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Bakgrund: Många personer i Sverige drabbas av diabetes typ 2 varje år. Insjuknandet medför att flera livsstilsförändringar bör göras för att komplikationer ska undvikas. Orems omvårdnadsteorier om egenvård, egenvårdsbrist och om omvårdnadssystem tillämpades som teoretisk utgångspunkt i studien. Syfte: Syftet var att beskriva patienters upplevelser av livsstilsförändringar vid diabetes typ 2. Metod: Metoden utgjordes av en systematisk litteraturstudie med induktiv ansats. Resultat: Analys resulterade i fyra huvudteman: Gemenskap, balans, motivation och förändring i grunden. Vissa patienter ville helst klara sig själv vid hantering av sjukdomen medan andra såg stödet utifrån som positivt för livsstilsförändringar. Rutiner och regler användes för att skapa balans och förenkla livet men kunde också brytas för att frambringa livskvalitet. Rädsla, kunskap och självkänsla var faktorer som påverkade livsstilsförändringar. Känslor som förknippades med livsstilsförändringar varierade mellan patienter men ofta upplevdes frustration. Slutsats: Upplevelser av livsstilsförändringar varierade mycket mellan patienter. Sjuksköterskor bör anpassa vård och hjälp till egenvård efter patienters unika situation eftersom upplevelser är olika. / Background: Many people in Sweden get type 2 diabetes each year. The disease requires several lifestyle changes and they should be made in order to avoid complications. Orems nursing theories of self-care, self-care deficit and nursingsystem was used as theoretical basis. Objective: The objective was to describe patients perceptions of lifestyle changes in type 2 diabetes. Method: The method consisted of a systematic literature review in a inductive approach. Result: The analysis resulted in four major themes: Community, balance, motivation and change of plea. Some patients would rather to take care of themselves in the handling of the disease while others found positive to look for support to get to make changes in their lifestyles. Procedures and rules used to create balance and simplify their lives could also be broken to increase life quality. Fear, knowledge and self esteem were factors that affected the lifestyle changes. Emotions associated with the lifestyle changes varied between patients but often it was perceived frustration. Conclusion: Experiences of lifestyle changes varied considerably between patients. Nurses should adjust care and assistance of self-care taking into consideration patients unique situation because the experiences are different.

Although the long-term therapeutic benefits of exercise are indisputable, contractile activity may induce divergent adaptations in insulin-resistant vs. insulin-sensitive skeletal muscle. The purpose of this study was to elucidate if the anabolic response following resistance exercise (RE) is altered in myocellular sub-fractions in the face of insulin resistance. Lean (Fa/?) and obese (fa/fa) Zucker rats were assigned to sedentary and RE groups and engaged in either cage rest or four lower-body RE sessions over an 8-d period. Despite obese Zucker rats having significantly smaller hindlimb muscles when compared to age-matched lean rats, basal 24-h fractional synthesis rates (FSR) of mixed protein pools were near normal in distally located muscle groups (gastrocnemius, plantaris, and soleus) and even augmented in those located more proximally (P<0.05; quadriceps). Although 2 x 2 ANOVA indicated a significant main effect of phenotype on mixed FSR in gastrocnemius and soleus (P < 0.05), phenotypic differences were partially accounted for by an exercise effect in the lean phenotype. Interestingly, obese rats exhibited a significant suppression of myofibrillar FSR compared to their lean counterparts (P<0.05; gastrocnemius), while synthesis rates of mitochondrial and cytosolic proteins were normal (gastrocnemius and quadriceps), suggesting a mechanism whereby translation of specific mRNA pools encoding for metabolic enzymes may be favored over other transcripts (e.g., contractile proteins) to cope with nutrient excess in the insulin-resistant state. Immunoblotting of the cytosolic fraction in gastrocnemius muscle indicated an augmented phosporylation of eIF4EBP1 (+ 9%) and p70s6k (+85%) in obese vs. lean rats, but a more potent baseline inhibition of polypeptide-chain elongation as evidenced by an increased phospho/total ratio of eEF2 (+78%) in the obese phenotype. Resistance exercise did not improve synthesis rates of myofibrillar, cytosolic, or mitochondrial proteins to the same extent in obese vs. lean rats, suggesting a desensitization to contractile-induced anabolic stimuli in the insulin-resistant state. We conclude that insulin resistance has diverse effects on protein metabolism, which may vary between muscle groups depending on fiber type distribution, location along the proximodistal body axis, and myocellular sub-fraction, and may blunt the anabolic response to voluntary resistance exercise.

