Controlling Type 2 Diabetes Mellitus jensen o'shea

Pre-test

The bolded choice is the answer my client chose before the teaching project was shown to them.

  • 1. What is the normal range of blood sugar levels?
  • A. 50-85 mg/dl
  • B. 70-100 mg/dl
  • C. 90-110 mg/dl
  • D. 150-170 mg/dl
  • 2. What does the A stand for in the ABCs of diabetes?
  • A. A1C
  • B. Airway
  • C. Artery
  • D. Ankle
  • 3. Which of these complications is not related to diabetes?
  • A. Foot ulcers
  • B. Nerve damage
  • C. Hearing impairment
  • D. Wheezing
  • 4. How many servings of fruit per day is recommended for a patient with diabetes?
  • A. 2-4 servings
  • B. 1-2 servings
  • C. 6-7 servings
  • D. 5-6 servings
  • According to the American Diabetes Association:
  • 29.1 million people in the United States, or 9.3% of the total population, has diabetes.
  • 25% of Americans over the age of 60 have diabetes. (That's 11.8 million seniors!)
  • Diabetes is the 7th leading cause of death in the United States
  • Diabetes is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness
  • Type 2 DM is the most common form of diabetes

Due to the prevalence of diabetes in the United States, Healthy people 2020 has made it their goal to "reduce the disease burden of diabetes mellitus (DM) and improve the quality of life for all persons who have, or are at risk for, DM."

(Assessment) My client, who is newly diagnosed with type 2 diabetes mellitus, has asked to learn more about how a healthy diet can control blood sugar levels, so the Healthy people 2020 objective I will be focusing on is, "improve glycemic control among persons with diabetes"

Objectives

  • To educate my client on the pathophysiology of type 2 diabetes mellitus
  • To educate my client on signs and symptoms of hyperglycemia and hypoglycemia
  • To inform my client on the possible complications that may arise from untreated or poorly managed diabetes mellitus
  • To educate my client on how to properly manage their type 2 diabetes mellitus
  • To discuss barriers that my client may experience while trying to manage their diabetes mellitus
  • To provide resources in the community that me be beneficial to my client's management of diabetes
  • To answer any questions my client may have about type 2 diabetes mellitus

WHAT IS TYPE 2 DIABETES MELLITUS?

Type 2 diabetes mellitus is a condition that causes your body's blood sugar levels to be higher than normal. Normally the hormone insulin is produced by the pancreas to breakdown the sugars eaten in your diet, but people with diabetes mellitus experience something called insulin resistance. Insulin resistance means that your body does not use insulin properly which causes the sugar levels in your blood to rise above normal; This is called hyperglycemia. Hypoglycemia, or low blood sugar, is also a complication of diabetes. If your blood sugar is not controlled properly, it can lead to serious complications or death.

  • Signs of hyperglycemia: Blood sugar above 100 mg/dL
  • Increased thirst
  • Headaches
  • Trouble concentrating
  • Blurred vision
  • Frequent urination
  • Fatigue
  • Signs of hypoglycemia: Blood sugar below 70 mg/dl
  • Excess sweating
  • Fainting
  • Excess hunger
  • Shakiness
  • Lightheadedness
  • Nausea or vomiting
  • mental status changes/confusion
  • Paleness (pallor)

Complications of Untreated Diabetes

  • Development of cardiovascular disease
  • Stroke
  • Nerve damage (neuropathy)
  • Kidney damage (nephropathy)
  • Eye damage (retinopothy) that can lead to blindness
  • Foot complications including poor circulation, blisters, ulcers, necrosis, and possible amputation.
  • Hearing impairment
  • Increased risk of infection
  • Increased risk of developing alzheimers

Management

Currently, there is no known cure to diabetes but there are multiple ways that this disease process can be managed. Sometimes it is necessary to combine multiple treatment options for optimal disease management. Management of diabetes mellitus should be individualized based on the severity of a client's disease process, preference and needs.

  • Healthy diet
  • Physical activity
  • Monitoring blood sugar levels
  • Insulin therapy
  • Bariatric surgery

Nutritional Management

A healthy diet is a very important part of maintaining healthy blood sugar levels. According to the US Library of Medicine and the National Institutes of Health, "multiple studies provide evidence that diabetes nutrition therapy is effective for improving glycemic control and other metabolic outcomes." Systematic reviews and clinical trials that were conducted have shown a 1-2% decrease in hemoglobin A1C levels with the use of nutrition therapy management. (Franz, 2014) Nutritional management and physical exercise may be enough to manage diabetes mellitus without the use of insulin.

What is Nutrition Therapy?

