The Pathophysiology of Diabetes - An Overview

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the University
Author Note

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Introduction
The pathophysiology of diabetes is associated to the levels of insulin in the body and
the ability of the body to utilize insulin. Generally, the beta cells of pancreas releases insulin
due to the increased concentration of the blood glucose level (American Diabetes
Association. 2018). This assignment centres round the conversation with a 65 years man
suffering from diabetes. The paper focuses on how the presence of chronic disease like
diabetes can affect his personal and professional. This will be followed by nursing assessment
using the Roper-Logan-Tierney framework, based on which some recommendations will be
made.
Background
A telephonic interview was conducted with a 65 years old man, Robert residing in the
community. He stays with his wife and his children. He works in a bank and it’s been 10
years since he is staying in Australia. He was diagnosed with type 2 diabetes since 45 years
of age and had not been much under control. His current blood sugar level is 196mg/dl that
is beyond the range of the blood glucose level. He had a family history of diabetes and also
suffers from the comorbidity obesity and hypertension. He did not report about the presence
of renal disease. He is a non –smoker but daily consumes 2-3 glasses of wine. He often
misses taking lunch and have to live on readymade pastas and bread. He loves caffeinated
drinks, but have recently restrained himself from taking those, due to his high blood sugar
level. It was also informed by Robert, that his wife normally cooks spicy food, which can be
stated as the part of their traditions.
Robert have admitted that he is becoming more dependent on others to help him
keeping a safe environment , which is probably due to his blurry vision. Robert does not faces
mush difficulties in the day to day communication, except the fact that during the hospital

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stay due to hypoglycaemic attack, he faced difficulties in communication due to his slurred
speech. He said that he had very limited physical activities and normally does desk jobs.
However, he is fond of gardening. His currently measured blood pressure of 220/100 mmHg.
He is asymptomatic and his current weight is 243 lb. He is under the medication Metformin
since last 5 years, and generally does not use any tools for home based glucose monitoring.
Collection of cues and processing of information
In T2D, the body fails to produce insulin or it resists the insulin to act on the
peripheral tissues, which termed as insulin resistance. It is evident from the case study, that
Robert has family history of T2D. There are several genes that are associated to T2D
affecting the secretion of insulin and action, as well as regulation of the body weight (Baynes,
2015). Decreased physical activity is related to physical activity, due to the fact that, it is the
physical activity that allows the muscle cells to use insulin and glucose more efficiently, thus
lowering the risk of diabetes. High glucose levels in the blood has been associated with
diabetic retinopathy that can impair vision in patients, due to the damage in the blood vessels
of the eye (Nentwich & Ulbig, 2015). Again, it has been stated that dietary beliefs and eating
patterns can affect the metabolic health in the T2D. Economic advancements and aberrant
dietary patters is associated with the onset of diabetes (Colles, Singh, Kohli & Mithal, 2013).
Discussion
A Roper Logan Tierney model should be used as a cognitive approach in the
assessment and care of the patients. While identifying the impact of a disease in the daily
activities of living, a RPL framework can be used. It has already mentioned by the
interviewee that diabetes symptoms have impacted upon his life in all aspects especially, his
daily activities of living.

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Maintaining a safe environment
Robert had been an independent man, however, he felt that he is becoming more
dependent on his wife and his children. This can be due to the diplopia, which is a symptom ,
that is normally caused by diabetes , making her vision blurred. When Robert suffers from
hypoglycemic attack and loses his mind, he seems to feel helpless and vulnerable.
Communication
Robert does not faces much difficulties in the day to day communication, except the
fact that during the hospital stay due to hypoglycemic attack, he faced difficulties in
communication due to his slurred speech. Robert has also confessed that he was embarrassed
due to the confusion due to the attack, which made himself conscious.
Eating and drinking
Robert doesn’t feel good about his restricted diet as he had to eliminate several food
from his diet chart, which he was very fond of. Robert’s wife might not be capable of
making lunches for him every day, for which, he had to skip meals.
Eliminating
Robert does not have any difficulties in eliminating except the fact that he had a
polyuria due to diabetes. Robert have also complained about his incontinence. In such a case,
Robert can be provided with a commode, in case he is unable to walk to the toilet.
Robert currently do not have any issues regarding his grooming. Robert feels that his
diabetes would hamper his active social life. In such a case, a diabetes specialist needs to be
appointed, that would help her to take part in various social activities like going to clubs for
bowling or eating out. .

