Effective Diabetes Management Strategies

This assignment requires the nurse to develop a comprehensive plan for Susan's effective diabetes management. Despite limited access to healthcare services, the nurse must educate Susan on how to use online resources, monitor blood glucose levels, and make healthy lifestyle choices such as physical activity and balanced diet. The nurse should also utilize telehealth services provided by diabetic educators and dieticians to support Susan in managing her condition effectively.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author note

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Answer one
The case scenario of Susan illustrates a case of poorly controlled type 2 diabetes with
obesity and symptoms of depression. The high insulin doses contributed to her weight gain, the
similarity of symptoms of hyperglycaemia and depression, combination of therapy in type 2
diabetes. After she presented with poorly controlled diabetes, she was advised to intake insulin
and lose weight. However, with increase in insulin dosage for hyperglycemia correction, she
gained weigh from glycosuria cessation, increase in fat synthesis and fluid retention. When
Susan tried to decrease her calorie intake, there was mismatch of insulin to her food consumption
that resulted in symptoms of hypoglycaemia and low blood glucose levels (Inzucchi et al. 2015).
Considering Susan’s condition, the poor access to healthcare and cost of care has serious
implications for her health and wellbeing. The poor management of diabetes is associated with
lack of access to healthcare services. The diminished access to healthcare and relative isolation
is linked to “missed patient” with diabetes in Susan’s case (Grabovschi, Loignon and Fortin
2013). The inaccessibility to healthcare services and lack of insurance coverage has an impact on
her overall diabetes care and course of treatment. She has shifted to a community where there is
no access to healthcare centres resulting in worse diabetes care and poor health outcomes. There
is no diabetes educator to teach her about hypoglycaemic symptoms and manage it through
lifestyle modifications. As a result, she is at greater risk for diabetic complications (Syed, Gerber
and Sharp 2013).
Susan is unable to visit a diabetes educator or diabetologist in healthcare services who
can assist her in managing diabetes. She is medically uninsured with limited healthcare services
that make it difficult for her to manage her diabetes condition. The cost of treatment and need for

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lifelong diabetic medications coupled with limited access to anti-diabetic medications in the
community are the major issues for treatment and management compliance (Sanders, Solberg
and Gauger 2013). As she is uninsured with no access to healthcare coverage, it is less likely for
her receive the proper standards of care that includes regular glucose checkups and monitoring,
preventative measures for her eyes and feet.
Apart from access to healthcare and cost implications, poor numeracy skills and low
health literacy about diabetes is also associated with poor glycemic control. Health literacy acts
as a part of routine care for the optimal diabetic management. Susan and her husband, Paul has
inadequate knowledge about diabetes, its symptoms and control and as a result, they are unable
to obtain, understand and communicate diabetic related information for making informed health
decisions (Mackey et al. 2016). The family is unable to manage the situation and there is overall
pressure on the relationship. There is lack of awareness about understanding of diabetes and that
is resulting in delayed complications recognition. The overall implications of poor diabetic
management are serious and can progress towards potential complications of diabetes. It can
cause life-threatening conditions like neuropathy, eye and foot damage, heart and blood vessel
disease, hearing impairments and psychological complications. Depression, obesity and high
blood pressure are co-morbid conditions that are affecting her quality of life. Therefore, access to
healthcare, patient education and empowerment are important for encouraging Susan and her
family in healthcare participation and better disease management.
Answer two
For a registered nurse, it is important to encourage Susan and her husband to access,
participate in making healthcare decisions, and manage their needs requiring healthcare. The

