Care Priorities for A Person Suffering from Type 2 Diabetes

Introduction to Person Suffering from Type 2 Diabetes

An interview was conducted with Mr. ABC (name changed), a 55-year-old male, residing in Melbourne, about his chronic condition of Diabetes Type 2. He mentioned that his diagnosis was made when he was 45 years old when he visited his doctor for chronic cough. On examination, a yeast infection was diagnosed in his lungs. Further investigations revealed that his blood sugar was very high. He was put on type 2 oral medication. He recalls feeling so bad at the end of the week that he scheduled a consultation with an endocrinologist, who found his blood glucose level was 700 mg/dl, diagnosed him with type 2 diabetes, and initiated him on the required anti-diabetic medications. The first thought that came to his mind when he was diagnosed was that since he was obese and had gained a lot of weight in the past 2-3 years, it could be one of the reasons for the same. But, he also thought that diabetes was hereditary, and since his parents didn't have it, he was shocked by his diagnosis. Later through the years, he has realized there is a need for more patient advocacy for people suffering from Type 2 diabetes in the lines of lifestyle management and weight management along with associated awareness about it not being completely subject to heredity as well. His current A1c is at 10.5% which is higher than the supposed normal.

He's been having a couple of problems with constant urination, which means he needs to get up several times through the night and is unable to sleep. He claims that the compulsion to urinate never goes anywhere, even though he is sleeping. It's also affecting his water consumption and inducing dehydration so he needs to drink more water to compensate for the water lost because of too much peeing. Also, he has been unable to manage his diet and physical activity, and exercise schedule for the past few months because of work stress and tension which has led to his improper eating patterns and not consuming his anti-glycemic medications on time. He has also had an admission to the ER for a hypoglycaemic attack last month. The patient mentioned that his primary concern was his lack of physical activity, increasing weight, and sedentary lifestyle which was becoming a hindrance in his glycemic control. Also, the concern of repeated urination, during night times is an issue of concern for him, where he is feeling increasingly uncomfortable due to the same. For Mr. ABC, the primary care priority would be to handle his glycemic control (sedentary lifestyle) and manage his polyuria symptoms.

Primary Care Priority Based on RLT Model- Glycemic Control

Mr. ABC's lack of physical activity is a major treatment issue and goal found for him depending on his interview, as per the RLT model (Holland et al., 2019). According to Mahmud et al (2018), physical activity facilitates a mutual interaction between the bodily and mental systems of the body. He says that "at the juncture of his illness, he wasn't motivated to go on his walks or daily bout of exercises as often as he's ever been." Owing to job stress, he found he was "unable to carve out time for some physical exercise as he's ever been." A significant component of this is lack of exercise or a completely sedentary lifestyle. Boosting his physical fitness and avoiding a sedentary lifestyle would enable him to minimize tension and better control his blood sugar and levels. Except for his eating habits, his failure to exhibit the ability to comply with his anti-glycemic medications is creating trouble and contributing to concerns such as hypoglycemic attacks. Decreasing the levels of blood glucose in diabetic patients has also been found to reduce mortality and morbidity rates. The primary aim of diabetes therapy is to achieve and retain glycemic control. Diabetes-related death and complications are influenced by glycemic control, which is a common cause (Sawani et al., 2020).

Significance of Glycemic Control

Around 25% of people with Type 2 diabetes have insistently compromised glycemic control, increasing their risk of microvascular complications. Adequate glycemic control associated with a healthy lifestyle has been related to improved clinical results, lower morbidity, and premature death of diabetic patients. Curative anti-glycemic therapies should be closely monitored in the recovery process of T2D patients to relieve symptoms (Staels et al., 2017). Diabetic retinopathy, micro-and macroalbuminuria, and micro-and macroalbuminuria were all more common in older adults with reduced glycemic function compared with those who maintained their HbA1c levels throughout the recommended readings. Several studies conducted with patients of T2DM have discovered a negative correlation regarding adherence to treatment protocols and medication regimens and the possibility of acute complications (Kayar et al., 2017). Poor medication tolerance, or a shortage thereof, has been attributed to the incidence of diabetic ketoacidosis in T2D patients, resulting in lengthy hospital stays.