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Care priorities and goal settings
Among the various care priorities that can be understood from the case study of
Robert, the two most important clinical priorities included improving knowledge in the
patient and maintenance of a balanced nutrition.
Goals
 S- To educate the patient about the monitoring of the glucose level, by using home based
glucometer.
 M- To make the blood glucose reading of less than 190mg/dl.
 A- To demonstrate the patient about the knowledge of medication adherence, symptoms,
diets.
A controlled blood glucose level will automatically mitigate the issues like slurred
speech, blurry vision and polyuria
R- To make the patient take up healthy life style habits, with a subsequent lowering of the
blood glucose level.
T- To decrease the blood sugar level and the condition of living within a time span of 6
months
Nursing interventions
The nursing interventions should aim at the self-management of diabetes, in order to
assist the patient in their daily activities of living as proposed in the Roper-Logan Tierney
model. Robert should be educated about the importance of home monitoring of glucose level
at home, as monitoring provides data on the degree of glucose monitoring (Makin &
Lansang, 2019). It is necessary to educate Robert about a low fat diet and high in while grains
ad fibre. This is because a diet that is low in fat and is high in fibre assists to control

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cholesterol and triglycerides. Normally three meals and an evening snack and complex
carbohydrate is recommended (Jafari & Britton, 2015). The patient should be educated about
the importance of mandatory reporting in case the glucose level shoots up. High BP should be
reported as hypertension is strongly associated with diabetes (Udo, 2016). Robert should be
explained about the necessity to adhere to the medication regimen. Suggestions for
medication adherence involves keeping of log books, where patient can also jot down their
glucose level after monitoring glucose level at home. It can be recommended to record daily
weight as weighing serves as an assessment tool for determining the adequacy of the
nutritional intake. It is necessary to ascertain the dietary program for identifying the
deviations and the deficits (Makin & Lansang, 2019). Easily affordable and low energy diet
can be recommended to Robert. It will be better if a dietician is consulted. As analysed by the
help of RPL model, Robert is quite upset about his restrictions in the diet. It is necessary to
understand the food preferences of the patient to integrate those food in the diet plan.
Being a nurse, it is necessary to know, whether Robert visits any clinic or gets an
equal amount of care. It is also necessary to understand whether Robert have received any
such teaching from the health care setting regarding diabetes management (Mulder et al.,
2016). In case the patient does not have any, provisions could be made to convey information
by printed patient information. According to the NSQHS standard nurses should facilitate
communication that support effective communication. Hence, it is necessary to communicate
the needs of diverse consumers. It is necessary to educate Mr. Robert about the importance of
mild exercises in controlling his body weight as well as diabetes. Accrording to Kirwan,
Sacks and Nieuwoudt, (2017), adults maintaining a physically active life style can reduce the
risk of developing the disrupted glucose tolerance, insulin resistance and type 2 diabetes.
Robert should be taught that he should not remain seated at his place at a stretch, but go for a
brisk walking amidst his work.

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Conclusion
It is evident from the case study that Mr. Robert has high glucose level, due to which
he had to restrict is diet. His vision is also getting affected due to the effect of
hyperglycaemia and there had been an episode where he had have slurry speech while being
admitted in to the hospital for hypoglycaemia. In the interview, Robert have mentioned about
how diabetes have impacted on his life and family, as he felt that he is becoming the too
dependent on his family members. However, the main two nursing interventions involves
teaching about adherence to the medical regimen, dietary guidelines and monitoring of
glucose at home.
;

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References
American Diabetes Association. (2018). 8. Pharmacologic approaches to glycemic treatment:
Standards of Medical Care in Diabetes-2018. Diabetes care, 41(Suppl 1), S73.
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