Type 2 Diabetes Assignment

This assignment provides an in-depth analysis of type 2 diabetes, including its pathophysiology, complications, and management. It also highlights the role of nurses in diabetes management and emphasizes the importance of patient education. The assignment covers topics such as macrovascular and microvascular complications, hypertension treatment, and lifestyle modifications. It offers valuable insights for healthcare professionals and individuals with type 2 diabetes.

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Type 2 Diabetes Assignment
Student’s Name
Institutional Affiliation

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Type 2 diabetes consists of a series of dysfunctions evident by hyperglycemia and
following a combination of resistance to insulin action in the muscles, liver together with
destroyed pancreatic beta cell activity resulting to ‘absolute’ insulin insufficiency. A resistance
to Insulin seems to precede, and results to raised insulin production to keep standard blood
glycemic levels (Kautzky-Willer, A., Harreiter, J., & Pacini, G. (2016). However, in vulnerable
patients, the beta cells of the pancreas cannot maintain the increased demand for hormone
insulin, and a slowly advanced deficiency of insulin progresses.
Type 2 diabetes mellitus is accountable for around 86% of all patients with diabetes in
Australia and by sheer members, accounts for more than half of the sum of public health and cost
responsibility associated with type 2 diabetes. The risk factors related to type 2 diabetes mellitus
include obesity (BMI greater than 30), inactivity, and sedentary lifestyle (excessive alcohol
intake, and chronic cigarette smoking). Abnormal cholesterol and triglyceride levels are a risk
for type 2 diabetes mellitus (Rewers, M., & Ludvigsson, J. 2016). Increasing age and genetic
factors are also a risk for type 2 diabetes development. Other causes of diabetes are, genetic
defects of beta cell function, pancreatic disease, and extravagant production of endogenous
hormonal antagonists to insulin.
Pathophysiology
Poor blood glucose control can cause vascular complications. These may be
macrovascular diseases, such as peripheral artery disease, cerebrovascular accident, coronary
artery disease, and microvascular disease retinopathy, polyneuropathy, and nephropathy.

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Optimal control of elevated levels of blood glucose can help prevent the complications and
symptoms resulting from hyperglycemia. Also, treatment of lipid disturbances and hypertension
significantly reduces the incidence and severity of vascular disease.
Macrovascular disease develops in type 2 diabetes mellitus thus promoting an early and
premature increase of long-term cardiovascular problems in type 2 diabetes. A series of
metabolic and hemodynamic factors have been considered to have an impact on accelerated
cardiovascular complications (Neal et al., 2017). Macrovascular complications of type 2 diabetes
mellitus result from excess free fatty acid, elevated blood glucose levels and insulin resistance.
Hyperglycemia, insulin resistance, and excess lipids cause elevated protein kinase activation,
oxidative stress and receptor activation for progressive glycation final products. These factors act
on the endothelium.
Reduced nitric oxide, the increment in endothelia, and elevated angiotensin ii promote
vasoconstriction that leads to hypertension and growth of smooth muscle cell in the vessels.
Diabetic retinal complication is the common cause of loss of sight in individuals between
30 and 65 years of age, in developed countries. The effective treatment is retinal
photocoagulation, especially if it’s administered at an early phase when a person has no
symptoms. Hyperglycemia usually elevates blood flow in the retina and metabolism and has
effects on the endothelial cells of the retina and loss of pericyte, resulting in vascular
autoregulation impairment.
Following unregulated flow of blood at first dilates the capillaries but also raise the
release of vasoactive substance and proliferation of endothelial cell, leading to closure of
capillaries. This results in persistent retinal hypoxia and provokes growth factors release,

