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. Type
2 diabetic patients are more susceptible to electrolyte imbalance.
2. Renal
dysfunction is associated to Type 2 diabetes mellitus.
1.4 AIMS
3. The aim of this
study is to evaluate the relationship between electrolyte imbalance and renal
function indices in Type II diabetes patients
1.5 OBJECTIVES
•
To determine the blood sugar level of patients.
•
To determine the blood electrolytes (Na+, K+,
Cl-) levels in the patients.
•
To determine the renal function indices (creatinine and urea)
in patients.
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