Diabetes Management Education: A Case Study

This article discusses the case study of a patient with type 2 diabetes mellitus and the importance of self-management education in controlling diabetes. It also explores various technologies and devices that can aid in diabetes management. The article emphasizes the role of nurses in educating and counseling patients on diabetes management.

DIABETES AWARENESS 1
DIABETES MANAGEMENT EDUCATION
By (Name)
Class (Course)
Professor (Tutor)
School (University)
City and State
The Date

DIABETES AWARENESS 2
Diabetes mellitus is a metabolic body disorder that is anticipated to have affected a large
population in Australia. The leading cause of diabetes mellitus is due to the failure or defects on
the pancreas which is the body organ that secretes insulin and results to high glucose levels in the
blood (Zwar et al, 2017). Nurses play a vital role in the management of the diabetic patient. The
following scenario demonstrates a case of a patient of the at the middle age with diabetes
complication.
Component A
Patient A is a 32-year-old man with 3-years history of type 2 diabetes mellitus. Patient A was
diagnosed with diabetes mellitus three years ago where he presented the symptoms of
hyperglycemia for one year before diagnosis. He had a high rate of blood glucose levels at 118-
127 mg/dl which was an indication of borderline diabetes. At the first time of diagnosis, Patient
was advised to start engaging in activities to reduce weight (Dempseyet al, 2014). The patient A
has been trying to reduce weight as he increased exercise for the six months but there was no
much significant change (Dietz et al, 2015). The physician prescribed the patient A on glyburide
25 mg every morning. He stopped taking the drug due to dizziness which was often accompanied
by a feeling of minor agitation and sweating mostly at afternoons (Capoccia, Odegard and
Letassy, 2016). Patient A also takes 10 mg of Lipitor (atorvastatin) for hypercholesterolemia.
The patient tolerated and adhered to the medication for the daily schedule. For the past six
months, he had also been taking pancreas elixir, chromium picolinate, and Gymnema Sylvester
so that he could improve his effort to control the disease. The Patient A has been very reluctant
in testing his blood glucose level while at home. During the Doctor’s appointment, patient A
explained that he had never falling seek sick in his early life as it is in nowadays. The patient said
that he does understand why he has diabetes despite that he ceased from taking sugary foods. His

DIABETES AWARENESS 3
wife has been encouraging him to treat diabetes through herbal medicines and weight loss
supplements of which she always researches on the internet for the recent diabetes management
updates. Patient A's diet history shown that he used to take a lot of carbohydrates in the form of
pasta and bread. His dinner has been usually 2 cups of cooked pasta, three to four slices of bread
(Italian) and hamade sauce. His wife prepared plain grilled meats for him but patient A most of
the time he found it tasteless. Patient A was once a smoker, but he stopped ten years ago. The
patient had never seen any dietician before, and he has never been instructed for self-monitoring
of the blood glucose. The medical records of his appointment indicated that his (A1C,
hemoglobin) has never been less than 8%. The blood pressure of the patient had been 150/70,
166/88 and 148/92 mmHg measured on separate occasions for the past one year at a local
healthcare screening center (Cicolini et al, 2014). The recent medical records of the patient A,
shown that he has been remarkably healthy for the past many years. Based on the assessment of
the patient A's medical history, physical examination, laboratory results, and records, the
following were the final assessment; Obesity (BMI 32.4 kg/m2), hyperlipidemia, uncontrolled
type diabetes mellitus (A1C>7%), low understanding of diabetes, elevated microalbumin level of
urine, self- care management and lifestyle deficit. The physical examination of the patient A
shown that he had a fasting capillary glucose level: 166 mg/dl, weight178Ib; 5'2"; mass body
index: 32. 6kg.m2. The blood pressure of the right arm read 154/96 mmHg, lying and that of the
right arm while sitting read 140/90 mmHg. Pulse rates were 88bpm and respirations of 20 per
minutes. The heart rate rhythm was regular with no gallops. The condition of patients A has been
as before after his last assessment for he has been advised and given several appointments by his
close General Practitioner (GP). With all the findings and assessment of the Patient A, there is a
need for a clearer program of self-management to the people within the community as they

