Diabetes Education Report: Palliative Care in Diabetes Cases

This report delves into diabetes education, focusing on the management and palliative care of diabetic patients through the analysis of four distinct case studies. It explores the two main types of diabetes, type 1 and type 2, and the critical role of insulin in regulating blood sugar levels. The report highlights the challenges associated with diabetes, including potential health complications and decreased life expectancy, emphasizing the importance of effective disease management. The discussion section outlines preventive measures and management strategies such as healthy eating habits, maintaining a healthy weight, staying active, and adhering to medication schedules. Each case study presents a unique scenario, detailing the specific challenges faced by patients and the palliative care approaches employed to improve their quality of life and manage their symptoms. The report provides valuable insights into the complexities of diabetes care, particularly end-of-life issues, and offers practical recommendations for healthcare professionals and caregivers on how to support diabetic patients.

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NURSING: DIABETES EDUCATION
Table of Contents
INTRODUCTION.....................................................................................................................................1
DISCUSSION............................................................................................................................................2
CASE STUDIES........................................................................................................................................3
Case 1......................................................................................................................................................3
CASE 2...................................................................................................................................................4
CASE 3...................................................................................................................................................5
CASE 4...................................................................................................................................................6
CONCLUSION..........................................................................................................................................7
REFERENCES..........................................................................................................................................8

INTRODUCTION
Diabetes is a type of disease where by a person’s blood pressure or blood sugar levels are
extremely high than normal (Dunning et al, 2014). There are two types of diabetes, i.e. type 1
and type 2. Normally or for a healthy human body, the pancreas (an organ located behind the
stomach) produces and releases insulin which is a hormone that helps the body in storing or
using the sugar and fat from the food consumed by the person. When food is broken is consumed
and digested in the human body, it enters the blood stream in form of glucose where by it is
broken down into energy to be used by the human body (Atkinson et al, 2014). Therefore,
diabetes can occur when the human body produces less volumes of insulin or no insulin at all
(Cho et al, 2013). Additionally, the body may fail to use the insulin produced effectively which
also causes diabetes. In type one diabetes, a person’s body does not make insulin at all and in
type 2 diabetes, the patient’s body does not use insulin effectively. Therefore, diabetes is a
disease that involves lack of enough insulin in the body, complete lack of insulin in the body or
failure of the body to make use of the insulin produced in the best way possible. The diabetes
patients need to manage the disease to be able to stay healthy (Gómez-Batiste et al, 2014).
Additionally, they can be provided with care by specialists and professional people whose
responsibility is to provide relief to the patients and family from the symptoms and stress
concerning serious illness and loss of life in the end. This is referred to as palliative care which
involves providing care to patients with serious illnesses.
Patients with diabetes, especially those at their end of life stages, require certain care needs
(Melville-Smith et al, 2011). Generally, diabetes is a disease that is associated with severe health
complications and problems and increased rates of deaths or rather decreased life expectancy
rates. However, diabetes doesn’t cause health complications and death on its own, poor and
uncontrolled disease and symptoms management does. Due to this, a patient’s health deteriorates
very fast and becomes complex to high levels as well where by the symptom worsen and other
health problems emerge like Neuropathy, vision problems, kidney diseases, heart diseases,
stroke, among others (Kyi et al, 2015). Therefore, it is important to ensure that these kind of
patients receive the required care for them to live longer (Hill et al, 2008). This is basically
known as the diabetes end-of-life care issues. These issues refer to techniques and methods that
can be used by diabetes specialists and experts to care for the diabetic patients (Horowitz, 2009).
This assignment will discuss four types of diabetes cases and give detailed information on the

required palliative and end-of-life care issues that should be involved in such cases. Basically,
end-of-life care issues involves taking care of diabetic patients who are on the verge of death. In
that case, the main aim for these practice is to ensure they have a comfortable and peaceful
experiences until their time of death (Keel et al, 2017). This includes focusing on pain and
symptoms management as well as providing psychological, social and spiritual support and
positive attitude towards the patients and their family members. This report will indicate various
most effective ways of dealing with such diabetic cases. It will provide valuable information on
how to take care of diabetic patients with conditions same as those listed in the four case studies.
DISCUSSION
For any type of diabetes (type 1 or 2 diabetes), the following methods can be used to prevent and
manage it:
Healthy Eating
Type 2 diabetes occurs when the body stops or prevents the insulin in the body from performing
its function. This can be caused by accumulated fats in the body which can prevent blood flow in
the body. When a person consumes foods with a lot of fats, sugar or salt they increase the levels
of body fat accumulation which can make the body to stop insulin flow and performance
(Minges et al, 2011). Therefore, to prevent and manage type 2 diabetes, patients are advised to
eat healthier (specifically consume more natural foods), foods with less fats, sugar or salt
(consume mostly the home cooked meals) and most importantly, consume the three types of
foods everyday (protein, carbohydrates and vitamins. In addition to that, the patients are advised
to consume plenty of water to help in food breakdown and increase insulin performance in the
body (Novak et al, 2017).
Being of healthy weight
This involves not being overweight or underweight. However, being overweight is the most
likely cause of being diabetic. Therefore, to prevent being overweight, people/patients are
advised to improve their health by eating less or reasonable amounts of foods, eating healthy
(e.g. eating less fatty foods) and being more active in their life.

