Chronic Disorder Management: Diabetes Type 2

This assignment discusses the pathophysiology of diabetes type 2, risk factors associated with it, and social determinants of health that impede self-management. Recommendations are made to improve self-management abilities.

Running head: CHRONIC DISORDER MANAGEMENT
CHRONIC DISORDER MANAGEMENT
Name of the student:
Name of the university:
Author note:

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Introduction:
The assignment would be mainly describing in details about a 30 year old patient who is
suffering from diabetes type 2. She had children to take care and therefore, she feels the need to
undertake changes in her life. She wants to develop self-management abilities by which she can
manage her own symptoms and prevent occurrence of any complications in her health. This
assignment would first discuss the pathophysiology of the disorder and the risk factors associated
with it. This assignment would thereby help in addressing the social determinants of health that
might affect her in developing self-management abilities and accordingly recommendations
would be made to her so that she can live better quality life.
Pathophysiology of the disorder:
Diabetes type 2 can be described as the health condition when the glucose levels of the
blood remains high. In normal conditions, the hormone insulin released from the beta cells in the
islets of Langerhans present in the pancreas mainly gets released when level of glucose increases
in blood after intake of food (Powers et al., 2017). This helps the cells of the body to respond in
ways by which they can absorb the glucose from the blood and use them for respiration and
production of energy. This energy drives the different organs to carry on their physiological
functions in the body to carry out essential activities in lives (Garber et al., 2016). In case of
patients with diabetes type 2, it has been found that the cells of the body become non responsive
even when insulin remains present in the blood. This prevents the glucose from the blood in
being absorbed by cells and so respiration and energy production cannot take place. Insulin
resistance by the cells can be attributed to that of the increased levels free fatty acids and pro-
inflammatory cytokines in plasma and this is seen to decrease glucose transport into the body

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cells. However, this abnormality also accompanies another physiological issue faced by the
body. In most cases, insulin secretion sufficiently and insulin resistance together results in
development of diabetes type 2 affecting the health of the individuals (Lean et al., 2018). The
patient in the case had developed diabetes type-2 resulting in increased blood glucose level
affecting the use of blood glucose in the production of energy. This increases the hence of organ
failure due to lack of energy required for functioning.
Risk factors for the disorder:
Some of the risk factors that contribute to the development of such disorder are heavy
weight being the main contributor of the insulin resistance in affected individuals. Another risk
factor that also acts as the contributor is the inactivity as well as lack of physical exercises. Often
family history also becomes a contributing risk factor for the development of diabetes type 2.
Race, age above 45, polycystic ovarian syndrome is some of the risk factors that result in the
development of the diabetes type 2 (Garber et al., 2017). In case of the patient, it was seen that
she was overweight and had sedentary lifestyles where she found no motivation for undertaking
of physical exercises and living an active life. Furthermore, her pregnancy period had made her
lazier and even after giving birth to her baby; she is seen to be inactive throughout the days.
Apart from that she was found to have family full of people suffering from diabetes which
indeed mark as a risk factor for her development of the disorder.
Inability of self-management:
Studies are of the opinion that diabetes type 2 can be successfully controlled when
individuals can develop self-management abilities and take care of their own selves successfully
(Chravala et al., 2016). The affected individuals should concentrate on preparing home cooked

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foods that need to be high on organic food products and nutritious food products with high
amount of fibers. They need to maintain their diets, check nutrition labels, drink plenty of water,
avoid salt in food and others. However, the patient in the case is observed to feel quite tired after
attending to her infant’s need throughout the day and also has no one to help her regarding it.
Therefore, she feels it to be easier to take in fast foods and take –away foods as she feels it is
hassle free and does not require her shopping and cooking (Chaudhury et al., 2017). Hence, she
does not cook her own food. Moreover, she gets tired and is yet not able to manage her time after
caring for the baby. She tried to relax by watching television, playing games on smart phones,
reading fashion magazines and others. Hence, she is also failing to undertake exercises and
physical activities important for diabetes management. She is careless about her medications and
feel that they handle make any difference. She even does not use the glucometer as she has
apathy towards it (Davies et al., 2018). In this way, she is failing in self-managing her disorder.
Studies are of the opinion that people need to alter their lifestyle choices and adopt health
behaviors that enable them to manage their diabetes symptoms. Individuals need to follow strict
low-carbohydrate diets with higher amounts of fruits and vegetables to prevent accumulation of
calories. They also need to ensure that they undertake rigorous physical activities that help them
burn their calories. Medication management is important to ensure blood glucose level and
prevent any dangerous situations like rising of complications and organ failures. No such self-
management attributes were found among the patient. She should be taught how smoking and
drinking affect the symptoms of diabetes so that she quits the behavior.
Social determinants of health that impede self-management:
Social determinants can be described as the living conditions where people are seen to
take birth, grow, live their life, survive and face death. Studies are of the opinion that social

