“Mantolsaahamathisthoolam, diabetes. Drowsiness Itching A family history of

“Mantolsaahamathisthoolam,
Athisnigdhammahasanam

Mrithyuprameharoopena, Kskhipramadhayagachati”1

This
Sanskrit slogan of charaka gives over all concepts of diabetes mellitus. This
means diabetes mellitus comes in form of death to those who are obese, live
without exercise and eat more, especially sweet items.1

Diabetes
mellitus is diseases known during the period of 1500 BC and it was described by
Ebers papyrus of ancient Egyptians. In 1000 BC sushrutha, the father of
medicine in India, diagnosed diabetes mellitus. The disease was explained by
Charaka in 400 BC and the same concept was described in 200 AD by Aratnus
Cappadocia.2

The
term “diabetes mellitus” is derived from the Greek word, “Diabetes” meaning “to
go through” or a siphon and the word “mellitus” is derived from the Latin word
“Mel” meaning honey describing the sweet odour of urine.3

According
to WHO (1994) diabetes mellitus is characterized by hyperglycemia and
disturbance of the carbohydrate, fat and protein metabolism that is associated
with absolute or relative deficiencies of insulin action or secretion.

The
different types of diabetes mellitus as adopted by the WHO (1995) include type
1 –insulin dependent diabetes mellitus (IDDM), type 2 –non-insulin dependent
diabetes mellitus (NIDDM) and gestational diabetes mellitus.4

The
American diabetes Association uses the acronyms DIABETES and CAUTION to help
identify the warning signs of diabetes.

Drowsiness

Itching

A family history
of diabetes

Blurred vision

Excessive weight

Tingling,
numbness, or pain in extremities

Easy fatigue

Skin infection,
slow healing of cuts and scratches especially on the feet .other signs are

Constant
urination

Abnormal thirst

Unusual hunger

The rapid loss of
weight

Irritability

Obvious weakness
and fatigue

Nausea and
vomiting.5

India
has now been declared by W.H.O as the diabetes capital of the world. The choice
of treatment and complaints is important for the metabolic control to be achieved
by the diabetes patients. While diet, exercise and oral drugs are useful in
controlling diabetes in many patients, it is now recognized that a large number
of type 2 diabetic patients require insulin therapy.6

Prevalence
of diabetes in adult’s world–wide was estimated to be 4.0% in 1995 and to rise
to 5.4% by the year 2025. It is higher in developed than in developing
countries. The number of adults with diabetes in the world will rise 135
million in 1995 to 300 million in the year 2025. The major part of this
numerical increase will occur in developing countries. There will be a 42% increase,
from 51 to 72 million, in the developed countries and a 170 % increase, from 84
million to 228 million, in the developing countries. Thus, by the year 2025,
more than 75% of people with diabetes will reside in developing countries, as
compared with 62% in 1995. The countries with the largest number of people with
diabetes are and will be in the year 2025,

India,
China and the US. In developing countries, the majority of people with diabetes
are in the range of 45- 64 years. In the developed countries, the majority of
people with diabetes are aged Above 65 years.7

Diabetes
is a global problem. It ranks as the sixth leading cause of death in the United
States, being listed as the primary cause of death to about 200 Americans every
day. Plus diabetes is listed as “contributing factor “in almost 400 more deaths
per day in the US. Thus diabetes helps kill about 600 Americans per day.8

Due
to complications from diabetes 82,000 lower limb amputations occur in the US
per year. Diabetes causes 12,000 – 24,000 new cases of blindness every year.
Diabetes account for nearly 400 Americans per day beginning dialysis or
receiving kidney transplant. Adults with diabetes have heart diseases and
stroke rate 2-4 times higher than non- diabetes. Above 73% of diabetes have
high blood pressure.8

Diabetes
is a growing public health problem, especially in India. The global prevalence
of type 2 diabetes is expected to double in the period between 2000-2025 and
may reach a level of almost 300 million patients. It is predicted that by the
year 2025, the maximum prevalence of diabetes would be in India and every 4th
diabetes in the world will be an Indian. In a period of 5 years the prevalence
has increased from 8.2% to 11.6 % in urban south India. The study also showed
that the prevalence of diabetes in urbanizing rural population was found to be
midway between that of rural and urban population.9

Diabetes,
i.e. higher glucose level is a slow, silent, stealthy and lethal killer. It
does such an intensive and extensive damage to our body than any other ailment.

