Acute and Primary Health Care

Acute and Primary Health Care

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chronic diseases

Chronic diseases are sicknesses of long duration that progress slowly. Various health conditions and illnesses can be categorized under the broad heading of chronic disease. The Chronic ailments are generally characterized by:

• various risk factors
• complex causality
• prolonged course of illness
• long latency periods
• Functional disability or impairment.

Many chronic ailments do not spontaneously resolve, and they are usually not cured wholly. There are several that can be directly life-threatening, for example stroke and heart attack. Others can persist for a while and can become severe in management terms (for instance diabetes). Many chronic illnesses persist in a person through life, but they do not usually cause death (for instance arthritis). For different reasons, including facts that more individuals are living to old age and the improvements in management and treatment, there has been an increase in chronic diseases prevalence in the past.

Chronic diseases like asthma, heart disease, and diabetes mellitus are the top causes of disability and death. They are caused by various reasons that include environment, lifestyle, and genetics and they are anticipated to be more frequent as people age and the risk factors increase. The burden caused by these situations can be high, not just for those individuals that have them, but for their families too.

Majoring on Diabetes;

Diabetes, frequently referred by doctors as diabetes mellitus, it explains various metabolic diseases wherein an individual has high blood (blood sugar) glucose, probably due to inadequate insulin production, or because of lack of proper response by the body’s cells to insulin, or both. A Patient having high blood sugar normally experiences frequent urination (polyuria) they may become ever more hungry (polyphagia) and thirsty (polydipsia).

Diabetes is of three types:

• Type 1 Diabetes

The immune system destroys the beta cells that make insulin in the pancreas, this cause severe, frequently total lack of insulin. This type of diabetes is common mostly during young adulthood and childhood but it can take place at any age. Individuals who have type 1 diabetes have to receive daily injections of insulin to sustain life, and they should do finger prick blood glucose tests regularly to check their diabetes. A progressive development in managing and introducing new technology has led to reduced complication rates and has greatly improved the life expectancy.

• Type 2 Diabetes

Individuals having this type of diabetes experience relative insulin deficiency and they are resistant to insulin action due to continuous failure of their pancreatic beta cells.

An inherited vulnerability to this type of diabetes is provoked by abdominal obesity. This Type of diabetes frequently occurs in the elderly and middle aged people, although it is becoming common in children, young adults and adolescents, mostly in the Aboriginal populations.

Diabetic complications and Type 2 diabetes are frequently asymptomatic, making it difficult for early diagnosis. In Aboriginal and other risky, under-resourced and remote groups, diabetes is usually undiagnosed till there is development of advanced complications. Around 90% of all diabetes cases in the world are of this type.

Some individuals can control their symptoms of type 2 Diabetes through weight loss, having a healthy diet, exercising, and observing their levels of blood glucose. Nevertheless, type 2 diabetes is usually a progressive sickness – it gets worse gradually – and the patient probably ends up having to take insulin, which is usually in the form of tablet.

Diabetic complications

Constantly elevated levels of blood glucose in the two types of Diabetes lead to damaging of small blood vessels inside the kidney and retina. Elevated concentrations of blood glucose interact with the high blood pressure as well as the altered blood lipids causing accelerated atherosclerosis within arteries in the legs, brain and heart.

Overweight and obese individuals have a greater risk of getting type 2 Diabetes when compared to the people having body weight that is healthy. People having lots of visceral fat, also identified as belly fat, abdominal obesity, or central obesity are particularly at risk. Being obese/overweight makes the body to release chemicals that are capable of destabilizing the body’s metabolic and cardiovascular systems. Men having low levels of testosterone have higher risk of getting type 2 Diabetes.

• Gestational Diabetes

This type usually affects the females during pregnancy. Various women have extremely high glucose levels in their blood; therefore their bodies are not capable of producing enough insulin for transporting all the glucose into their cells, this result in progressive rise in glucose levels. Gestational diabetes is generally asymptomatic, and it is detected through screening tests.  Its Treatment consists of modification on diet and, in a number of cases, injection of insulin. Up to 50% of the women that have experienced gestational diabetes consequently get type 2 Diabetes. Gestational diabetes’ diagnosis is usually made during pregnancy. Most of the patients having gestational diabetes may control their diabetes through dieting and exercising.

What Is Pre-Diabetes?

Majority of patients having type 2 Diabetes at first had pre-Diabetes. The levels of their blood glucose were higher than the normal, but it was not high enough to merit a diagnosis of diabetes. The body cells then become resistant to insulin.

Diabetes mellitus is classified as a disorder of the metabolism. Metabolism is how bodies use the food that is digested for growth and energy. Most of what is eaten is broken down to glucose, a form of sugar inside the blood. Glucose is the main fuel source for our bodies. When food is digested, glucose goes to the bloodstream. The cells use glucose for growth and energy. Nevertheless, glucose cannot go into the cells without presence of insulin. Insulin enables the cells to take the glucose. Insulin is a hormone which is produced by pancreas.