DIABETES AWARENESS 4
seemed to have little knowledge about the best control approaches of diabetes (Willis et al,
2014).
Component B
The Australian government has included diabetes as one of the national health concerns due to
its related mortality and morbidity rates and substantial national health expenses. The healthcare
cost of Australia from 2004 to 2005 on diabetes was equivalent to A$989 million. As a registered
nurse working within the prominent population at a regional public healthcare center, I am
supposed to take immediate program strategies to educate the youths about the management and
control of diabetes. The Australian Institute of health and welfare showed that the persons aged
between 15 to 24 years were the most uneducated about the control measures of diabetes
(Dawson, Nkowane and Whelan, 2015). The advanced nurses play a primary role in educating
the community on the medical management concerning diabetes. The proper combination of
expertise and clinical skills in counseling and teaching enables the care delivery at an appropriate
manner that is not only cost reducing but also effective. As one of the registered nurses, I played
an important role in advanced nursing practice in sharing the understanding of diabetes with the
patient A who was very confused about his condition. I shared with the patient his health
outcomes and educated him on the importance of regular self-monitoring to avoid further
complications of diabetes mellitus. The application of the nursing standard and diabetes mellitus
guidelines in partnering with the patient not only improves the care services but also strengthens
the patient responsibility as a self- manager (MacMillan et al, 2014). In accordance with the
2016 census the local regional I was working as a registered nurse, an approximately 1.6% of
youths had little knowledge on diabetes mellitus than the middle age populations in the urban
areas. In the local health care center, the primary nursing model of care was applied. This is

DIABETES AWARENESS 5
where one nurse was allocated to several patients within the assigned beds. Throughout the
nursing activities, the nurse had to work in consultation with the other nurses in charge, the
department medical officer, the allied health professional like dietician, physiotherapist,
pathologist, radiologist, and also the medical registrar. This collaboration helped the nurses to be
more thorough during the assessments and have significant autonomy in their responsibilities and
this encouraged holistic patient-centered care and better nurse-patient interactions. About 15-
17% of the young persons with type diabetes mellitus were using the involved treatment plans as
they were advised by their general practitioners so as to maintain their glycemic control. The
optimum and regular self-management of diabetes mellitus was one of the key health outcomes
that the Patient A never utilized in controlling his diabetes (Kueh et al, 2015). This means that
patient A had inadequate knowledge about self- management education. This created a
difference in the other health outcomes like normal clinical outcomes. The patient A was very
reluctant in checking his blood glucose level and also, he sometime refuses to take his prescribed
drugs such as glyburide due to dizziness effects. There is a significance linkage between
adhering to the self- management therapy and optimum clinical outcomes. The transition from
the youthful age to the fathering age or the working-age result to lack of structure and thus, it
complicates the self- management which may lead to poor management of diabetes. The other
key outcome for the patient A his habit of skipping medication and optimum clinical outcomes
only because of some minor side effects which normal sometimes when someone is at the
beginning of a long-term chronic illnesses. Skipping medication for diabetes result to
deteriorating of the health of a patient. The patient A also used to try many methods and different
health practitioners as he wanted to reassure his condition very fast (Vlachopoulos et al, 2015).

DIABETES AWARENESS 6
This is contrary to the diabetes mellitus management where the victim has to adhere to the
doctor's advice and follow the medications as prescribed to get better result of the disease.
Some of the technologies that would help patient A to achieve optimum clinical outcomes and
self- management are discussed below (Strainet al, 2014).
Regular monitoring of the glucose level is a contemporary technology Australia which has been
known to improve the control of glycemia through maintenance of the standard compliance in
the body. Continuous monitoring of the body's glucose level for at least twice each day is always
useful as one can monitor every reading either low or high (Younossi et al, 2016). Some patients
adopt the administration of insulin to regulate their diabetes. Other use insulin pumps which
contain rapid insulin action which is delivered through the infusion into the body via the
subcutaneous layer around the abdomen or to the thighs. The insulin pump action tries to mimic
the regular insulin that is produced by the pancreas. It requires keen observation as the pump
program has to be managed well and proper recording of the patient's blood glucose level and the
number of carbohydrates he or she consumes to enable the pump to titrate the required quantity
of insulin (Woolf et al, 2015). One of the importance of using the pump is the less
hyperglycemic and hypoglycemic episodes as a result of continuous infusion and also the more
significant lifestyle flexibility. Most youths with diabetes rarely adhere to the insulin injections.
Although the development of a practical device that administers while calculating the appropriate
dosage in the body, self-management remains the most recommended method before the use of
the insulin pump (Rubino et al, 2016).
A permanent porta Cath is a venous device that is implanted on the upper chest or the arm under
the skin which is another option for the patient with chronic diabetes illness. This catheter is
located into one of the large blood veins, most likely the jugular or the subclavian vein and