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determinants of health are those social factors which have the ability to affect the health of
people directly or indirectly and can even prevent the successful development of self-coping and
self-management abilities of the people (Low Wang et al., 2016).
One of the social determinants of health is seen to be education and health literacy. When
education level of the individuals are low and when individuals have low levels of health
literacy, they are not able to understand the importance of proper lifestyle choices and health
behaviors. They are often seen to adapt to unhealthy lifestyles that make them more prone to
develop various disorders. It has been found in the case of the patient that she had poor levels of
education when she left her academics mid-way and started working for the local market.
Education helps individuals to identify nutritious food products and avoid food products which
are high on calories that can harm health (Garber et al., 2018). Therefore, the patient was not
aware the foods that needed to included in her diet and those which she should have avoided.
Health literacy can be explained as the degree to which an individual have the capacity in
obtaining, processing as well as basic health information services required for making
appropriate health decisions. Because of poor health literacy, individuals are often seen to fail
miserably in understanding the ways to manage their symptoms of the disorder and develop self-
coping abilities to manage the symptoms (Lin et al., 2016). In the case of the patient, it was seen
that he had poor health literacy as she did not know how to access healthcare services and she
was careless about her own health not knowing the complications that could arise. Poor health
literacy always left her confused about the care interventions that she needed to follow. All these
showed that she had poor self-management abilities and was found to be very casual in her
approach.

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Another social determinant of health is low income and unemployment. Studies are of the
opinion that low income and unemployment are associated with the occurrence of many chronic
ailments with diabetes type-2 being one of them. This can be exemplified with the help of an
example. Low income or unemployment means financial instability. This makes individuals to
purchase cheaper fast foods and take-away foods which are higher on calories that act as
contributors for obesity and diabetes disorder. They cannot purchase organic foods which are
costlier but have high levels of nutrients (Moore & Catalano, 2018). As a result, people are seen
to lack nutrients in their diet and increases chance of getting overweight and develop diabetes
because of fast foods which are cheaper. In the case of the patient it was found that she was not
working for the last two years during her pregnancy period and even after giving birth to her
baby. She was entirely dependent on her husband who worked as a mechanic and was currently
not earning as much required for maintaining a household for three people. Hence, it could be
seen that low income had made it difficult for the patient to purchase essential food products
required to maintain a healthy diet and lives on cheaper quality food that has exposed her to
develop diabetes type 2.
Lack of healthcare accesses is another social determinant of health that can also affect the
self-management abilities of the people. Many of the communities in the suburban and the rural
areas are seen to have very few or eve lack appropriate community healthcare centers of primary
healthcare professionals. It can be found that people often need to travel longer distances that not
only affect their physical health but also affects them financially through transportation costs.
Moreover, absent or inadequate care as well as discrimination and stigmatization from the
healthcare professionals can also result in avoiding attending healthcare centers for check-ups,
consultations and education until the patients face severe consequences (Le Roux et al., 2017). In

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case of the patient, it was seen that she used to live in a low-income neighborhood in a sub-urban
state which lacked primary healthcare services and community healthcare services. As a result,
she was not able to seek for help, consultations and follow-ups when she required support in
managing her healthcare (Booth et al., 2016). The travelling of long hours along with a baby
often made it inconvenient for her for which she had not been able to access the healthcare
services. This might have acted as a barrier for development of self-management abilities for her
symptoms of diabetes.
Analysis and application:
The foremost aspect that needs to be taken into consideration for effective development
of self-management abilities is the development of health literacy level and to educate her
sufficiently. This approach is important in order to help the person understand the importance of
maintaining healthy behaviors and healthy diet practices. The professionals need to ensure that
they educate her about the causes and risk factors for the disorder along with explaining the
consequences that might occur like foot amputations, diabetic retinopathy, glaucoma, kidney
disorders, nephropathy, and many others. Once, she becomes educated, she would become aware
of the importance of developing self-management capabilities and would be seen to undertake
healthy lifestyle voices (Reusch et al., 2017). Developing her health literacy would make her
understand the healthcare services that she needs to access in order to help herself overcome the
symptoms of the disorder. The patient should be educated about how to use glucometer to
measure the blood sugar level to find out whether the blood glucose level is within limits or that
she needs urgent care from professionals. In such a scenario, many of the studies have revealed
that only health education to patients might not make them develop self-management abilities as
they might lack the apathy to follow the advices of the professional. In such situations, the

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professionals can undertake motivational interviewing for the patients. it is found that
motivational interviewing is a counseling procedure that actually helps in resolving the
ambivalent feelings as well as the insecurities for finding internal motivation that is required for
changing the behaviors. This would help the patient to develop motivation for acquiring self-
management abilities for managing diabetes (Booth et al., 2016). The nurse would teach her the
importance of medication, help her manage the doses and take them on time. The professionals
can develop alarm systems which would help her take the medications at right time. The patient
should be encouraged to undertake physical exercises, going for jogging and brisk walking,
swimming sessions and others to maintain his health and avoid sedentary lives with poor
practices like being engaged in Smartphone use and others.
Another barrier to her self-management ability is the lack of financial stability
experienced by the family. In such cases, the professional can refer her to many governmental
funding agencies from where, her family can get financial support (Davies et a.l., 2018). The
professional should also advocate about the social determinants of health of low income and try
to initiate different schemes for people who face such financial crisis in order o reduce the
prevalence of the disorder. The government should initiate development of laws by which
organic foods, fruits and vegetables are found at cheaper price and levy taxes on the sale of fast
foods which are harmful for health of people. Another issue to self-management skill
development in the patient is the access to healthcare services (Goldstein et al., 2016). Hence,
professionals can initiate telehealth services through which the professionals can initiate the
healthcare support services over the internet or through video conferencing systems. In this way,
the patient would be able to seek for healthcare supports from professionals over the internet
through healthcare technologies for which she would not have to travel for longer distances. She