Nutrition therapy is an approach to optimize a client's health by making nutritional and lifestyle changes. Nutritional therapy for a client with diabetes mellitus focuses on a diet with reduced fat intake, counting carbohydrates, meal planning, healthy food or exchange choices, physical activity and behavioral changes. It is important to meet with a registered dietician to help create an individualized nutrition care plan.

What Foods Should I be Eating?

See the chart below, provided by the Joslin Diabetes Center, for daily nutrition recommendations...

Picture provided by Joslin Diabetes Center

What Foods Should I Avoid?

  • Sugary foods
  • Fruit juices
  • Dried fruits
  • White rice, bread and flour
  • Full-fat dairy
  • Trans fat
  • Packaged snacks
  • Large quantities of carbohydrates

Action Steps

What steps can you start taking to better control your glycemic index? The National Institute of Diabetes and Digestive and Kidney Diseases suggests that...

  1. Learn about diabetes: In order to best manage your diabetes, it is important understand the process of diabetes and how it can be managed!
  2. Know your diabetic ABCs: A: A1C test. This test is used to measure your average blood sugar levels over the past three months. You want your A1C levels to be below 7. B: Blood pressure. Diabetes is a common cause of high blood pressure. High blood pressure can lead to severe complications if untreated such as stroke or heart attacks. In general, the goal blood pressure for a diabetic patient is less than 140/90. C: Cholesterol. High cholesterol is another common problem faced by diabetics. It is important to have your cholesterol checked regularly to prevent complications.
  3. Learn how to live with diabetes: Eat a healthy well balanced diet, exercise daily, remain as stress free as possible, monitor blood sugar levels and follow your medication regimen. These actions will help to best manage your diabetes.
  4. Get routine care to stay healthy: See your health care provider at least two times a year to screen for complications. It is important to have your blood pressure checked, your feet checked, and have your weight monitored at each visit to ensure optimal health. Be sure to ask your physician any questions or discuss any concerns you may have.

Motivators

Why should I take action?

  • Having more energy
  • Need to urinate less often
  • Improved healing
  • Fewer skin and bladder infections
  • Decreased chance of heart attack or stroke
  • Decreased chance of pain, numbness and tingling caused by nerve damage
  • Feeling of self empowerment
  • Extended life expectancy
  • Improved quality of life

Barriers

  • Communication Barriers: It may be hard for older adults to understand what they are being taught due to hearing impairment, memory loss and cognitive impairment
  • Educational Barriers: It may be difficult for some older adults to understand information being taught due to their lack of education and minimal reading skills
  • Financial Barrier: It may be difficult to try to manage diabetes through a healthy diet if an adult does not have enough money to afford healthy foods. Someone may not be able to afford insulin or a glucose meter to help manage their diabetes.
  • Time: It may be difficult to try and find time to exercise in order to manage diabetes.
  • Support System: Some client's may be overwhelmed with the management of diabetes and can lack motivation for self care when there is not a support system available.

Community Resources

  • Individual or group diabetes counseling
  • Diabetes support groups located in the community
  • Local Dieticians can help to set up an individualized care plan to help manage your diabetes
  • Home-care services can be contacted if assistance with medication preparation or administration is needed
  • Educational brochures focusing on diabetes and care managements can be found at a local physicians office or local clinical

Post-test

This test was given to my client after they were shown my teaching tool. The bolded choice is the answer my client chose.

  • 1. What is a normal range for blood sugar levels?
  • A. 50-85 mg/dl
  • B. 70-100 mg/dl
  • C. 90-110 mg/dl
  • D. 150-170 mg/dl
  • 2. What doe the A stand for in the ABCs of diabetes?
  • A. A1C
  • B. Airway
  • C. Artery
  • D. Ankle
  • 3. Which of these complications is not related to diabetes?
  • A. Foot ulcers
  • B. Nerve damage
  • C. Hearing impairment
  • D. Wheezing
  • 4. How many servings of fruit per day is recommended for a patient with diabetes?
  • A. 2-4 servings
  • B. 1-2 servings
  • C. 6-7 servings
  • D. 5-6 servings

(Correct answers: 1. B 70-100 mg/dl 2. A. A1C 3. D wheezing 4. A 2-4 servings)

References

4 Steps to Manage Your Diabetes for Life | NIDDK. (n.d.). Retrieved March 02, 2017, from https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/4-steps

Diabetes. (n.d.). Retrieved March 02, 2017, from https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes

Franz, M. J., Boucher, J. L., & Evert, A. B. (2014). Evidence-based diabetes nutrition therapy recommendations are effective: the key is individualization. Retrieved March 02, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938438/

Joslin Diabetes Center | Diabetes Food Pyramid. (n.d.). Retrieved March 02, 2017, from http://www.joslin.org/info/know_your_food_groups_with_diabetes.html

(Unfortunately I am unable to correctly format the references to meet APA standards because this application will not let me provide a hanging indent)

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