Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Background about Diabetes

Diabetes is a serious, life-long condition affecting many Canadians. With the current understanding of the importance of glucose management for complication prevention in type 2 diabetes, insulin therapy is being considered as an early treatment option. Insulin therapy is no longer the treatment of last resort, but may be a proactive choice for many people (Canadian Diabetes Association (CDA), 2003a; Meltzer et al., 1998).

There are three main forms of diabetes:

  1. Type 1 diabetes affects approximately 10% of all people with diabetes and is primarily a result of an inability to produce insulin due to autoimmune destruction of the pancreatic beta cells. It is often diagnosed at a young age and requires insulin treatment. People with type 1 diabetes are susceptible to diabetic ketoacidosis if they do not take the required insulin.
  2. Type 2 diabetes affects approximately 90% of those diagnosed with diabetes and results from a combination of insufficient insulin production and/or insulin resistance at the cell level.
  3. Gestational diabetes (GDM) is diagnosed during pregnancy and affects 3.5 to 3.8% in the non-Aboriginal population (CDA, 2003a). Up to 40% of women who have had GDM will develop type 2 diabetes as they age (Health Canada, 2002).

Type 2 diabetes is considered to be a progressive condition. Many individuals develop secondary failure on oral antihyperglycemic agents, which means that eventually insulin is required. Approximately 50% of all clients with type 2 diabetes eventually require insulin therapy to maintain optimal glycemic control (DeWitt & Hirsch, 2003; Grissinger & Lease, 2003; Turner, Cull, Frighi, Holman, & UKPDS Group, 1999).