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including vascular endothelial growth factor (VEGF), that plays a significant role in provoking
the damaging change in growth of endothelial cells (promoting new vessel structure) and raised
vascular permeability (promoting retinal exudation and leakage).
Macular edema should be suspected in diabetic patients if there is visual acuity
impairment, even if this is related with only moderate peripheral non-proliferative retinal disease
and there is no other pathology. Macular edema can only be excluded on slit lamp retinal
biomicroscopy. If macular changes are observed by direct ophthalmoscopy or retinal
photography, referable maculopathy should be suspected. Acute visual loss happens with
vitreous hemorrhage or retinal detachment.
Neuropathy is a common and early complication found in around 30 percent of patients
with diabetes. Although in some of the individuals it can result in serious disability, and usually
it has no symptoms in most patients. Like retinopathy, it occurs as a result of metabolic
imbalance, and occurrence is linked to the time of diabetes existence and the level of metabolic
regulation. There are facts that the central nervous system function is altered by chronic
diabetes; the effect of diabetes is primarily evident in the peripheral nervous system.
Diabetic nephropathy is a significant cause of complications and death and is now amidst
the major reason of end-stage renal disease (ESRD) (as cited in Wanner et al., 2016). Diabetic
nephropathy is found with other macrovascular and microvascular complications, and treatment
is often tough. The advantages of prevention of ESRD are crucial. The first pathological changes
coincide with the onset of microalbuminuria and involve making the glomerular basement
membrane thicker and compilation of matrix matter in the mesangium. Afterwards, nodular
deposits are typical, and glomerulosclerosis become worse as heavy protein in the urine occurs
until glomeruli are increasingly lost and renal activity deteriorates (Fitchett et al., 2016).

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Effective management and treatment of hypertension and diabetes require healthcare
provider and patient to work hand in hand with each other to balance non-pharmacological and
pharmacological intervention to prevent target organ destruction.
Management
The goals in the care of people with hypertension and type 2 diabetes are to do away with
manifestation to stop or reduce the occurrence of complications. The target blood pressure levels
are systolic of < 140 and diastolic of < 90. Multiple drug therapy is essential in obtaining blood
pressure targets. ARBs or ACE inhibitors are the standard treatment for hypertension in
individuals with diabetes. ACE inhibitors delay kidney disease progression, reduce the risk of
cerebrovascular accident, and myocardial infarction (MI).
ACE inhibitors can elevate serum potassium levels. Therefore ACEIs Should not be
administered to patients who have bilateral renal artery stenosis or with a history of angioedema.
One of the complications of ACE inhibitors therapy includes a dry cough and a switch to an
ARB may be beneficial. ARBs, like ACE inhibitors, prevent diabetic kidney disease progression
and are therefore recommended as first-line alternative therapy for individuals who cannot
tolerate ACE inhibitors.
Frequently used ARBs are losartan, telmisartan, and irbesartan. These drugs can promote
changes in glucose metabolism, hypokalemia, and volume depletion, so it’s necessary to take
little or moderate dosages to reduce these risks. It is essential to check potassium levels and give
supplements as required regularly. If ARBs and ACE inhibitors are insufficient in BP reduction

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to target levels, a diuretic is added to the therapy. The diuretic administered depends on
glomerular filtration rates (GFR).
Goals of treatment for type 2 diabetes mellitus include microvascular (i.e. kidney and eye
disease) risk reduction via glycemic control, reduction in macrovascular (i.e. Coronary,
peripheral vascular, cerebrovascular) risk through smoking cessation, monitoring of lipids and
hypertension, metabolic and neurologic risk reduction via blood sugar control.
Approaches to diabetic complications include yearly dilated eye examination, HbA1c
every 3 to 6 months, annual microalbumin check, foot examination at each visit, starting therapy
to decrease low-density lipoprotein cholesterol, blood pressure less than 130/80mmHg, lower in
diabetic nephropathy (Inzucchi et al., 2015).
Non-pharmacological treatment of hypertension and diabetes mellitus include lifestyle
emendation, stop alcohol intake and cigarette smoking. BMI management, undertaking regular
physical activity, and reducing salt intake can help reduce complications.
Nurses are essential partners in evaluating and helping diabetic patients and all people
with hypertension to prevent overall cardiovascular risks. Comprehensive care for these patients
through the engagement of nurses provide improved health outcomes in primary care. Nurses
may also be key practitioners in evaluating and monitoring patient’s difficulties with compliance
with pharmacological interventions or lifestyle changes (Munshi et al., 2016). Personalized
treatment modification and lifestyle counselling are recommended to maintain target glycemic
levels and blood pressure.
Nurses play an important role in diabetes management by identifying and treating
hyperglycemia and hypoglycemia, promoting self-care, and creating awareness of how mental

