers to when there is excess glucose in the blood, and it passes through the kidneys for filtering, the excess glucose accumulates in the tubules within the kidneys. Once there, it blocks the re absorption of water, leading to an increased concentration of water in the bloodstream. The water in the bloodstream now distorts electrolytes in the body. Sodium for instance is an extracellular ion, when the excess fluid in the bloodstream it tends to follow down with water to the kidney causing two major diseases; Hyponatremia (occurs when there is low sodium ion the body) or Hypernatremia (when there is excess sodium ion in the body). In the case of hyponatremia, it could be the sodium ions gets excreted with water through the kidney. In hypernatremia, the excess sodium flows to the kidney where it is reabsorbed into the bloodstream thereby, creating unstable count of the ion in the body. The same thing applies to Potassium ion, which is an intracellular ion. Its movement is also not predictable as the body cells suffer from osmotic diuresis.
According to Webster Dictionary, electrolytes basically are any of the ions (sodium, chlorine, calcium, etc) that in biological fluid that regulate or affect most metabolic processes (such as the flow of nutrients into and waste products out of cells). Electrolytes are present in the human body. Fluid and electrolyte balance play important roles in maintaining the homeostasis in the body, and also in protecting cellular function, tissue perfusion, acid-base balance, nerve conduction, blood clottingand muscle contraction. Potassium, sodium, calcium, etc are all important for proper electrolytebalance. According to Husain (2009), the relationship between blood glucose and electrolytes is complex and electrolyte imbalance may affect the course of diabetes and its management. Electrolyte imbalance resulting from kidney failure, dehydration, fever, and vomiting hasbeen suggested as one of the contributing factors toward complications observed in diabetes and otherendocrine disorders. Electrolytes play an important role in controlling the fluid levels, acid base balance, and regulation of neurological and myocardial functions, oxygen delivery and many other biological processes.(Deepti, 2017) Patients with Diabetes mellitus are more prone to develop electrolyte imbalance and complications.
Diabetes is very serious that some of the complications can be life threatening if not carefully managed before it grows to a very critical stage. Researchers have put together some facts about diabetes such as the fact that diabetes is a long-term condition that causes high blood sugar levels.
Diabetic nephropathy is one of the complications of diabetes mellitus, which ultimately leads to renal failure, which is also a cause of electrolyte imbalance in diabetic patients. Diabetes mellitus was identified as an independent risk factor for hyponatremia and hypomagnesaemia. Various path physiological factors like; nutritional status, coexistent acid-base imbalance, certain drugs, other co morbid diseases like renal disease or acute illness, alone or in combination, also play a key role in electrolyte imbalance (Liamis et al 2013).
1.2 STATEMENT OF PROBLEM
Diabetes causes osmotic diuresis with lead to electrolyte imbalance and renal malfunction.
1.3 HYPOTHESIS
1.4 AIMS
1.5 OBJECTIVES
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