Nursing Management for Glycemic Control

Regulating his medicine doses will help him keep his blood sugar under the balance, resulting in a decrease in his A1c and blood sugar levels. In addition, nutritional changes and management will help prevent an exacerbation of his glucose levels or an abrupt drop in his glucose levels progressing to a hypoglycaemic assault (Dutta et al., 2016). Apart from keeping an appropriate diet for him to avoid hypoglycemic problems, the aim is to lower his A1c levels. Another target treatment aim in his case will be to improve his physical activity in the form of Yoga for up to 10 minutes per day to minimize insulin resistance and encourage a healthier body as a by-product of a healthy mind to alleviate anxiety and eliminate psychological experiences (Ventura et al., 2018). His anxiety caused by diabetes can be mitigated by growing his physical activity, which also improves his quality of life (Bassi et al., 2021).

Most importantly, these therapies should have strengthened his blood glucose control. These therapies would also help him feel less anxious over his blood glucose levels. In addition, proper patient knowledge and information of his condition and glycemic management will aid in his ability to provide self-care. Mr. ABC will be cared for by a multi-disciplinary team that includes a dietitian, nutritionist, and diabetic nurse (Tan et al., 2020). This nurse taught him how to use a sugar adjustment algorithm and how to properly monitor his blood glucose levels. The nurse also assisted him in developing a successful exercise regimen. He had also been referred to a dietician, who helped him create a healthy eating plan that included more fiber and fewer carbohydrates. Patient-centered care, which allows patients to keep a record of their blood glucose levels, insulin dosages, physical activity, and food schedules, can also aid in bringing about significant improvements inappropriate behavior and blood sugar control (AIHW, 2018).

Primary Care Priority- Polyuria

Depending on his conversation, the patient's primary objective concern was that he was having problems with excessive urination and had established polyuria, a diabetes concern (Holland et al., 2019). As per the RLT model, the ADL associated with this issue of polyuria is removed. He was unable to talk about it at first, but he realized it was becoming a bigger issue now. When it comes to patients' bowel and bladder evacuation, it's usually a sensitive subject that demands the utmost respect and dignity (Marks, 2021). Polyuria is a condition that arises as a result of high levels of blood glucose in the body (Glassford, 2017).

Significance of Polyuria

If polyuria and, as a result, blood glucose levels are not regulated, it can lead to serious complications. These are attributed to improper glucose distribution from the blood to the body tissues, leading to increased blood glucose, elevated glucose in the urine, and loss of fluids from the urine. Ketone bodies (chiefly acetoacetate and -hydroxybutyrate) accumulate in the bloodstream when insulin levels decrease to the point that lipid metabolism is no longer blocked, inducing metabolic acidosis and compensating respiratory alkalosis due to hyperventilation. If left untreated, ketoacidosis may cause brain edoema, mental illness, unconsciousness, coma, and death if compensating mechanisms malfunction (Kahanovitz et al., 2017). Suitable therapy can prevent acute ketoacidosis and hypoglycemia, but using exogenous insulin to manage glucose levels to near-normal levels is exceedingly difficult. Hypoglycemia is a typical side effect of increasing treatment, and it can vary from mild and inconvenient to serious and life-threatening. Given these issues, the majority of individuals with T2D appear to have mild-to-moderate hyperglycemia, and months of exposure can cause damage. Long-term complications of inadequately managed diabetes include damage to medium and wide blood vessels, which can cause heart disease, stroke, and peripheral artery disease, as well as effects resulting from injuries to comparatively narrow blood vessels (microvascular disease), such as nephrotic syndrome, that could cause kidney failure, and neuropathic pain, that can refer to sensory and autonomic impairment (Larsen et al, 2019).

Nursing Management of Polyuria

As completion of his recovery, he will need to be put on a diet to reduce his carbohydrate consumption and increase his fiber intake. The recovery plan that was recommended for him was dependent on his assessment, which included blood glucose, A1c, and carbohydrate intake measurements. This treatment aims to reduce the symptoms of polyuria by reducing carbohydrate consumption and decreasing blood glucose levels. Counseling may be given, as well as the patient's presence in the treatment package (NSQHS, 2020). Chang et al. (2018) suggests that good counseling is required to reduce the intake of added carbohydrates. As a consequence of the situation, his repeated urination should reduce. The patient must be aware of the locations of toilets wherever he visits, and he was offered the ability of someone utilizing a commode if he didn't think he'd be able to make it to one.