DIABETES AWARENESS 7
settles to the superior vena cava. The other option is an insertion of the catheter in the central
peripherally which is a longer intravenous catheter that is inserted into the antecubital blood
vein. These catheter stays in the blood vein for about 18 months while maintaining high
management integrity (Hay et al, 2014). One of the problems associated with the peripheral
catheter is that it requires weekly flushing through standard salty and heparin locking. The porta
Cathy needs to be flushed only after they have been accessed and it is usually after every four
weeks. The other demerits of the peripheral catheter are that it remains eternally on the arm
which requires the high standard of hygiene and thus it is at high risk of infections (Bolea-
Alamañac et al, 2014). For someone like the patient A who is very anxious about recovery from
diabetes use of such devices like porta Cath and peripheral catheter could be of more
disadvantages than the advantages.
The best-recommended control measures of the diabetes mellitus as advised to the patient A in
the case study is self- management. The self- management of diabetes is applicable both in the
hospital emergency department for the people with diabetes mellitus and also at homes. The
registered nurses only need to have the appropriate education od the management and control of
diabetes while performing their duties to the patients. The nurses should also have enough
confidence while delivering the appropriate care and information about the disease to their client.
Also, self-management education is essential to the diabetic patient as not all the patients can
follow the appropriate management plan (Hollis, Glaister and Anne, 2014). It is essential for all
nurses to desire in having the understanding an array of different educational practices and self-
management programs that can be individualized. The nurses should incorporate both the
diabetes nursing guidelines and medical acre while counseling and maintaining the educating
roles to the patients. Operating beyond the educator role is an advanced practice for the nurses to

DIABETES AWARENESS 8
holistically assess the needs of the patient through understanding the patients' main roles towards
the improvement and maintaining their health wellness (Drummond et al, 2015). In conducting
the patient's assessment, the advanced nursing practices explores the medical history of the
patient and performing the necessary physical examination. The self-management education
program remains the most appropriate as recommended by the American Diabetes Association
through encouraging and providing education at least every year (Holloway and Galvin, 2016).
Education programs could be of much importance in advising and directing the patient A on his
regular diets and activities such as exercises that could help in regulating the blood sugar level.
The control of the glycemic leads to the development of the microvascular outcomes in both the
type 1 and type 2 diabetes. It is crucial for the registered nurse to deliver quality education to the
patient A and his family to minimize the intake of the fats and caloric while increasing the more
physical exercises to sufficiently control the glycemic, obesity and weight (Goff and Dyson,
2015).
Reflective Conclusion
The study has fully improved my knowledge of utilizing the most effective approach to
management, diagnosis, and treatment of diabetes. I can deduce that use of self- management
education on diabetes in most of the regional areas is the most applicable and efficient program.
Acting the patient advocate is one of the crucial roles I played in my clinical practice. The
majority of young adults living with type 2 diabetes have the high risk of developing some of the
diabetic complications such as diabetes ketoacidosis (Zhang et al, 2014). There is much to
recommended the patient A to attain the more appropriate management at the current stage of his
illness before that condition worsens. Diabetes ketoacidosis is a life-threatening situation, and
due the recent assessment of the patient A, if it develops in his case, it can compromise his

DIABETES AWARENESS 9
body's immune system which is very critical for a diabetic patient. There is the need for more
education to the youths concerning the control of diabetes regarding the self- continuous
monitoring of the blood glucose level. As per the case of patient A, the level state of the illness is
towards commencing on self-administer to regulate and maintain his glycemia. As a nurse
working in the hospital department where that patient A has several appointments, my role is to
encourage him on the best practice guidelines for improving the diabetes condition through
proper management of the glycemia. To ensure this, education to the patient A is primary on how
to manage through an individualized daily plan. Therefore, it is the role of the nurses to empower
the young adults on self – management at their critical conditions for those living with diabetes.
The self- management education, the young adults are prepared to live in productive and
effective life's through their life transitions while minimizing the cases of future health
complications as well as morbidity rates.

DIABETES AWARENESS 10
References
Bolea-Alamañac, B., Nutt, D.J., Adamou, M., Asherson, P., Bazire, S., Coghill, D., Heal, D.,
Müller, U., Nash, J., Santosh, P. and Sayal, K., 2014. Evidence-based guidelines for the
pharmacological management of attention deficit hyperactivity disorder: update on
recommendations from the British Association for Psychopharmacology. Journal of
psychopharmacology, 28(3), pp.179-203.
Capoccia, K., Odegard, P.S. and Letassy, N., 2016. Medication adherence with diabetes
medication: a systematic review of the literature. The Diabetes Educator, 42(1), pp.34-71.
Cicolini, G., Simonetti, V., Comparcini, D., Celiberti, I., Di Nicola, M., Capasso, L.M., Flacco,
M.E., Bucci, M., Mezzetti, A. and Manzoli, L., 2014. Efficacy of a nurse-led email reminder
program for cardiovascular prevention risk reduction in hypertensive patients: a randomized
controlled trial. International journal of nursing studies, 51(6), pp.833-843.
Dawson, A.J., Nkowane, A.M. and Whelan, A., 2015. Approaches to improving the contribution
of the nursing and midwifery workforce to increasing universal access to primary health care for
vulnerable populations: a systematic review. Human resources for health, 13(1), p.97.
Dempsey, P.C., Owen, N., Biddle, S.J. and Dunstan, D.W., 2014. Managing sedentary behavior
to reduce the risk of diabetes and cardiovascular disease. Current diabetes reports, 14(9), p.522.