Keeping active
This is a different way of keeping fit or rather reducing the chances of being overweight. This
will help a person to lose weight and be healthy by keeping the body active and therefore
keeping insulin performance levels high. This include being involved in activities like walks,
joggings, participating in sports, hunting, gardening to name a few.
Taking medications
Patients are advised to take medications exactly as instructed by the doctor to prevent possible
complications of their health conditions.
CASE STUDIES
Case 1
This case study, the patient is already diagnosed with diabetes, specifically type 2 diabetes. Type
2 diabetes is whereby the human body is not able to make effective use of the insulin produced
or rather when the patient’s body stops the insulin produced from working at all. In most cases,
the aboriginal patients usually have type 2 diabetes. Therefore, I can say that, the patient in this
case study has type 2 diabetes as well. This can be indicated by the fact that the patient’s use for
steroids medication which cause an increase in his glucose levels in the blood. However, the
body did not seem to produce enough insulin to breakdown the glucose and the body was not
able to manage the insulin already produced effectively to breakdown the glucose. Therefore, the
experts decided to introduce more insulin into the patient’s body to help him manage his eating
rates and glucose breakdown which would further help in managing the patient’s body weight.
The following palliative practices and end-of-life issues can be involved in this case:
Prevention and management of diabetes
Introduction of healthy lifestyle programs.
This involves the patient’s eating habits whereby they are advised to eat more healthy foods, i.e.
food with less fats, salt and sugar and generally balanced diet foods. The practice can help these
patients to manage their weight and their symptoms which later increase their rates of survival
(Paul et al, 2017).

Diabetes programs and services
This includes providing culturally appropriate primary health care services and practices that can
cause adverse and effective improvement in the management of aboriginal diabetic patients.
Effective strategies in management of medication and patient appetite
Changes in meals sizes and frequencies can cause adverse impacts on a patient’s glucose levels
which relate directly to insulin performance and production. In his case, the patient was starting
to feel too tired to eat as required which would later cause effects to his glucose levels hence low
levels of insulin production and release. Therefore, the patient should focus on managing his
eating habits by eating healthier and increasing the frequencies and amounts of food eaten
(Reardon et al, 2017). By doing this, he can increase the glucose levels in the body naturally
rather than take the steroids he is currently taking, which increase the glucose levels to abnormal
standards.
Also, the patient is also facing challenges with his medications especially the steroids and
nutritional supplements that he is has been instructed to use. Therefore for this case, the patient
can be provided with powdered or syrup form of metformin (medication he is currently taking)
instead of the tablets to reduce the challenge facing him when swallowing them.
Additionally, once they were consulted, the diabetes expert team seemed to agree on the need for
continuous steroid medication for the patient. Generally, when steroids are taken by diabetic
patients, the aim is to reduce symptom impacts but they can also cause adverse effects like
hyperglycaemic symptoms and high glucose rise during certain times of the day. Therefore, to
reduce all these effects, the patient should be medicated with sulphonylurea, e.g. glclazide or
isophane insulin e.g., humulin which can help manage those effects.

