Case Study of Type 2 Diabetes

This case study explores the background, key issues, and recommendations for nursing professionals in managing type 2 diabetes. It discusses preventive measures, referral services, interventions, risks of overweight and smoking, medication management, and policy implementation. Read to understand how to improve the quality of life for patients with type 2 diabetes.

Running head: CASE STUDY OF TYPE 2 DIABETES
CASE STUDY OF TYPE 2 DIABETES
Name of the student:
Name of the university:
Author note:

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Part A:
Background:
Diabetes can be described as the chronic disorder which had presently taken the shape of
an epidemic in the nation. The sugar levels in the blood are mainly controlled by insulin which is
actually a hormone that is released from the beta cells of the islets of Langerhans from the
pancreas. Insulin helps the cells of the body to become responsive to the presence of glucose in
the blood and thereby absorbs the glucose from the blood to contribute to the respiration process
(DeFronzo et al. 2015). There are a plethora of risk factors for onset and progression of diabetes.
Although some factors are heritable, rest is preventable. Obesity is the chief risk factor, with
millions of individuals facing obesity across the globe, which increases their likelihood of
suffering from the metabolic syndrome. Sedentary lifestyle and lack of sufficient exercise also
damages the health. In addition, consumption of a western diet, with a dependence on poor
quality fats, processed foods, and less fiber content is a chief contributor (Rawshani et al. 2018).
Hence, the glucose level of the blood increases making the patient suffers from various
complications. It has become one of the most concerning chronic health disorders in the nation
affecting for about 85% of the people in the nation.
Key issues:
Around 1.7 million people in the nation are currently suffering from diabetes with
100000 people being affected by it in the past year (Diabetes Australia 2018). Diabetes can
result to huge number of complications which in turn increases the suffering of the patients. One
of them is the cardiovascular disorders along with nerve kidney damage called neuropathy.
Studies have found increased association between kidney damage of nephropathy and eye

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damage of (retonipathy) (American Diabetes Association 2018). It would also result in causing
food damage. Nerve damage in the feet as well as poor blood flow to the feet can increase the
risk if various types of foot complications (Sullivan and Ghushchyan 2016). When left untreated,
cuts and blisters can help in developing serious infections which would not heal properly. These
infections might ultimately require toe, foot as well as leg amputation (Iglay et al. 2016).
Diabetes also increases the risk of an individual to develop skin problems like that of
bacterial and fungal infections. Many of the studies have even stated that that diabetes had
resulted in hearing impairment; even depression symptoms have been found to be associated
with diabetes (Chiang et al. 2015). The total annual cost of the impact of diabetes in the nation is
estimated to be around $14.6 billion. About 280 people in the nation are being affected everyday
in the nation counting to about one person every five minutes (Diabetes Australia 2018).
Recommendation:
Nursing professionals should be focusing more on preventive measures for treatment of
diabetes than on curative measures. It has become one of the health burdens in the nation and in
order to reduce the prevalence of the disorder as well as the expenditure of healthcare resources
because of diabetes, undertaking preventive care strategies is important. Nursing professionals
should arrange for screening sessions that will determine the BMI of the population, thus
facilitating identification of obese individuals, who are at a high-risk for diabetes
(Diabetesaustralia.com.au 2016). This would help the nurse to identify the vulnerable individuals
as well as the already affected individuals and accordingly help them to develop knowledge
about how to manage the disorders successfully.

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In addition, nursing professionals are also required to encourage the patients to take care of their
skin, eye, foot and oral health for preventing further complications. Dietary modification,
undertaking exercises and physical activities and overcoming sedentary lifestyle are important to
overcome the symptoms of diabetes (Diabetesaustralia.com.au 2016). Australian National
Diabetes Strategy 2016-2020 has also put forward 7 important goals that need to be met by the
governmental and non-governmental organizations to overcome the present health crisis. These
are preventing people from developing diabetes, promoting awareness, reducing occurrences of
diabetes related complications, reducing impacts of pre-existing diabetes, reducing impact of
priority groups, strengthening prevention and care and others (Diabetes Australia 2018). In
addition, the policy also considers contemporary strategies to diabetes services; role of
governments, role of stakeholders, evaluates alignment of current efforts with recognized needs,
maximizes the well-organized use of accessible resources, and articulates visualization
for detecting preventing, and managing diabetes. In addition, the policy has also gained support
from Primary Health Care Advisory Group, Medicare Benefits Schedule Review Taskforce, and
National Strategic Framework for Chronic Conditions that work towards providing better care to
people, aligning evidence with services, and developing partnership with stakeholders and
jurisdictions, respectively (Department of Health 2015).
Conclusion:
From the above discussion, it can be seen that diabetes has become one of the most
concerning chronic health disorder in the nation of Australia becoming a health burden on the
national economy. It is very important for nursing professionals to reduce the prevalence of
diabetes in the nation and therefore they should take up preventive measures. Developing health
promotion and health education to make people aware of the disorder can help vulnerable

