The etiology (cause)
of diabetes is not confirmed. Although it appears that diabetes may be genetic,
environmental factors also may contribute to its occurrence. For example,
viruses or obesity may precipitate the disease in people who have a genetic
predisposition.
The World Health
Organization indicates that the prevalence of the disease is increasing
worldwide, especially in areas showing improvement in living standards.
The abnormal
concentration of glucose in the blood of diabetic clients draws water from the
cells to the blood. When hyperglycemia exceeds the renalthreshold,
the glucose is excreted in the urine (glycosuria). With the loss ofthe
cellular fluid, the client experiences polyuria (excessive
urination), and polydipsia (excessive thirst)
typically results.
The inability to
metabolize glucose causes the body to break down its own tissue for protein and
fat. This response causes polyphagia (excessive
appe-tite), but at the same time a loss of weight, weakness, and fatigue occur.
The body’s use of protein from its own tissue causes it to excrete nitrogen.
Because the untreated
diabetic client cannot use carbohydrates for energy, excessive amounts of fats
are broken down, and consequently the liver produces ketones from the fatty
acids. In healthy people, ketones aresubsequently broken down to carbon dioxide
and water, yielding energy. In diabetic clients, fats break down faster than
the body can handle them. Ketones collect in the blood (ketonemia) and must be excreted
in the urine (ketonuria). Ketones are acids
that lower blood pH, causing acidosis. Acidosis can lead to diabetic coma, which can result in
death if the client is not treated quickly with fluids and insulin.
In
addition to the symptoms previously mentioned, diabetic clients suffer from
diseases of the vascular
system. Atherosclerosis (a condition in which there is a heavy
buildup of fatty substances inside artery walls, reducing blood flow) is a
major cause of death among diabetic clients. Damage to the small blood vessels
can cause retinal degeneration. Retinopathy is the leading cause of blindness
in the United States. Nerve damage (neuropathy) is not uncommon, and infections,
particularly of the urinary tract, are frequent problems.
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