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successful diabetes management is dependent on one’s ability to achieve diabetes control by
adhering to a treatment regimen like blood glucose monitoring, medication, diet and exercise.
Firstly, the RN needs to develop a nurse-patient therapeutic relationship with Susan in
providing patient-centred care. This would enable nurse to interact with the family and
understand their needs and preferences. Building trust and providing emotional support with the
family can be helpful in better management of her chronic illness. Trust is important in context
to chronic illness management because of enhanced patient vulnerability, increased
independence and health outcomes uncertainty (Rathert, Wyrwich, and Boren 2013). This
empowers and encourages Susan and her husband to take an active part in the health decisions
for diabetes management.
For the self-management in diabetes, nurse-patient therapeutic relationship is crucial
where communication is the cornerstone. This would be helpful in considering the multiple
factors like Susan’s physical condition of uncontrolled diabetes, cultural preferences, values,
emotional state and readiness to communicate with the healthcare professionals. The nurse
should demonstrate effective communication entails being non-judgmental, empathetic,
approachable, understanding, caring, and sympathetic and having ethical qualities that a nurse
should exhibit through interpersonal communication skills. The nurse needs to demonstrate
active listening skills, non-verbal and verbal communication skills, emotional stability and
patience for better health outcomes.
As the family has inadequate knowledge about diabetes and symptoms control, the nurse
need to educate them and support in self-management of the disease. This support refers to the
implementation and sustenance of coping behaviours and skills for diabetes self-management.
Patient education is important to make Susan and her husband to understand diabetes and

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implications of poor diabetes management. Through effective communication, the nurse needs to
make Susan and her family understand the basics of diabetes by providing information about
type 2 diabetes and its complications. For the better diabetes management, the nurse needs to
educate how to monitor the blood glucose levels, medication compliance and solutions for self-
management of the disease.
As they have limited access to healthcare services, the nurse need to teach the patient
about how to use online resources and diabetes self-management tools that can be helpful for
her in managing her condition. An online education program like Diabetes self-management
support (DSMS) can be beneficial in addressing Susan’s cultural needs, emotional concerns,
current knowledge, financial status, health literacy and family support that influences Susan’s
ability to meet the challenges of diabetes self-management (Gao et al. 2013).
An innovative technology for DSM education is telehealth. As she is unable to meet the
diabetes educator personally, an online diabetes educator can help to make them understand
how to manage diabetes. Diabetes TeleCare administered by diabetic educator and dietician can
be helpful in effectively providing healthcare services to the family for better chronic disease
management (Fitzner and Moss 2013). It is a cost-effective delivery of family and patient
education. For self-monitoring of blood, glucose levels with monitors at home, the nurse need to
teach them how to use it that can be helpful for Susan to assess the efficacy of treatment and
accordingly make decisions to manage the condition. In addition, making healthy lifestyle
choices like physical activity, balanced diet, and regular blood sugar monitoring and medication
compliance can be helpful in effective self-management of diabetes.

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References
Fitzner, K. and Moss, G., 2013. Telehealth—an effective delivery method for diabetes self-
management education?. Population health management, 16(3), pp.169-177.
Gao, J., Wang, J., Zheng, P., Haardörfer, R., Kegler, M.C., Zhu, Y. and Fu, H., 2013. Effects of
self-care, self-efficacy, social support on glycemic control in adults with type 2 diabetes. BMC
family practice, 14(1), p.66.
Grabovschi, C., Loignon, C. and Fortin, M., 2013. Mapping the concept of vulnerability related
to health care disparities: a scoping review. BMC health services research, 13(1), p.94.
Inzucchi, S.E., Bergenstal, R.M., Buse, J.B., Diamant, M., Ferrannini, E., Nauck, M., Peters,
A.L., Tsapas, A., Wender, R. and Matthews, D.R., 2015. Management of hyperglycemia in type
2 diabetes, 2015: a patient-centered approach: update to a position statement of the American
Diabetes Association and the European Association for the Study of Diabetes. Diabetes
care, 38(1), pp.140-149.
Mackey, L.M., Doody, C., Werner, E.L. and Fullen, B., 2016. Self-management skills in chronic
disease management: what role does health literacy have?. Medical decision making, 36(6),
pp.741-759.
Rathert, C., Wyrwich, M.D. and Boren, S.A., 2013. Patient-centered care and outcomes: a
systematic review of the literature. Medical Care Research and Review, 70(4), pp.351-379.
Sanders, J., Solberg, B. and Gauger, M., 2013. Breaking barriers to care: a community of
solution for chronic disease management. The Journal of the American Board of Family
Medicine, 26(3), pp.311-315.

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Syed, S.T., Gerber, B.S. and Sharp, L.K., 2013. Traveling towards disease: transportation
barriers to health care access. Journal of community health, 38(5), pp.976-993.