Management of Diabetes Assignment 2022

Running head: MEDICAL
Management of Diabetes
Name of the Student
Name of the University
Author Note

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Introduction- Clinical nursing management is an umbrella term that encompasses
providing direction, organising and exerting supervision, with the aim of ensuring the
delivery of effective patient care, while meeting quality health standards. This assignment is
based on a case study where a septuagenarian, Valerie has three grandsons and walks her dog
to the park every day. Her routine also encompasses driving to pick up her grandchildren
from school, and she is an extremely motivated individual. However, she has been recently
diagnosed with diabetes mellitus, which has made her overwhelmed due to absence of any
familial history of the condition. At a BMI of 30, she is currently under medications for
hypertension and arthritis and her GP has recommended administration of basal insulin for
keeping a check on her blood glucose levels. This case study will discuss the goals of her
therapy, insulin management principles, nutrition therapy, and will also elucidate on the role
of diabetes educator in providing her the necessary help and assistance.
Goals of the therapy- Diabetes mellitus (DM) refers to the metabolic syndrome that is
primarily characterised by an increase in blood sugar levels in the body over a prolonged
period and the symptoms commonly comprise of increased thirst, increased urination, and
increased hunger. The patient Valerie has been diagnosed with the condition, marked by a
random blood glucose level of 17 mmol/L. Hence, the primary goal of the therapy would be
to maintain blood glucose levels at 6–8mmol/L, prior to meals (fasting plasma level) and 6–
10mmol/L, two hours after having a meal (plasma glucose). According to guidelines
published by the World Health Organization, patients demonstrating fasting levels of 6.1-
6.9 mmol/l (110 to 125 mg/dl) are thought to suffer from impaired fasting glucose (WHO,
2006). In addition, conducting the HbA1c test for glycated haemoglobin also helps in
determining the three-month mean blood glucose levels in a patient, owing to the average
lifespan of four months of red blood cells. Hence, another goal of this therapy would be to
maintain the HbA1c range at 7%, or a bit higher in order to prevent the onset of

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hypoglycaemia (Bloomgarden, Einhorn & Handelsman, 2017). The overall goal of the
therapy would be to evade acute decompensation, delay and/or prevent the onset of late
illness complications, reduce mortality, and enhance the health-related quality of life.
Blood glucose monitoring- Valerie will also be provided assistance on the strategies
that need to be adopted for effectively checking the concentration of glucose in her
bloodstream. This step is predominantly imperative in diabetes management since it helps in
keeping a track on increase or decrease of glucose levels (Lane & Mastrototaro, 2018). This
in turn will provide an overview on the individual pattern of changes in blood glucose, and
will also aid the planning and formulation of activities, meal plans, and time of medications,
in addition, the step will also ensure quick response to hyperglycaemia and/or
hypoglycaemia, besides facilitating the recognition for dietary modifications, insulin therapy,
and exercise.
Principles of insulin management- The hormone insulin is continuously secreted from
the beta cells of islets of Langerhans, present in the pancreas, in a glucose-dependent fashion.
Furthermore, secretion of the hormone is also triggered in relation to accumulation of oral
carbohydrates, together with a prolonged insulin release during the first phase that brings
about a suppression of production of hepatic glucose, followed by a second insulin release
phase covering the ingested carbohydrates (Zhong et al., 2016). Thus, insulin therapy is
generally recommended by an endocrinologist, in order to lower the levels of glucose in the
bloodstream. It is an endogenous hormone and helps in reversing the impairment in function
of beta cells by transferring the accumulated glucose to glycogen that gets stored in the liver.
On injecting the hormone typically under the skin using an insulin pen or syringe, it starts
working on the glucose that has been consumed. According to Chiasson (2009) while rapid-
acting insulin (insulin lispro) work within 15 minutes of administration, and their action last
for 3-5 hours, short-acting (regular insulin) and long-acting insulin (insulin glargine) exert an