Conclusion on Person Suffering from Type 2 Diabetes

Given the tough case, utilizing the RLT model of therapy to enable the students to focus and achieve their goals was beneficial. Although an RLT model assessment takes time, it was selected for this situation because it considers the patient's needs rationally and gives him a rundown of his health condition. The design also helped the care team formulate a recovery plan for the patient that was personalized to his individual needs. The healthcare facility's initiatives identified and resolved the patient's concerns, and he was discharged and allowed to return home. When considering his treatment approach, it's apparent that combining the RLT paradigm with the nursing process culminated in a fruitful method for defining, planning, implementing, and updating his treatment.

References for Person Suffering from Type 2 Diabetes

Australian Institute of Health and Welfare. (2018) Australian Health 2018. www.aihw.gov.au/getmedia/7c42913d-295f-4bc9-9c24-4e44eff4a04a/aihw-aus-221.pdf

Bassi, G., Mancinelli, E., Di Riso, D., &Salcuni, S. (2021). Parental Stress, Anxiety and Depression Symptoms Associated with Self-Efficacy in Paediatric Type 1 Diabetes: A Literature Review. International Journal of Environmental Research and Public Health18(1), 152. https://doi.org/10.3390/ijerph18010152

Chang, E., & Johnson, A. (2018). Living with chronic illness and disability. Principles for nursing practice (3rd ed) Sydney: Elsevier Australia.

Dutta, T., Kudva, Y. C., Persson, X. M. T., Schenck, L. A., Ford, G. C., Singh, R. J., ... & Nair, K. S. (2016). Impact of long-term poor and good glycemic control on metabolomics alterations in type 1 diabetic people. The Journal of Clinical Endocrinology & Metabolism101(3), 1023-1033. https://academic.oup.com/jcem/article/101/3/1023/2804850#59803214

World Health Organization. (2015). Non communicablediseases. http://www.who.int/ncds/en/

Glassford, M. A. (2017). Recognizing type 1 diabetes mellitus in children & adolescents. The Nurse Practitioner42(6), 16-22.

Kahanovitz, L., Sluss, P. M., & Russell, S. J. (2017). Type 1 diabetes–a clinical perspective. Point of care16(1), 37.

Kayar, Y., Ilhan, A., Kayar, N. B., Unver, N., Coban, G., Ekinci, I., ... & Eroglu, H. (2017). Relationship between the poor glycemic control and risk factors, life style and complications. https://www.alliedacademies.org/articles/relationship-between-the-poor-glycemic-control -and-risk-factors-life-style-and-complications.html

Larsen, P. D., &Lubkin, I. M. (2019). Chronic Illness: Impact and intervention (10th ed.).London: Churchill Livingston.

Mahmud, F. H., Elbarbary, N. S., Fröhlich‐Reiterer, E., Holl, R. W., Kordonouri, O., Knip, M., ... & Craig, M. E. (2018). ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatric diabetes19, 275-286. https://doi.org/10.1111/pedi.12740

Marks, B. E. (2021). Initial Evaluation of Polydipsia and Polyuria. In Endocrine Conditions in Pediatrics (pp. 107-111). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3- 030-52215-5_17

Holland, K., & Jenkins, J. (Eds.). (2019). Applying the Roper-Logan-Tierney Model in Practice-E-Book. Elsevier Health Sciences.

Sawani, S., Siddiqui, A. R., Azam, S. I., Humayun, K., Ahmed, A., Habib, A., ... & Iqbal, R. (2020). Lifestyle changes and glycemic control in type 1 diabetes mellitus: a trial protocol with factorial design approach. Trials21, 1-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171752/

Staels, F., Moyson, C., & Mathieu, C. (2017). Metformin as add‐on to intensive insulin therapy in type 1 diabetes mellitus. Diabetes, Obesity and Metabolism19(10), 1463-1467. https://doi.org/10.1111/dom.12948

Sudbury, Massachusetts: Jones and Bartlett. Levett-Jones, T. (2018). Clinical Reasoning: Learning to Think Like a Nurse (2nd ed.).

Tan, H. Q. M., Chin, Y. H., Ng, C. H., Liow, Y., Devi, M. K., Khoo, C. M., & Goh, L. H. (2020). Multidisciplinary team approach to diabetes. An outlook on providers’ and patients’ perspectives. Primary Care Diabetes.

Ventura, A., & Evans, S. (2018). What are the benefits of yoga for people with diabetes?. Journal of Yoga and Physiotherapy4(3).

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