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would be taught to incorporate her glucometer readings everyday over the internet technologies
that can be also monitored by healthcare professionals daily to identify whether the glucose level
of the patient is safe or not.
Conclusion:
From the above discussion, it can be seen that the patient is suffering from type-2
diabetes where she is unable to self-manage her symptoms successfully. Some of the barriers that
inhibited her to develop her self-management abilities are the poor health literacy and low
education level, low income as well as lack of access to healthcare services. The healthcare
professionals have the responsibility in helping as well as encouraging the patient to develop
self-management abilities. For that, they need to undertake initiatives by which such social
determinants of health can be modified to ensure that the patient develop such skills and develop
a better quality life.

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Referencing:
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R. L. (2016). Pharmacologic management of type 2 diabetes: 2016 interim
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Chaudhury, A., Duvoor, C., Dendi, R., Sena, V., Kraleti, S., Chada, A., ... & Kuriakose, K.
(2017). Clinical review of antidiabetic drugs: Implications for type 2 diabetes mellitus
management. Frontiers in Endocrinology, 8, 6.
Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for
adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic
control. Patient education and counseling, 99(6), 926-943.
Davies, M. J., D’Alessio, D. A., Fradkin, J., Kernan, W. N., Mathieu, C., Mingrone, G., ... &
Buse, J. B. (2018). Management of hyperglycaemia in type 2 diabetes, 2018. A consensus
report by the American Diabetes Association (ADA) and the European Association for
the Study of Diabetes (EASD). Diabetologia, 61(12), 2461-2498.
Garber, A. J., Abrahamson, M. J., Barzilay, J. I., Blonde, L., Bloomgarden, Z. T., Bush, M. A., ...
& Garber, J. R. (2016). Consensus statement by the American Association of Clinical
Endocrinologists and American College of Endocrinology on the comprehensive type 2
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Garber, A. J., Abrahamson, M. J., Barzilay, J. I., Blonde, L., Bloomgarden, Z. T., Bush, M. A., ...
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Lin, D., Xiao, M., Zhao, J., Li, Z., Xing, B., Li, X., ... & Chen, H. (2016). An overview of plant
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Appendix:
Event and the management style:
The patient was seen to order fast foods from the local take-away shops which were
delivered to her within thirty minutes. Her refrigerator was seen to be filled with canned and
frozen foods and even had a number of beer cans and sweetened beverages in them. The
refrigerator had no fresh vegetables and even fruits were seen to be absent as well. After
interrogating, the patient stated that she does not take any initiative to cook food. She feels very
stressed while shopping and cooking foods. She stated that when she can get cheaper foods
without the need to cook and shop, she does not feel like cooking for herself. Her husband also
has his meals outside and her baby lives on milk products. So, she does not cook for herself as
she finds no problems on consuming fast foods.
Things learnt from observing the person:
It was seen that the patient was actually now aware of the fact that the lifestyle choices
and the health behaviors that she follows are harmful for her health and that they are contributing
to development of diabetes. It was learnt that she had poor health literacy level and that she was
also not educated enough about the impacts of undertaking fast foods on the daily basis. It was
also found that she had stacked up huge number of beer bottles in her fridge which shows that
she has the habit of drinking to a large extent. Even she has sweetened beverages that contain
huge levels of calories which make individuals prone to develop obesity. She was not aware how
her health behaviors had been the main contributor of the disorder of diabetes and lack of
education and health literacy had made her rely on this type of diet.

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Analysis of the situation:
This situation helps in reflecting a fact that poor level of health literacy as well as low
levels of educational attainment in her life might have resulted in a gap in the knowledge in how
fast foods result in calorie gain. Moreover, as she finds it easier to order for prepared foods than
to cook food in home in the presence of the baby, she actually settled with the first option. She
was not aware of the risk factors and causes of diabetes type 2 and how she needs to manage her
diet in order so as to avoid weight gain and overcome complications associated with diabetes.
Hence, it is important for the healthcare professionals to educate her in ways by which she
becomes knowledgeable about the proper diets she needs to maintain so as to ensure proper
management of weight and prevent diabetes.
Conclusion:
The patient had poor levels of education and had low health literacy level. For this, she
used to consume diets which were high on calories and were more prone to develop obesity and
diabetes. Hence, it is necessary to develop her health literacy so that she can modify her diets and
lifestyle choices that would help her in managing the symptoms successfully.