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effect that last for 5-8 hours and 20-26 hours, respectively. However, several potential
concerns that are associated with insulin therapy include pain, gain in body weight, and
hypoglycaemia (Kanchi et al., 2018). Nonetheless, necessary education must be provided to
Valerie, in relation to insulin administration. She will be taught about the correct dosage and
route of administration, and insulin storage measures. Further efforts will also be taken to
help Valerie understand about the underlying factors that might lead to hypoglycaemia,
filling of devices, injection site, rotation, and timing.
Exercise- According to Villafaina et al. (2017) exercise and physical activity have
been identified as an essential component of monitoring blood glucose levels, and they also
enhance heart rate variability. Thus, assistance will be taken from an exercise physiologist
who will help Valerie show adherence to specific lifestyle modifications that will effectively
manage sedentary lifestyle. On performing exercise, the muscles present in the body will be
able to utilise glucose, without the help of insulin, thereby lowering her HbA1c levels
(Najafipour et al., 2017). In other words, taking into consideration the fact that the patient is
insulin resistant, performing physical activity will also facilitate preventing the onset of long-
term health complications, particularly cardiovascular problems. Valerie is at an increased
risk of developing arteriosclerosis due to hypertension, which in turn will increase her
likelihood of suffering a heart attack. Exercise regimen that comprises of large muscle
movement, jogging, cycling, swimming, resistance and interval training with free weight will
help in maintaining a healthy heart and will also ensure normal cholesterol levels in the
blood, thereby lowering blood pressure, and helping in better management of glucose
(Francois et al., 2017). On following the aforementioned regimen, range of motion will also
be greatly improved around her joints, besides enhancing her gait, and preventing fall risks.
Nutrition therapy- A dietician will play an important role in the implementation of a
therapeutic approach for the treatment of this metabolic syndrome through the use of a

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precisely tailored diet. The role of medical nutrition therapy when directed by a dietician
nutritionist (RDN) is to effectively lower the susceptibility of developing health
complications. Valerie will gain benefit from the education that will be imparted to her about
the role of good nutrition in diabetes management, keeping into consideration the goals of the
therapy. She will be provided assistance to maintain a diabetic diet that will help in
minimising notably high glucose levels. Valerie will be recommended to consume a diet that
will comprise of low amount of refined carbohydrates and sugar, while containing
comparatively high content of dietary fibre, particularly soluble fibre (Evert et al., 2014).
Moreover, the dietician will also encourage Valerie to eat small repeated meals throughout
the day. Some key recommendations will include consumption of sucrose-containing food
product that will act as substitutes for other types of carbohydrates (NHMRC, 2013).
Moreover, Valerie will also be advised to keep a count of the carbohydrates that are present
in food being consumed. This will help her to manage diabetes better (NDSS, 2018).
Recommendation of a low-carbohydrate diet will form a core aspect of dietary modification
since I has been associated with weight loss, and subsequent management of glucose levels.
Further recommendations will also focus on moderation in relation to consumption of alcohol
since it results in inhibition of glycogenesis in the liver, which in turn can also trigger the
onset of hypoglycaemia (Franz et al., 2017). Valerie will also be educated that heavy drinking
can lower the sensitivity of the body to insulin, thus increasing the glucose levels in
bloodstream.
Medication management- There is a common consensus that keeping a control on
blood glucose levels helps in preventing the onset of eye and renal problems. Though the
general practitioner will implement insulin therapy on the patient initially, it will be
concomitant with the administration of anti-diabetic medication such as, metformin owing to
its association with reduction in mortality. This drug has been identified as a first-line