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health problems can affect people with diabetes. Nurses assist patients with safe administration
of insulin.
Nurses promote self-care by helping patients to develop their own self-care plan,
observing and reporting concerns that may arise and affect the patient’s ability to self-care, and
encouraging patients to use their individualized care plans.
Nurses assist patients to meet their nutritional needs by helping them to create and follow
their dietary plan. This helps in weight regulation and promoting optimal control of blood
glucose and blood pressure. Nurses also encourage safe administration and use of insulin and
oral antihyperglycemic medication. They describe the effects of insulin and oral
antihyperglcemic agents on blood glucose. People are educated on how to inject insulin and
proper sharps disposal.
Nurses’ contribution to the management of hyperglycemia and hypoglycemia include
stating normal glucose range, identifying signs and symptoms of hypo/hyperglycemia, and
demonstrating competent use of blood glucose monitoring equipment to confirm
hypo/hyperglycemia. They also offer the right treatment as per local guidelines.
Educational plan
Diabetes patient education is recognized as a crucial part of effective diabetic treatment.
Education for individuals with hypertension and diabetes increase their understanding and
knowledge of the illness. Studies conducted show that patient ill-controlled diabetes mellitus,

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personal education and attention are superior to mass education (Zhao, F. F., Suhonen, R.,
Koskinen, S., & Leino‐Kilpi, H. 2017). However tough and everyday obligations like adjusting
and taking medication, self-monitoring of glucose levels, nutritional modification, feet care, and
regular attendance for medical care place is a monetary burden and psychological on individuals
with diabetes and hypertension (Bowen et al., 2016).
Studies have shown that, while there have been various steps taken in the medical
management of type 2 diabetes mellitus and hypertension, their practice put a huge demand on
individuals with diabetes mellitus and their caregivers( Deakin et a, 2005;Clark, 2008). Self-care
corroborated by patient education is paramount for attainment of essential knowledge and
decision making skills.
Patient education promote self-care and change of behavior. It has a significant effect on
adapting new food choices, and increasing the oftenness of physical exercise (Hsu et al., 2015).
Diabetes education promotes consumption of low fat foods, five portions of fruits and
vegetables, three meals daily, and restriction of refined sugar consumption to one product/less
per day. Consumption of an increased amount of fiber protects against developing high blood
pressure. Regular physical activities (walking and running) for 15 to 30 minutes most days of the
week can reduce the blood pressure. Also, during exercise, blood glucose monitoring is crucial
since it can go too low.
Foot care is essential for diabetes patients. The feet are at risk for complications in people
with diabetes. Disease of the Peripheral vessels and peripheral nerve defects increase the risk of
feet problems (Bonner, T., Foster, M., & Spears-Lanoix, E. 2016).

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The importance of optimal blood glucose and blood pressure regulation is understood by
patients with diabetes and hypertension through education. Patient education enables people with
diabetes and hypertension to be adherent to their medical treatment and care. Adherence to
medication decreases the risk of complications resulting from poor blood glucose control and
blood pressure (Marso et al., 2016).
Self-monitoring of glycemic levels is crucial. Diabetes patients are educated on
hyperglycemia and hypoglycemia. With this knowledge patients are able to monitor their blood
glucose.
Patient education is important in smoking and alcohol cessation. Smoking increases the
risk for stroke and myocardial infarction. More than two out of three individuals with type 2
diabetes mellitus die of myocardial infarction or a cerebrovascular accident. Smoking also raises
blood glucose and increases the risk for other complications (vascular and nerve damage) caused
by diabetes (McEwen et al., 2015). Drinking alcohol can affect blood glucose. Alcohol is broken
down in the liver. This can block the liver from making new glucose making the blood glucose to
fall. It is advisable to drink light beers or dry wines.
Patient education enhances health-related life quality including psychological, physical,
and social function. It helps reduce depression and anxiety. Patient education may reduce
diabetes and hypertension-related admissions to the hospital.