DIABETES AWARENESS 11
Dietz, W.H., Baur, L.A., Hall, K., Puhl, R.M., Taveras, E.M., Uauy, R. and Kopelman, P., 2015.
Management of obesity: improvement of health-care training and systems for prevention and
care. The Lancet, 385(9986), pp.2521-2533.
Drummond, M.F., Sculpher, M.J., Claxton, K., Stoddart, G.L. and Torrance, G.W., 2015.
Methods for the economic evaluation of health care programmes. Oxford university press.
Goff, L. and Dyson, P. eds., 2015. Advanced nutrition and dietetics in diabetes. John Wiley &
Sons.
Hay, P., Chinn, D., Forbes, D., Madden, S., Newton, R., Sugenor, L., Touyz, S. and Ward, W.,
2014. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for
the treatment of eating disorders. Australian & New Zealand Journal of Psychiatry, 48(11),
pp.977-1008.
Hollis, M., Glaister, K. and Anne Lapsley, J., 2014. Do practice nurses have the knowledge to
provide diabetes self-management education?. Contemporary nurse, 46(2), pp.234-241.
Holloway, I. and Galvin, K., 2016. Qualitative research in nursing and healthcare. John Wiley &
Sons.
Kueh, Y.C., Morris, T., Borkoles, E. and Shee, H., 2015. Modelling of diabetes knowledge,
attitudes, self-management, and quality of life: a cross-sectional study with an Australian sample.
Health and quality of life outcomes, 13(1), p.129.
MacMillan, F., Kirk, A., Mutrie, N., Matthews, L., Robertson, K. and Saunders, D.H., 2014. A
systematic review of physical activity and sedentary behavior intervention studies in youth with

DIABETES AWARENESS 12
type 1 diabetes: study characteristics, intervention design, and efficacy. Pediatric diabetes, 15(3),
pp.175-189.
Rubino, F., Nathan, D.M., Eckel, R.H., Schauer, P.R., Alberti, K.G.M., Zimmet, P.Z., Del Prato,
S., Ji, L., Sadikot, S.M., Herman, W.H. and Amiel, S.A., 2016. Metabolic surgery in the
treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations.
Surgery for Obesity and Related Diseases, 12(6), pp.1144-1162.
Strain, W.D., Cos, X., Hirst, M., Vencio, S., Mohan, V., Vokó, Z., Yabe, D., Blüher, M. and
Paldánius, P.M., 2014. Time to do more: addressing clinical inertia in the management of type 2
diabetes mellitus. Diabetes research and clinical practice, 105(3), pp.302-312.
Vlachopoulos, C., Xaplanteris, P., Aboyans, V., Brodmann, M., Cífková, R., Cosentino, F., De
Carlo, M., Gallino, A., Landmesser, U., Laurent, S. and Lekakis, J., 2015. The role of vascular
biomarkers for primary and secondary prevention. A position paper from the European Society
of Cardiology Working Group on peripheral circulation: Endorsed by the Association for
Research into Arterial Structure and Physiology (ARTERY) Society. Atherosclerosis, 241(2),
pp.507-532.
Willis, A., Rivers, P., Gray, L.J., Davies, M. and Khunti, K., 2014. The effectiveness of
screening for diabetes and cardiovascular disease risk factors in a community pharmacy setting.
PloS one, 9(4), p.e91157.

DIABETES AWARENESS 13
Woolf, S.H., Purnell, J.Q., Simon, S.M., Zimmerman, E.B., Camberos, G.J., Haley, A. and
Fields, R.P., 2015. Translating evidence into population health improvement: strategies and
barriers. Annual review of public health, 36, pp.463-482.
Younossi, Z.M., Koenig, A.B., Abdelatif, D., Fazel, Y., Henry, L. and Wymer, M., 2016. Global
epidemiology of nonalcoholic fatty liver disease—meta‐analytic assessment of prevalence,
incidence, and outcomes. Hepatology, 64(1), pp.73-84.
Zhang, C., Tobias, D.K., Chavarro, J.E., Bao, W., Wang, D., Ley, S.H. and Hu, F.B., 2014.
Adherence to healthy lifestyle and risk of gestational diabetes mellitus: prospective cohort study.
Bmj, 349, p.g5450.
Zwar, N., Harris, M., Griffiths, R., Roland, M., Dennis, S., Powell Davies, G. and Hasan, I.,
2017. A systematic review of chronic disease management.