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individuals prevent the occurrence of the disorder. They need to modify lifestyle choices and
unhealthy dietary patterns to overcome any chances of developing diabetes and live better
quality lives.
Part B:
Introduction:
Type 2 diabetes is one of the most concerning chronic health issues that are proving to be
a health burden on Australian economy. The prevalence rate of type 2 diabetes is increasing at an
alarming rate with 85% people of the nation being affected by the disorder (Diabetes Australia
2018). The case study also shows Jean who is unable to cope up with the symptoms of type 2
diabetes and had been hospitalized after exacerbation of the symptoms. This assignment would
be discussing various referral services and interventions that can be applied for Jean to help her
develop better quality life.
Risk of overweight and obesity and treatment approach:
One of the most concerning risk factors for type 2 diabetes is being overweight or
obesity. It is not known whether Jean is obese or overweight but the case study has shown that
she has gained weight over the years. Increase in body weight may result in enhanced
accumulation of fatty acids as well as different pro-inflammatory cytokines in the plasma that
can impact the glucose transport to the cell. It has been found that when cells contain fat
molecules, they become less sensitive to insulin (Speight et al. 2016). Some of the factors that
can result in obesity as well as type 2 diabetes are unhealthy food consumption which is high on
calories like takeaway foods and fast foods (Delaney et al., 2017). Jean had stated that her family
relies on take-away foods with little consumption of fruits and vegetables. She also takes in

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sweetened beverages which are quite high in calorie content. Jean will be referred to the family
obesity clinic (Nepean Family Obesity Service) that has been opened in Western Sydney. Owing
to correlation between obesity and type 2 diabetes, an expert team of doctors, dieticians,
physiotherapists, psychologists, and nurses will help Jean gain awareness on the metabolic
syndrome. In addition, the clinic service will also take into consideration a plethora of social,
cultural, lifestyle and genetic issues that are imperative for maintaining a healthy weight (NSW
Government 2017).
Jean had already been proposed by weight management plan by the previous nurse but
she had felt embarrassed. The Healthy Eating and Active Living Strategy of the NSW
government will also prove effective in management of the health condition. Jean will be
referred to the ‘Get Healthy’ program, which is a six month long telephone-based service
assisting NSW adults to make continued improvements in physical activity, healthy eating, and
maintaining a healthy body weight (NSW Government 2016).
Studies are of the opinion that Aboriginal individuals do not feel comfortable with
strangers which may impact information sharing and relationship building with healthcare
professionals (NSW Government 2017). Thus, she will also receive referral for the program
‘Culture Health Communities’ designed specifically for Aboriginal people by fostering a
collaboration between culture and communities, with the aim of enhancing health and wellbeing
(NSW Government 2016).
Risk of smoking and treatment approach:
Another important concerning risk factor for type 2 diabetes is smoking tobacco to a
large extent. Studies have found that smoking increase the inflammation in the body that occurs

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when chemicals in the cigarette smoke causes injury to the cells making them swelled and
interfere with the cell functioning systems smoking is also seen to cause oxidative stress which is
a condition that occur when chemicals from the cigarette smoke combine with that of oxygen in
the body resulting in damage to the cells (Browne et al. 2015). Abdominal obesity is again a risk
factor for type 2 diabetes as it can encourage the production of cortisol that increases blood
sugar. As smokers have high levels of cortisol than that of no-smokers. Moreover, studies are of
the opinion that smokers with type 2 diabetes have higher risks for serious complications like
that of heart and kidney disorders and also poor blood flow in the legs and feet making
individuals prone to infections and possible leg amputations. Therefore, Jean will be referred to
the NSW Quitline, a private telephone advice and information service, whereby professional
telephone advisors will provide her the much needed encouragement, support and resources for
quitting smoking. Free callback service, helpful information on smoking cessation, and
individually tailored cessation programs are some key attributes of this service, which will help
Jean reduce smoking, while displaying cultural sensitivity towards her Aboriginal background
(NSW Government 2018).
Retinopathy and peripheral neuropathy risks also increases in case of smokers who have
type 2 diabetes (Scanlon et al. 2017). Furthermore, Jean will also obtain referral to the
‘iCanQuit’ service that has been designed with the sole intention of motivating citizens to quit
smoking, by providing necessary information and resources needed to make a quit effort (NSW
Government 2018). This interactive service will also allows Jean to share her accounts about
current, previous, or planned cessation attempts, and will deliver accommodating hints such as,
goal tracker and calculator for demonstrating the everyday consequences of quitting.
Medication management:

