Case Study: Diabetes Type 2 and Nursing Interventions

This case study discusses the impact of diabetes type 2 on a patient and the role of nursing interventions in managing the condition. It explores the physical, psychological, and social factors affecting the patient's health and suggests strategies for improving health outcomes.

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Diabetes type 2
Diabetes is one of the most common health conditions among people. It is not restricted to a
particular state or country; it has been affecting people from all around the world. Diabetes type
2 accounts for nearly 90 to 95 per cent of all diabetes cases (Donath, and Shoelson, 2011). The
statistics of national diabetes statistics report 2017 reported that nearly 23.1 million individuals
had identified with this health condition. Specifically, in the US nearly 5300 kids and teenagers
aged between 10 to 19 tears had this health issue. It is estimated that higher than 1 on seventeen
individuals in the UK has diabetes type 2. Role of nurses is important while dealing with people
having this issue. Their main role is to provide quality health care and keep the patient's data
confidential (Zinman et al., 2015). Diabetes is a long-lasting disease that cannot be cured;
therefore most of the patients are concern about the confidentiality of their case. Therefore is the
duty of the nurses and other health care provider to safe and keep their information secret
(Donath, and Shoelson, 2011). In this particular essay the safe and effective delivery of care,
upkeep, and management of the person with a complex health issue, and the opportunities to
promote the health of adults will be discussed.
Jack is the 36 years old man African-American man living with his wife with 2 children. He
works 8 hours daily in a packing company. His wife is also working in a garment company to
provide financial support to the family. He has identified with type 2 diabetes 6 months ago and
prescribed with metformin in order to maintain his misbalanced insulin regulation. He also
gained a lot of weight in the last 1 years and unable to work efficiently. He has been smoking
nearly 15 cigarettes per day and drinks three to four drinks of wine. He also stated that he is not
observing any improvement with the prescribed medicines. His wife revealed that he is not very
interactive with other people these days and like to stay alone. He has also been facing issues like

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hypercholesterolemia and hypertension. Since he was diagnosed with diabetes, he is also
suffering from stress and depression. Other health issues he has been facing include excessive
hunger, blurred vision, fatigue, frequent urination, sleeplessness, and excessive thirst. These
health situations are causing a lack of alertness and concentrations towards his work and family.
He has been assessed when he was admitted in the hospital and his vital sign assessment report
shows that the respiratory is 25 breaths per minute, heart rate 120 BPM, SpO2 is 96 per cent. The
patient is admitted to the hospital and currently prescribed with sulfonylureas, meglitinides,
thiazolidinedione, DPP-4 inhibitors, and GLP-1 receptor agonists along with the metformin.
Diabetes is a lifelong disorder that influences body functioning. The pancreases generate a
hormone called insulin which is the main triggering factor to turn the glucose from the foodstuff
to energy. In diabetes type, the insulin is not controlled defectively or it is not being used by the
cells, this is called insulin resistance (Bupa. 2019). The body tries to cope up with the adverse
situation but it ultimately leads to sugar build-up in the blood. The sign and symptoms associated
with diabetes type include fatigue, increased thirst, and hunger, headaches, loss of consciousness,
frequent urination, increased blood pressure and respiration rate (NHS. 2017). Insulin resistance
is the main cause of these health conditions, insulin is the hormone that permits the body to
maintain the sugar in the blood. Insulin resistance is the condition in which the cells are not able
to use insulin resourcefully. As an outcome, it takes additional insulin than usual to carriage
blood sugar or glucose into body cells, to be used instantly for fuel or kept for future use (Bupa.
2019). A fall in efficacy in receiving glucose to the cells produces a difficulty for cell
performance; glucose is usually the body's most rapid and most willingly obtainable source of
energy. As discussed in the case study the patient is also recognized with symptoms similar to
these health conditions. Diabetes type 2 can be caused by insulin resistance mostly. There are