A person having diabetes has a situation where the amount of blood glucose is extremely elevated (hyperglycemia) It is as a result of either the body not producing enough insulin, producing no insulin, or having cells that do not respond well to the insulin produced by the pancreas. This leads to building up of too much glucose inside the blood. Excess blood glucose is finally passed out of the body inside urine.

Burden of the disease

Diabetes is a major cause of death within Australia and it is the fastest growing disease worldwide. Diabetes mellitus is among Western Australia (WA)’s most important issues of health. Every day, almost 30 individuals are diagnosed with diabetes in WA. Type 2 diabetes is the form that is most common; it comprises 85 to 90% of those that have diabetes. The occurrence of type 2 diabetes has been growing. International and WA data shows that occurrence of type 1 diabetes increases approximately at 3% yearly. Diabetes burden is unequally distributed across the society. Diabetes-related mortality in 2001-03 in nearly all disadvantaged parts of Australia was higher by 82% than the areas that were least disadvantaged.

Diabetes in the Aboriginal people

The commonness of diabetes is two or four times advanced amongst Aboriginal individuals than among the non-Aboriginal people. In various Aboriginal communities that are remote diabetes occurrence is as high as 30%. The Type 2 diabetes usually develops at the younger age, and it is linked to various risk factors for example abdominal obesity, hypertension and Dyslipidaemia. Others also have the renal disease. Diabetes is seen to be a major contributor of the excess Aboriginal people mortality whose life expectation compared to other Australians is 17 years less. In WA, diabetes death rates are 13 times higher when it comes to female and it is six times higher when it comes to the male Aboriginal citizens than for the non- Aboriginal citizens. Various studies have shown clearly that weight loss can delay or prevent Type 2 diabetes in the high-risk persons

Diabetes Complications

Diabetes is recognized to be:

• A major cause of the cardiovascular disease
• a very common reason for starting renal dialysis
• a common cause of the blindness amongst people who are under 60 years
• a very common cause of amputation of the non-traumatic lower-limb
• among the most common chronic sickness in children

Hospital admissions

People who have diabetes stay longer in hospitals and the outcomes are poorer. In Western Australia, the diabetes related problems admission rate to hospitals for Aboriginal when dealing with age females is 17 times higher and it is 10 times higher for the Aboriginal males when compared with non-Aboriginal people

Diabetes awareness, early diagnosis and prevention services

Type 2 diabetes together with its complications is very avoidable. People who have IFG/ IGT or a history of gestational diabetes can reduce the risk of getting type 2 Diabetes by possibly 60% by regular physical activity, eating healthy and moderate loss of weight. An environment that supports and promotes healthy lifestyle is very important in reducing diabetes risk in the society. Diabetes prevention and awareness services are offered by many individuals and organizations in the government, the non-government and the private sectors

Long term and initial managing of type 2 diabetes

A lot of patients having type 2 Diabetes are usually managed in the society by the general practitioners, through variable input from educators of diabetes and dieticians by referring the patient directly to particular practitioners, or to the multidisciplinary teams that operate in the government, the non-government and the private sectors within the larger group practices, the General Practice Divisions, different community services, teaching hospitals or general hospitals. A lot of patients are as well referred to ophthalmologists, podiatrists and optometrists while some to the public or private endocrinologists

Self-management education on Diabetes, a cornerstone of the diabetes care, is offered by dieticians, registered nurses and additional health professionals who have undergone further training to be diabetes educators. Education on Diabetes is as well provided by the general practitioners, nurses, specialists, pharmacists, dieticians, websites and other different sources.

The Aboriginal people, persons living within the outer metropolitan, rural and regional parts and members of the other vulnerable and high risk groups continue suffering diabetic complications of high rates, and they are over-represented in the admission statistics of hospitals.

Lacking knowledge of the available resources and lack of coordination of the large organizations number as well as individuals to provide diabetes services pose as major barriers to the access and the optimal health results. There is a great need of developing well-organized interface amid community health and general practice services at local level.

Innovative strategies are required for overcoming challenges that are posed by the cultural factors, service gaps, language, remote locations and special needs of the Aboriginal people as well as other vulnerable and high risk groups who suffer from unduly high morbidity rates plus mortality from diabetes.

Early detection and most favorable management of the complications; specialist services

People having recognized diabetic complications require timely access to the right GP as well as specialist management services. Improved control of the blood pressure, glucose and lipids as well as Smoking cessation slows progression of the diabetic complications. Multidisciplinary high-risk and Professional podiatry foot services are very effective for avoiding amputations and ulceration. Laser photocoagulation is extremely effective when it comes to preventing loss of vision in people who have advanced diabetic retinopathy. Access to additional specialists is required for best management of the adva.............