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Jean is seen to forget her medications often. Two insights can be drawn from this action.
One of them might be that she is not aware of the ways of action of the medication or how the
medication is helping her to overcome the symptoms of the type 2 diabetes. She might be not
aware of the consequences if medication is not taken properly. All such lack of health literacy
might be resulting in her apathy to take medications making her forget to take the medications.
Studies are of the opinion that lack of health literacy can result in lack of knowledge about
importance of medications and hence results in either stopping of taking medications, not
following the regimes of medications or taking more dose of medications than required (Van
Netten et al. 2018). In such situation, she would be first educated about the importance of
medications and also the consequences that remain associated by missing of medications. Her
husband or any of her family members can help her in reminding about the medications. Alarms
can be set for this action as well. Her family members and her husband can be taught about the
importance of type 2 diabetes management, procedures of management and medications so that
they can take care of her and also keep a check over her medication regime to assure that she is
taking medication properly.
Policy implementation and services for Jean and her family:
Jean is an indigenous lady who has been residing in the South western Sydney in NSW.
In spite of various types of steps that had been taken by the government, they are still
unrecognized and uncounted. This had been one of the main barriers in improving the indigenous
health in the nation. This can be well-reflected through the scenario. In the year 2016, type 2
diabetes related deaths accounted for about 7.8% of all the deaths of the indigenous people (Holt
et al. 2017). It has been found that the standardised death rate for that of type 2 diabetes is five
times higher for the indigenous people when compared to that of the non-indigenous people in

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the year 2016 like 81.2% and 16.4% of the deaths per 10000 people respectively. Therefore, to
address this health gap, the national government had implemented the Closing the gap policy for
all the Local Health Districts (Stephens et al. 201. Even the NSW Aboriginal Health Plan 2013-
2023 had promised in contributing to the closing the gap policy where the framework is found to
be based on six important principles (Health and Social Policy 2017). These are creating the
evidence and implementing work, building trust through local partnerships, ensuring integrated
planning and service delivery, culturally safe practice and building the performance monitoring,
increasing the number of the Aboriginal workforce, management and accountability. In addition,
the South Australian Aboriginal Diabetes Strategy 2017-2021 has also been specifically designed
for meeting the requirements of Aboriginal people. The recommendations stated in this strategy
focus on prioritising a state-wide rejoinder to diabetes, besides guiding possible healthcare
diabetes reforms and related comorbidities (Healthinfonet.ecu.edu.au 2016).
SWSLHD had been seen to put forward the Aboriginal health impact statement policy which
mainly shows that NSW health care professional and stuffs need to develop cultural knowledge
and cultural awareness about the Aboriginal principles and provide culturally competent care that
aligns with their cultural traditions, customs, expectations and others (Webster et al. 2017).
Hence, Jean must be referred to the Aboriginal Tobacco Control Project, a segment of ‘Close the
Gap’ that aims to lower the rates of smoking prevalence by as much as 5%. Taking into
consideration the fact that Jean is an active smoker, she will the project will help her seek
support from South Western Sydney and Sydney Local Health Districts (SWS & SLHD) and
Aboriginal Health Units, whereby she will gain an access to aboriginal doctors, medical services
and health workers, who will facilitate smoking cessation. In addition, the service will also help

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her gain a sound understanding of different smoking cessation techniques, besides providing her
access to affordable patches for Nicotine Replacement Therapy (NSW Government 2018).
In addition, Jean will also be referrd to Patient Transport Service (PTS), also referred to as Non-
Emergency Patient Transport that will help her gain access to the referral services. PTS will
coordinate booking and dispatch of most non-urgent patient transportation reserves in Hunter
New England and the greater metropolitan Sydney (NSW Government 2018). Furthermore,
Operational Fleets will also play a crucial role in transporting her to and from private and private
healthcare facilities that are imperative for enhancing her health and wellbeing.
Conclusion:
From above discussion, it can be seen that chronic disorder like type 2 diabetes is a long-
term health condition. Self-management of such symptoms of this chronic ailment is extremely
important for the reduction of hospitalization as well as with the hospital stay. Jean is an
aboriginal woman who is suffering from type 2 diabetes and had faced exacerbation of the
symptoms. Therefore, the patient needs to be sent for referral to healthcare services that are in
alignment with her Aboriginal values and perceptions, and also take into account the different
risk factors which might have increased her likelihood of developing the metabolic syndrome.
Proper references to community health services for Aboriginals can help Jean to get culturally
competent care which would make her happy and satisfied.

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