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different factors that have been influencing health improvement (Nolan, Damm, and Prentki,
2011). Risk factors associated with this health condition include being overweight, fat
distribution in the body (if most of the fat is stored in the stomach), hereditary, race (American,
Indian, Asian and Hispanic people are more probable to have DT2). Lifestyle and psychological
problems related risk factor includes stress and depression, high consumption of tobacco and
alcohol (Diabetes UK, 2019).
Mr Jack has done any physical activity since he was diagnosed with diabetes and has also
become socially isolated. As discussed by his wife that he is not very active in the social
conversation. She also stated that he drinks a lot of alcohol and smokes nearly 20 cigarettes a
day. He is also reported to have increased thirst and hunger issues. Stress and depression also
increase the risk of diabetes worsening and leads to reduced health outcomes. According to
Pouwer, and Speight (2016), individuals who report chronic sleeping problems, depression, and
stress are at increased risk of developing diabetes type 2, although the mechanism of this is
poorly understood. Social isolations or detachment can also impact a person negatively as they
start ignoring their health requirement. The socially isolated people usually have increased
consumption of tobacco and alcohol. As mentioned in the case study the patient has also
developed a negative perception about the medication and found it unsuccessful to maintain his
health contention.
There are different treatment choices available for diabetes type 2. The treatment has been
applied in the case of Jack includes medication like metformin, sulfonylureas, meglitinides,
thiazolidinedione, DPP-4 inhibitors, and GLP-1 receptor agonists (Meier, 2012). Metformin is
the primary medicine recommended for diabetes type 2 (Kahn, Cooper, and Del Prato, 2014).
This specific medicine mainly works by dropping the production of glucose in the liver and

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enhancing the body's sensitivity to the hormone insulin. Sulfonylureas are the second line
medication in order to treat diabetes type 2. DPP-4 inhibitors are recognized as the add-on
treatment for persons with type 2 diabetes who are taking metformin and sulfonylurea (Tahrani,
Bailey, Del Prato, and Barnett, 2011). The assessment of the patient displays that he has high
blood pressure increased breathing rate and spo2. The treatment options provided to Mr Jack was
although favourable and high quality but psychological interventions can also be provided to the
patient in order to maintain his mind-body balance, where the nurses' professionals can play a
major role. Nurses are the main area when it comes to providing quality care to the patient; they
spend more time with the patient compared to other health professionals. Therefore they can be a
pillar in the treatment process and can work as the link between the patient and the physician
(Tahrani et al., 2011). The nurses can help the patient to manage the medication such as taking
medication on time, on right time and in right quantity (Rawal, Tapp, Williams, Chan, Yasin,
and Oldenburg, 2012). Nurses can also provide emotional support which is the main issues has
been seen among the people with diabetes and as reported by the patient. Nurses can educate the
person in relation to the negative impacts of unhealthy eating habits, lack of exercise, and not
socializing with the people. For that nurses should build a therapeutic communication with the
patient by using effective communication with the diseased person (Rawal et al., 2012). The
decision-making process should undertake in the presence of the patient and their family
members. The patient should be asked to fill the consent form in order to prevent any future
ethical or cultural issues (Chen, Creedy, Lin, and Wollin, 2012).
Some of the nursing interventions can be implanted along with the medication treatment includes
self-management education, nutrition, smoking cessation, psychological care, physical activity,
insulin therapy, regular assessment of vital signs and insulin level. Self-management is the most

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important aspect of nursing care that should be implemented in the treatment process of every
diabetic patient. Smoking can be also stopped with proper education. Different researchers
believed that provided physical activity related education might be beneficial to achieve the
health goals already set for the patient with diabetes type 2 (Al-Khawaldeh, Al-Hassan, and
Froelicher, 2012). Regular assessment can be helpful in order to check any implications
associated with the symptoms of this health condition it gives the physicians an idea about how
disease can be managed. Regular assessment of insulin and glucose level is helpful to manage
the insulin and glucose production in the body (Chen et al., 2012).
Health promotion is distinct as the processes that enable people to progress and improve switch
over their fitness and comprises both health teaching and approaches to encounter social and
environmental causes of health. Health promotion plays a vital role in the managing of diabetes
type 2 (Lindström, Absetz, Hemiö, Peltomäki, and Peltonen, 2010). Health promotion
approaches in T2DM might contain one or a grouping of programs directing health and
nutritional education, self-management, mental support, or establish initiatives directing health
care specialists, and in adding have a purpose to increase awareness of diabetes-related risk
factors. These health promotions strategies are proven to be effective to provide quality care to
the patient (Chen, Pei, Kuang, Chen, Chen, Li, and Yang, 2015). As mentioned in the case study
Mr Jack has lost his belief in medicine and thinks that the prescribed medication are no more
effective in his case, therefor psychological support is important. Health diet is other nursing
interventions that can be implemented in this case as good nutrition intake can act as the defense
process in this situation. Some of the recommended foodstuffs are brown rice, oatmeal, fruits,
beans, green leafy vegetables (Lindström et al., 2010). Food like sugar, pasta, white bread,