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Bakgrund: Diabetes typ 2 är en kronisk sjukdom som ökar kraftigt i världen. Behandlingen grundar sig i livsstilsrelaterade åtgärder som ofta innebär en förändring av kost- och motionsvanor. Egenvård vid kronisk sjukdom beskrivs som en process som påverkas av olika faktorer. Sjuksköterskan har en viktig uppgift i att stödja personen i denna process utifrån varje individs behov och erfarenheter. För att kunna ge adekvat stöd är det betydelsefullt att få en ökad förståelse av upplevelsen av egenvård vid diabetes typ 2. Syfte: Syftet var att beskriva upplevelsen av egenvård hos personer med diabetes typ 2. Metod: En litteraturöversikt genomfördes baserat på tio kvalitativa artiklar hämtade från databaserna CINAHL och PubMed. Artiklarna analyserades och de likheter som identifierades lyftes fram och bildade nya teman. Resultat: Det övergripandet temat som representerar hela resultatet är upplevelsen av en inre kamp. Temat beskriver hur egenvården upplevs som en ständig kamp där sjukdomens krav vägs mot vad som är betydelsefullt i livet. Subtemat, upplevelsen av att integrera egenvården i vardagen berör egenvårdsprocessen. Resterande subteman; sociala relationers betydelse för egenvården, informationens och kunskapens betydelse för egenvården och den psykiska och fysiska miljöns betydelse för egenvården beskriver vad som underlättar samt försvårar integration av egenvård i dagliga livet. Diskussion: Författarna diskuterar svårigheter med att integrera nya vanor i livet och vad som påverkar egenvårdsprocessen. Diskussionen berör bland annat autonomi, syn på framtiden och behovet av att skapa kontroll över sin livssituation. Diskussionen knyter även an till Meleis' transitionsteori. / Background: Type 2 diabetes is a chronic disease that is increasing worldwide. The treatment is based on lifestyle-related measures that often mean a change in diet and exercise habits. Self-management in chronic illness is described as a process that is influenced by various factors. Nurses have a key role in supporting the person in this process based on each individual's needs and experiences. In order to provide adequate support, it is important to get a better understanding of the experience of self-management in type 2 diabetes. Aim: The aim was to describe the experience of self-management among people with type 2 diabetes. Methods: A literature review based on ten scientific articles. All articles were qualitative and found in the databases CINAHL and PubMed. The articles were analyzed and the similarities were highlighted and created new themes. Results: The overall theme representing the result is the experience of an inner struggle. The theme describes how self-management is experienced as a constant struggle between the disease demands and what is valuable in life. The sub-theme, the experience of integrating self-management in daily life, affects the self-management process. The remaining sub-themes describe the barriers to and facilitators of integrating self-management in daily life. Discussions: The authors discuss the difficulty of integrating new habits in life and what influences the process. The discussion includes autonomy, view of the future and the need to gain control. The discussion also relates to Meleis' Transition Theory.

Type 2 diabetes is a complex chronic metabolic disorder characterized by hyperglycemia associated with a relative deficiency of insulin secretion and a reduced response of target tissues to insulin. Considerable efforts have been put into the development of models describing the glucose-insulin system. The best known is Bergman’s “minimal” model for glucose, which is estimating glucose concentrations using fixed insulin concentrations as input. However, due to the involved feedback mechanisms, simultaneous modeling of both entities would be advantageous. This is particularly relevant if the model is intended to be used as a predictive tool. The mechanism-based glucose-insulin model presented in this thesis is able to simultaneously describe glucose and insulin profiles following a wide variety of clinical provocation experiments, such as intravenous and oral glucose tolerance tests, clamp studies and sequential meal tests over 24 hours. It consists of sub-models for glucose, labeled glucose and insulin kinetics. It also incorporates control mechanisms for the regulation of glucose production, insulin secretion, and glucose uptake. Simultaneous analysis of all data by nonlinear mixed effect modeling was performed in NONMEM. Even if this model is a crude representation of a complex physiological system, its ability to represent the main processes of this system was established by identifying: 1) the difference in insulin secretion and insulin sensitivity between healthy volunteers and type 2 diabetics, 2) the action of incretin hormones after oral administration of glucose, 3) the circadian variation of insulin secretion and 4) the correct mechanism of action of a glucokinase activator, a new oral antidiabetic compound acting on both the pancreas and the liver. These promising results represent a proof of concept of a mechanistic drug-disease model that could play an important role in the clinical development of anti-diabetic drugs.