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medication or the metabolic condition and will play an important role in diabetes
management in the patient by inhibiting the mitochondrial respiratory chain (complex
I), glucagon-induced elevation of cyclic adenosine monophosphate (cAMP), and
mitochondrial glycerophosphate dehydrogenase, besides promoting the activation of AMP-
activated protein kinase (AMPK) and protein kinase A (PKA) (Forslund et al., 2015).
Furthermore, administration of this medication will also be governed by the fact that
metformin will reduce gluconeogenesis or liver glucose production, besides exerting an
insulin-sensitizing effect that will have numerous actions on tissues such as the liver, adipose
tissue, endothelium, skeletal muscle, and the ovary.
Diabetes self-management- Diabetes self-management education and support
(DSME/S) will provide assistance to Valerie for navigating all decisions that are related to
diabetes management, which in turn will improve health outcomes. Self-management will be
based on education program that will be tailored based on the individual needs and
preferences of Valerie, concomitant with her life experiences. Self-management will facilitate
eating healthy, being physically active, taking medications, problem solving, and lowering
risks of future health complications (Powers et al., 2017). Thus, self-management education
will form an essential part of the care plan since it will ensure that the patient has the
necessary confidence and skills for exerting a control over her health. Four essential time
points that are imperative for self-management education are namely, (i) at the time of
diagnosis, (ii) when complicating factors begin to appear, (iii) annually, and (iv) during
transition (Beck et al., 2018). In other words, self-management will guarantee that Valerie
shows adherence to all recommendations and medications that have been prescribed and
advised by the healthcare professionals, thus keeping a regular check on her blood glucose
levels and maintaining it within the normal range.

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Role of diabetes educator- Diabetes educators have been recognised as an essential
asset to the multidisciplinary team of healthcare professionals and demonstrate unique skills
that help in implementing programs and processes for improving glycaemic control. Taking
into consideration the fact that Valerie has been diagnosed with the metabolic condition
recently, which in turn has overwhelmed her family members, help from a diabetes educator
will prove imperative in providing her comprehensive education on the illness. The educator
will play an important role in communicating with interdisciplinary team members at the time
of quality improvement, tool development, medication safety, and clinical informatics.
According to Pearson et al. (2019) the educator will also govern individual medication
management plan, evidence-based hyperglycaemia and hypoglycaemia protocols, and plan of
care for smooth patient transition. The diabetes educator must be accomplished in this
teaching and learning procedure and must also possess a good training and understanding of
the illness and its complications. Furthermore, the roles and responsibilities of a diabetes
educator also encompasses use of different theories such as, social cognitive theory, health
belief model, and the transtheoretical model that will address the multifaceted behavioural
changes and will also take into account the feelings of susceptibility and level of anxiety
about diabetes-related problems amid the patient and her family members (Burke, Sherr &
Lipman, 2014).
Role of multidisciplinary team members- There is a need to adopt an interdisciplinary
team (IDT) approach for diabetes management in the patient, with the aim of helping Valerie
accomplish her glycaemic goal. Healthcare professionals who will form a part of this
interdisciplinary team will be namely, the general practitioner, endocrinologist, dietician,
exercise physiologist, and pharmacist (McGill et al., 2017). Implementation of
interdisciplinary care approach will help in demonstration of shared leadership, responsibility
and accountability for care planning, and will also facilitate the delivery of a comprehensive

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and holistic care regimen for the patient. It will act in the form of a collaborative effort where
all professionals will demonstrate respect towards each other and accept the decisions taken,
for enhancing the health outcome (Simmons et al., 2015). The principle focus of this team
would be continuity of care and it will also emphasise on development of protocol for
meeting the physical needs of the patient, thus improving coordination of care services.
Conclusion- Thus, it can be concluded that the primary focus of this case study was to
keep a check on the glycaemic index of Valerie, in order to prevent her from suffering any
further diabetes related health complications. While conducting nursing assessment, it is
imperative for a nursing professional to collect necessary information about the
psychological, social, physiological, and spiritual conditions of a patient, which in turn
facilitates the development of nursing goals, followed by implementation of a care plan.
However, for the purpose of accomplishing this goal, efforts need to be taken by
multidisciplinary healthcare team where her unique physical needs will be addressed, and she
will be educated on the potential advantages of showing compliance to medication regimen
and lifestyle modifications. A tem approach for the metabolic condition will effectively help
Valerie in coping with the array of health complications that might arise later. In addition,
diabetes education will also provide assistance in self-management of the illness, thus
enhancing her health-related quality of life.

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