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pastries, and flour should be avoided that can enhance the insulin-related problem in the body.
Physical activity drops the level of blood glucose, therefore it is mainly essential to exercise
frequently in case of diabetes. Like anybody else, diabetes patient must aim to perform a
minimum of 30 minutes of modest exercise, minimally five times in a week. Any activity can be
performed that gets the patient somewhat out of breath and increases the heart rate. Though, the
patient must not twitch a new exercise without asking the GP or diabetes upkeep team first. As
workout may affect the level of blood glucose, the patient and the care team might have to
regulate the insulin handling, or diet strategy, in order to retain the glucose level stable (Chen et
al., 2015).
Conclusion
Diabetes is the health conditions in which the insulin balance is disturbed. Diabetes type 2 is a
form of diabetes which affected nearly 23.1 million people specifically in the US. The patient in
the case study has been facing issues related to diabetes type 2 and it associated health outcomes.
Some of the physical factors that impacted his health conditions include smoking cigarettes, lack
of physical activity. The psychological factors include; stress, depression, and lack of belief in
the medication and the social factor are social isolations. The nursing interventions like health
food, proper regular exercise, healthy communication with the patient; including the patient and
their families in the decision-making process can be implemented in this case. Physical activity
can help the body enhance the insulin management, psychological support might help the patient
to cope with the stress, and depression related issues and to improve his perception related to the
medication. Some of the recommendations to enhance the health quality of the patient include;
prevention of overweight, maintaining the optimum BMI, practicing the endurance activity,

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ensuring saturated fat consumption, stop smoking and reducing the amount of alcohol intake.
Regular assessment of vital signs and insulin level should be done.

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References
Al-Khawaldeh, O.A., Al-Hassan, M.A. and Froelicher, E.S., 2012. Self-efficacy, self-
management, and glycaemic control in adults with type 2 diabetes mellitus. Journal of Diabetes
and its Complications, 26(1), pp.10-16.
Bupa. 2019. Diabetes 2 type [online]. Available from: https://www.bupa.co.uk/health-
information/diabetes/type-2-diabetes [Accessed 27 February 2019].
Chen, L., Pei, J.H., Kuang, J., Chen, H.M., Chen, Z., Li, Z.W. and Yang, H.Z., 2015. Effect of
lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism, 64(2),
pp.338-347.
Chen, S.M., Creedy, D., Lin, H.S. and Wollin, J., 2012. Effects of motivational interviewing
intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: a
randomized controlled trial. International journal of nursing studies, 49(6), pp.637-644.
Diabetes UK .2019. Diabetes risk factors [online]. Available from:
https://www.diabetes.org.uk/preventing-type-2-diabetes/diabetes-risk-factors [Accessed 27
February 2019].
Donath, M.Y. and Shoelson, S.E., 2011. Type 2 diabetes as an inflammatory disease. Nature
Reviews Immunology, 11(2), p.98.
Kahn, S.E., Cooper, M.E. and Del Prato, S., 2014. Pathophysiology and treatment of type 2
diabetes: perspectives on the past, present, and future. The Lancet, 383(9922), pp.1068-1083.

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Lindström, J., Absetz, P., Hemiö, K., Peltomäki, P. and Peltonen, M., 2010. Reducing the risk of
type 2 diabetes with nutrition and physical activity–efficacy and implementation of lifestyle
interventions in Finland. Public health nutrition, 13(6A), pp.993-999.
Meier, J.J., 2012. GLP-1 receptor agonists for the individualized treatment of type 2 diabetes
mellitus. Nature Reviews Endocrinology, 8(12), p.728.
NHS. 2017. What is type 2 diabetes [online]? Available from:
https://www.nhs.uk/conditions/type-2-diabetes/ [Accesses 27 February 2019].
Nolan, C.J., Damm, P. and Prentki, M., 2011. Type 2 diabetes across generations: from
pathophysiology to prevention and management. The Lancet, 378(9786), pp.169-181.
Rawal, L.B., Tapp, R.J., Williams, E.D., Chan, C., Yasin, S. and Oldenburg, B., 2012.
Prevention of type 2 diabetes and its complications in developing countries: a
review. International journal of behavioural medicine, 19(2), pp.121-133.
Tahrani, A.A., Bailey, C.J., Del Prato, S. and Barnett, A.H., 2011. Management of type 2
diabetes: new and future developments in treatment. The Lancet, 378(9786), pp.182-197.
Zinman, B., Wanner, C., Lachin, J.M., Fitchett, D., Bluhmki, E., Hantel, S., Mattheus, M.,
Devins, T., Johansen, O.E., Woerle, H.J. and Broedl, U.C., 2015. Empagliflozin, cardiovascular
outcomes, and mortality in type 2 diabetes. New England Journal of Medicine, 373(22), pp.2117-
2128.