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References
Wanner, C., Inzucchi, S. E., Lachin, J. M., Fitchett, D., von Eynatten, M., Mattheus, M., ... &
Zinman, B. (2016). Empagliflozin and progression of kidney disease in type 2
diabetes. New England Journal of Medicine, 375(4), 323-334.
Neal, B., Perkovic, V., Mahaffey, K. W., De Zeeuw, D., Fulcher, G., Erondu, N., ... & Matthews,
D. R. (2017). Canagliflozin and cardiovascular and renal events in type 2 diabetes. New
England Journal of Medicine, 377(7), 644-657.
Marso, S. P., Daniels, G. H., Brown-Frandsen, K., Kristensen, P., Mann, J. F., Nauck, M. A., ...
& Steinberg, W. M. (2016). Liraglutide and cardiovascular outcomes in type 2
diabetes. New England Journal of Medicine, 375(4), 311-322.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ... &
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), 140-149.
Rewers, M., & Ludvigsson, J. (2016). Environmental risk factors for type 1 diabetes. The
Lancet, 387(10035), 2340-2348.
Fitchett, D., Zinman, B., Wanner, C., Lachin, J. M., Hantel, S., Salsali, A., ... & Inzucchi, S. E.
(2016). Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high

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11
cardiovascular risk: results of the EMPA-REG OUTCOME® trial. European heart
journal, 37(19), 1526-1534.
Hsu, W. C., Araneta, M. R. G., Kanaya, A. M., Chiang, J. L., & Fujimoto, W. (2015). BMI cut
points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes
care, 38(1), 150-158.
Kautzky-Willer, A., Harreiter, J., & Pacini, G. (2016). Sex and gender differences in risk,
pathophysiology and complications of type 2 diabetes mellitus. Endocrine reviews, 37(3),
278-316.
Ballestri, S., Zona, S., Targher, G., Romagnoli, D., Baldelli, E., Nascimbeni, F., ... & Lonardo,
A. (2016). Nonalcoholic fatty liver disease is associated with an almost twofold increased
risk of incident type 2 diabetes and metabolic syndrome. Evidence from a systematic
review and meta‐analysis. Journal of gastroenterology and hepatology, 31(5), 936-944.
Shah, A. D., Langenberg, C., Rapsomaniki, E., Denaxas, S., Pujades-Rodriguez, M., Gale, C.
P., ... & Hemingway, H. (2015). Type 2 diabetes and incidence of cardiovascular
diseases: a cohort study in 1· 9 million people. The lancet Diabetes &
endocrinology, 3(2), 105-113.
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., ... & Vivian,
E. (2017). Diabetes self-management education and support in type 2 diabetes: a joint
position statement of the American Diabetes Association, the American Association of
Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes
Educator, 43(1), 40-53.

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Bowen, M. E., Cavanaugh, K. L., Wolff, K., Davis, D., Gregory, R. P., Shintani, A., ... &
Rothman, R. L. (2016). The diabetes nutrition education study randomized controlled
trial: a comparative effectiveness study of approaches to nutrition in diabetes self-
management education. Patient education and counseling, 99(8), 1368-1376.
Zhao, F. F., Suhonen, R., Koskinen, S., & Leino‐Kilpi, H. (2017). Theory‐based self‐
management educational interventions on patients with type 2 diabetes: a systematic
review and meta‐analysis of randomized controlled trials. Journal of advanced
nursing, 73(4), 812-833.
McEwen, L. N., Ibrahim, M., Ali, N. M., Assaad-Khalil, S. H., Tantawi, H. R., Nasr, G., ... &
Bahijri, S. M. (2015). Impact of an individualized type 2 diabetes education program on
clinical outcomes during Ramadan. BMJ Open Diabetes Research and Care, 3(1),
e000111.
Bonner, T., Foster, M., & Spears-Lanoix, E. (2016). Type 2 diabetes–related foot care
knowledge and foot self-care practice interventions in the United States: a systematic
review of the literature. Diabetic foot & ankle, 7(1), 29758.
Munshi, M. N., Florez, H., Huang, E. S., Kalyani, R. R., Mupanomunda, M., Pandya, N., ... &
Haas, L. B. (2016). Management of diabetes in long-term care and skilled nursing
facilities: a position statement of the American Diabetes Association. Diabetes
care, 39(2), 308-318.