In
another study the knowledge, beliefs, and practices of diabetes receiving free
medical care and those paying for medical care in Tamilnadu, India was
compared. A questionnaire was administered to elicit diabetes patients
‘knowledge regarding diet, exercise, adverse effects, habits, and other
matters; their beliefs about diabetes; and their practices regarding diet,
medication and self monitoring. The results showed a large gap between
knowledge and action in both groups and a need for increased efforts toward
patient education regarding diabetes.10

Lack
of knowledge among diabetes patients may alter their practice. Hence the
investigator had an interest to assess the knowledge of diabetes patient. As
the glycemic level is much influenced by dietary practices, the knowledge
regarding diet becomes an important strategy to be assessed.10

A
concept mapping study conducted to assess the nutritional knowledge in diabetes
patients and evaluated the therapeutic patient education. 5 diabetes patients
and their family members were selected as a sample. Before the education
session, patients and their family members are knowledge about food. After
education, new knowledge and new links between old and recent knowledge testify
of learning. This research shows that using the pre – existing knowledge of
network of parents and children could contribute to improve their education on
nutrition.11

According
to the IDF’s 2003 statistics, committee of RSSDI 2009 report, the world health
organization and the International diabetes federation predict that India has
the highest numbers of diabetes in the world.12 hence knowledge about the
disease plays a vital role  in future
development of disease and its early prevention 
and detection. Research studies have shown that wherever massive
education regarding diabetes mellitus is provided to general population, it
resulted in significant increase in knowledge about the disease.13

            Through
the research report, it is evident that lack of knowledge is a contributing
factor for the Indians to rank first globally in diabetes.12 so enhancing
knowledge of diabetes of diabetes especially about diabetic diet is very useful
among patient with diabetes mellitus.13

‘The
overall goal of care is to control or regulate the disease rather than cure.’

‘Knowledge
is power.’ hence the investigator felt the need to help patients to enhance the
knowledge on diabetic complication .knowledge enhancement can be done in
variety of ways. Mass awareness program by means of teaching or a HEP would be
of great help. The investigator had chosen the health education programme as
knowledge weapon, because it can be used in future as a reference for all the
patients with diabetes mellitus.

Hormone is a mediator molecule that
is released in one part of the body but regulates the activity of cells in
other parts of the body. The islets of langerhans of the pancreas regulate
blood sugar levels by producing a hormone called insulin.1

Insulin is the principle regulator
of the metabolism and storage of ingested carbohydrates and proteins. An
increased blood glucose level is the major stimulus for insulin synthesis and secretion.2

The insulin alterations result in
disordered metabolism of carbohydrates, fat the proteins and causes
hyperglycemia and finally leading to a condition called as Diabetes mellitus.2

            According
to Joyce.M.Black, the overall term Diabetes mellitus includes four subclasses:

a. Insulin dependent Diabetes
Mellitus

b. Non-Insulin dependent Diabetes
Mellitus

c.
Secondary Diabetes Mellitus

d.
Malnutrition related Diabetes Mellitus.3

       The exogenous insulin is needed in Diabetes
Mellitus when a patient has inadequate insulin to meet specific metabolic
needs.3

Diabetes is difficult to manage as
it imposes lifelong demands on people with diabetes and their families. People
with diabetes might need insulin injection either because they don’t produce
enough insulin in their bodies or they cannot properly use the insulin that
they do produce or both.3

            Successful
self management in Diabetes helps the patient feel better. Education is an
important aspect of self-management, teaching the client on self administration
of insulin helps the patient helps to build self confidence and pride of
contribution in their management.4

   The nurse has an important role to play in
the management of Diabetes.  The nurse
has the responsibility of teaching the self injection of Insulin to the patient
and the family members or significant others and she has to begin this as soon
as the need for the insulin has been established and use written or verbal
instructions and demonstration techniques for teaching the patients.4