Antro tipo cukrinis diabetas yra viena iš aktualiausių dabartinės medicinos problemų, kurios etiopatogenetinis pagrindas ypač glaudžiai siejasi su visuomenės papročiais ir gyvenimo būdu (WHO, 2006). Su gyvenimo būdu susietų rizikos veiksnių plėtra XX amžiuje įgavo epideminio pobūdžio metabolinių sutrikimų išraišką tarp atskirų, bet sąlyginai identiškai gyvenančių, individų grupių (King H. et al., 1998; Wild S. et al., 2004). Nepalankių socialinių ir ekonominių veiksnių įtaka ypač skatina metabolinių sutrikimų, kurie pasireiškia kaip metabolinis sindromas ir 2 tipo cukrinis diabetas, gausėjimą. Pasirinkus hipotezę, kad šiuolaikinės civilizacijos įpirštas gyvenimo būdas yra palankus 2 tipo cukrinio diabeto manifestavimui, prognozuojama, kad 2030 metais šia liga sirgs apie 366 milijonai planetos gyventojų (Wild S. et al., 2004). Metabolinių sutrikimų visuma įvardinta kaip „cukrinis diabetas” tampa vis dažnesne regėjimo sutrikimų, aklumo, kojų amputacijų, inkstų funkcijos nepakankamumo, blogos gyvenimo kokybės, prarasto darbingumo bei ankstyvesnio mirtingumo priežastimi. Tai – liga, esanti penktoje vietoje pagal mirtingumą po užkrečiamų, širdies ir kraujagyslių ligų, vėžio ir nelaimingų atsitikimų (Roglic G. et al., 2005). Lietuvoje cukrinio diabeto problema tampa vis aktualesnė, didėja sergančiųjų šia liga skaičius. Jei 1966 m. šalyje tebuvo suskaičiuotas 3561 sergantysis cukriniu diabetu (Sideraite Š., 1998), tai 1997 m. sausio 1 d. jau buvo užregistruoti 26896 sergantieji šia... [toliau žr. visą tekstą] / Diabetes mellitus is one of the main health issues in Lithuania. Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia, resulting from defects in insulin secretion, insulin action or both. The disease is associated with significant increased risk of long–term microvascular and macrovascular complications. The number of cases of diabetes worldwide in 2000 among adults 20 years of age is estimated to be 171 million. Diabetes is becoming a world pandemic with an estimated increase till 366 million cases by 2030, especially in developing countries. The number of people with diabetes is increasing due to population growth, aging, urbanization, and increasing prevalence of obesity . The aim of our study to assess clinical, laboratory data, risk factors and quality of life of new type 2 diabetes mellitus cases. A case–control study included 234 cases with newly confirmed diagnose of type 2 diabetes mellitus in 2001 and 468 controls who were free of the disease. Cases and controls were matched by gender and age (+5 yr.). Ratio of case and controls was 1:2. Two questionnaires were used in this study (1st one – to collect information on possible risk factors of type 2 diabetes mellitus, the 2nd one – EQ–5D questionnaire – to measure quality of life for patients with newly diagnosed type 2 diabetes mellitus). Variables were retained in models as confounders when inclusion changed the value of the odds ratio (OR) by more than 10% in any exposure category. The... [to full text]

The current study used phenomenology to explore how Mainland Chinese immigrants with type 2 diabetes engage in the self-management of diabetes in Canada. A total of 18 participants were interviewed (8 were male and 10 were female). The average age of the participants was 50.7 years old. Overall, participants were highly motivated in their diabetes management. They were seeking information on how to manage their diabetes from both formal and informal channels. The majority of them didn’t include traditional Chinese medication in their treatment due to the negative views they had towards it. They had a fear of western medication because of the possible side effects associated with it; however, many of them had to take medication when their condition was not managed with lifestyle intervention alone. Participants were in favour of lifestyle intervention, including diet management and physical activity. They changed from mindless eating to mindful eating, specifically, reducing their overall food intake with reduced carbohydrate, protein and increased vegetable intake. They acknowledged the importance of physical activity in diabetes management, but encountered more barriers in achieving the desired level of physical activity. Glucose level was used as a biofeedback to the changes they made in western medication, nutrition therapy, and physical activity. Balance and control were achieved as they have learned to manage their condition while living a “normal” life.

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No description available.