Promoting Self-Management Skills for Type 2 Diabetes Mellitus in Older Adults

Running head: ADULT NURSING
Adult Nursing
Name of the Student
Name of the University
Author Note

1ADULT NURSING
Introduction
According to the National Health Service (NHS) (2019), long term physical health
condition (LTHC) or chronic condition is a health problem that requires the ongoing
management for years. A Long term condition (LTC) is non-curable but can be controlled by
the application of medication or other therapies. According to The Kings Fund (2019), LTC
is prevalent among the older adults and people from the poor socio-economic class.
Treatment and care for people suffering from the LTC is estimated to amount around £7 in
every £10 of total expenditure of health and social care. The common LTCs are non-
communicable diseases, communicable diseases, certain mental disorders (schizophrenia,
depression) and ongoing impairments in structures (joint disorders and blindness). Common
communicable disease is Acquired Immuno Deficiency Syndrome (AIDS). The non-
communicable diseases are diabetes, cardiovascular disease, chronic respiratory disease, pain,
chronic neurological disease (multiple sclerosis), fatigue syndrome and irritable bowel
syndrome [National Health Service (NHS), 2019].
The following essay is based on the case study of an older adult who is suffering from
the LTC, Type 2 Diabetes Mellitus (T2DM). According to the Diabetes UK (2019), T2DM is
a metabolic disorder that cause development of hyperglycemia (high blood glucose level;
BGL) as the hepatic cells of the body develops insulin resistance thus unable to recognize the
insulin in blood for the uptake of blood glucose. In other words, in T2DM, the body is
unable to metabolize glucose (simple sugar) leading to high BGL. Prolong high BGL leads to
organ damage. Poor lifestyle habits, obesity and genetic pre-disposition increase the
vulnerability of developing T2DM. Unmanaged T2DM leads to the development macro and
microvascular complications hampering overall quality of life (Diabetes UK, 2019).
Macrovascular complications of T2DM include cardio-vascular disease and micro-vascular

2ADULT NURSING
complications include diabetic retinopathy (damage to eyes), blindness, renal neuropathy and
peripheral neuropathy (World Health Organisation [WHO], 2019).
According to the International Diabetes Federation (IDF), 371 million people across
the globe suffer from diabetes and this figure is going to exceed 550 million by the end of
2030. National Institute for Health and Care Excellence [NICE] (2019) has guidelines for
care and management of T2DM among older adults that focuses on the degree of patient’s
education, management of the cardio-vascular disease due to diabetes dietary monitoring and
management, reduction in the blood glucose levels. In spite of repeated initiatives made by
UK government, more than 2.7 million people have been diagnosed with T2DM and more
than 750,000 people with T2DM are undiagnosed (Diabetes UK, 2019).
The purpose of this essay is to highlight one clinical priority from the case study
followed by rationale of the selection of the problem, physiological and psychological aspects
of the problem. This will be followed by nursing assessment and interventions in order to
address that clinical priority, followed by evaluation of the outcomes. The main scope of this
essay is to discuss the nursing assessment, management and evaluation for T2DM as LTC.
The conduction to this essay is important as improved care for the older adults will help in
avoiding unwanted morbidity and mortality associated with T2DM (WHO, 2019).
Overview of the patient
Before gathering all the health-related information from the patient, verbal consent
from the patient is obtained. While taking the consent, the patient was informed about how
his information will be used in the essay. He was also informed that his name will never be
disclosed (kept confidential) at any point of time within the essay. According to the 5th code
of conduct by the Nursing and Midwifery Council (NMC) (2018), it is important for the
nursing professional to take informed consent from the patient.

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Patient X is 68 years old retired man with a 7 years history of T2DM. Although he
was diagnosed with diabetes 7 years back, he had developed symptoms of high BGL
(hyperglycemia) 2 years before diagnosis. As per his memory, he had fasting blood glucose
level of 118-127 mg/dl at the time of T2DM detection indicating “borderline diabetes”. He
had past episodes of nocturia (night time urine) after having large meals of pasta and pastries.
His doctor advised him to reduce weight (15 lb minimum). However, no action was taken
further. Patient X reports that he has gained 11 lb during the past 2 years, has less than the
optimal control of diabetes while developing foot pain and cold feet at night. He had been
trying to lose weight by increasing the physical exercise; however, he is unable to do so due
to foot pain. He had started taking the medication of glyburide (diabeta), 2.5 mg per day in
morning. However, he had stopped doing so due to nausea. He is often accompanied with
profuse sweating and sensation of mild agitation during afternoon. Patient X reported that he
also takes atorvastatin (Lipitor) 10 mg per day for managing his high cholesterol level or
hypercholesterolemia [elevated levels of low density lipo-protein (LDL) and cholesterol
along with low levels of high density lipoprotein (HDL)]. He has tolerated atorvastatin and
adheres to the daily schedule. During past 6 months, the doctor has prescribed him to take
chromium picolinate, gymnema sylvestre, and a “pancreas elixir” to improve his diabetic
control. However, he has stopped having these supplements when to failed to note any
significant positive results.
Patient X lives alone after death of his wife and both his sons live out of the city. He
depends on ready to eat food, ordered online, does not tests his blood glucose level at home,
and is doubtful regarding how this procedure can improve his diabetic control. Patient X
quoted that “I just don’t understand, how knowing the number can help me with diabetes as I
already know my diabetic?” Patient X states that “I have never been sick a day in my life and
look at me now”. His diet history states excessive intake of carbohydrate in the form of pasta