Approach to the patient with diabetic polyneuropathy

Prema definiciji Svjetske zdravstvene organizacije, šećerna bolest je trajna metabolička patologija koja se karakterizira visokom razinom glukoze u krvi, što s vremenom dovodi do oštećenja krvnih žila u srcu, očima, bubrezima i živcima. Prema procjenama Međunarodne federacije za dijabetes (IDF) za 2015. godinu, svjetska populacija od 20 do 79 godina obuhvaća 415 milijuna ljudi sa šećernom bolešću, dok u Republici Hrvatskoj registar CroDiab bilježi 254,296 odraslih osoba koje imaju šećernu bolest. Važno je napomenuti da se procjenjuje kako i do 40 % oboljelih nije dijagnosticirano, čime ukupan broj zaraženih prelazi 400,000. U skladu sa službenom klasifikacijom, postoje različiti tipovi šećerne bolesti, pri čemu su najvažnija dva tipa DM tip1 i DM tip2. Klinička slika ove bolesti značajno varira, ovisno o tipu, dobi pacijenta te prisutnim drugim bolestima. Simptomi šećerne bolesti obuhvaćaju mnoge znakove, a dijagnoza se potvrđuje mjerenjem glukoze u krvi. Preporučuje se posebno mjerenje glukoze na prazan želudac. Dijabetička polineuropatija je jedna od kroničnih komplikacija šećerne bolesti koja se manifestira kao niz oštećenja živčanog sustava. Njeni kompleksni patofiziološki mehanizmi ukazuju na različite moguće uzroke. Detaljni simptomi i znakovi manifestirane polineuropatije, kao i neinvazivne neurofiziološke analize, ključni su za dijagnosticiranje pojedinih manifestacija polineuropatije. Medicinska sestra je neophodan član zdravstvenog tima u dijagnostici, liječenju i prevenciji dijabetičke polineuropatije. Njena uloga se posebno ističe kroz proces planiranja zdravstvene njege, gdje se uspostavlja pozitivna interakcija između nje i pacijenata. Tokom pružanja zdravstvene brige, medicinske sestre posvećuju vrijeme rješavanju problema pacijenata kroz različite intervencije, uključujući neposrednu fizičku pomoć, vođenje, usmjeravanje, motivaciju te edukaciju i savjetovanje. S obzirom na kronični tok neuropatije, konstantna briga specijaliziranog zdravstvenog tima, u kojem medicinska sestra ima ključnu ulogu, je neophodna.SUMMARY: According to the definition of the World Health Organization, diabetes is a chronic metabolic disorder characterized by elevated blood glucose levels, which over time leads to damage to blood vessels in the heart, eyes, kidneys, and nerves. According to estimates from the International Diabetes Federation (IDF) for the year 2015, the global population between the ages of 20 and 79 includes 415 million people with diabetes, while in the Republic of Croatia, the CroDiab registry records 254,296 adults with diabetes. It is important to note that it is estimated that up to 40% of those affected have not been diagnosed, resulting in a total number of over 400,000 cases. In accordance with the official classification, there are various types of diabetes, with the two most important types being DM type 1 and DM type 2. The clinical presentation of this disease varies significantly, depending on the type, patient age, and other coexisting conditions. Diabetes symptoms encompass many signs, and the diagnosis is confirmed through blood glucose measurement, with fasting glucose measurement particularly recommended. Diabetic polyneuropathy is one of the chronic complications of diabetes that manifests as a series of nerve system impairments. Its complex pathophysiological mechanisms suggest various possible causes. Detailed symptoms and signs of manifest polyneuropathy, as well as non-invasive neurophysiological analyses, are crucial for diagnosing specific manifestations of polyneuropathy. A nurse is an essential member of the healthcare team in diagnosing, treating, and preventing diabetic polyneuropathy. Their role is particularly highlighted in the healthcare planning process, establishing a positive interaction between them and patients. During the provision of healthcare, nurses dedicate time to addressing patient issues through various interventions, including direct physical assistance, guidance, direction, motivation, education, and counseling. Given the chronic course of neuropathy, continuous care by a specialized healthcare team, in which nurses play a key role, is essential