CASE 2
The patient in this case has been facing challenges in his eating habits and when taking his
medication (daily injections). Basically, the patient was unable to eat as required for a diabetic
patient which means that his glucose levels were low. Also, he was unable to get the required
number of injections required for his condition which led to health deterioration. Due to low
glucose levels, the body was not able to produce enough insulin to break down the glucose
already in the body. Therefore, in this case, the palliative and end-of-life issues that can be
implemented to the patient are:
When the diabetes expert decided to advice the patient into taking one meal and fewer insulin
shots during to increase his life expectancy, they were trying to reduce and manage his meals to
regular intakes and the insulin intake being given according to meal intake. Therefore, the nurse
can use Repaglinide or Nataglinide to help the patient manage the disease itself.
To add to that, the patient was originally prescribed to for insulin shots per day which he later
found difficult to manage. Therefore, the GP decided to replace his long lasting insulin shots
with short acting insulin shots which were more effective during his final experiences. Therefore,
the patient care givers should focus on ensuring that the insulin injections are monitored and
administered at the required times and frequencies (Savage et al, 2012). Also by replacing the
long acting insulin with short acting insulin results in the management of a patient’s insulin
levels and therefore symptom management because in the end, only shot would be needed for the
patients to survive per day.
CASE 3
In this case, Elsie the patient is was facing a lot of challenges when it came to her body weight
management. Later, the patient lost appetite for food which led her to miss meals frequently.
Later, Elsie’s conditions worsened and diabetic symptoms increase including increased
confusion levels which was caused by low levels of glucose in the blood. Additionally, Elsie’
often failed and refused to take her oral medication which led to release of low metformin levels.
Generally, it is important to note that, the patient in this case has challenges in managing her
body weight, she does not take enough meals per day which means that there is certainly low
glucose amounts in the body hence low or no insulin levels and that she has challenges in taking
oral medications. With such challenges and problems, there are higher chances of increasing the

symptoms that are experienced by diabetic patients. There are different palliative care practices
and end-of-life care issues that can implemented in such a scenario, i.e.
Healthy eating habits
The patient should be encouraged into eating healthy and high nutrition foods. For instance, the
patient should be given three meals per day that are balanced in diet. Also, the patient should be
advised on reducing her rates of eating fatty foods or foods with high amounts of sugar and salt
(Tafelski, et al, 2015). Through this, she will be able to manage her weight effectively and easily.
Keeping body active
The case study information states that Elsie is challenged by the issue of managing her body
weight. The care to be provided to this patient should include practices that will help her keep
her body active hence leading to weight reduction. Such activities like sport and play
participation, walking and doing simple body exercises. This will help her keep her body active,
which is also a way of increasing the blood flow in the body and therefore increasing the need
for glucose in the body. His will also increase the chances for the body to need food which will
lead to insulin production in the body.
Strategies for medications and appetite management
The GP should also improvise a different way to administer insulin into the patient’s blood
stream rather than through oral medication. In the case study, Elsie had been failing and refusing
to take her oral medications. Therefore, the GP should come up with better ways through which
the patient is comfortable with and can manage, e.g. injections. With injections, the patient will
not only be easy but it will react faster than the oral medications (Siegelaar et al, 2010).
When it comes to appetite management issue, the care givers should improvise better ways for
the patient to eat. For instance, balanced diet foods should be encouraged. Also, they should give
the patient foods whose responsibility is to increase appetite to the patient, e.g. nutritional
supplements. However, these medications should be in a form that can be injected into a
patient’s body not orally take.

CASE 4
The patient is of old age and faces challenges when taking her oral medication, even fluids. The
patient could not take any solid or fluid food or medication. The patient was receiving insulin
shots which means that her body was not producing enough insulin to break down the glucose in
the body or rather the body did not allow the insulin produced to act on the glucose. The patient
is then facing a lot of risks especially those that relate with ketoacidosis. Therefore, for the
patient to have longer life, easy and comfortable end days, the following palliative and end-of-
life issues should be implemented:
The nurses should focus on ensuring that the patients eats at regular reasonable intervals.
However, the foods should certainly be inform of injectable liquids. This is simply because the
patient cannot take in foods that are in solid on liquid form and which require oral ingestion. In
other words, the care givers should focus on giving the patient food supplements that can be
injected into the blood stream and not ingested orally.
Also, the care givers should rather inject the insulin that the patient is advised to take rather than
give then inform of liquid or solid form, e.g. tablet form. When the insulin and food supplements
are injected directly into the blood stream, they will react at a faster rate when ingested into the
body inform of solid or liquid forms. By reacting faster, they will produce more energy and at a
faster rate hence making the patient move on their own and be active on their own. Through this,
the patient will therefore be able to live longer.
Additionally, the care givers should focus on educating the family relatives of the patients on the
best and most effective ways for caring for the patients especially when giving the insulin
injections (v et al, 2017).
The care givers should also concentrate on devising better ways of improving the patient’s health
and energy. This is should be done especially in the case of old people on the verge of death
(Dunning et al, 2013).

CONCLUSION
Diabetic complications often lead to hospital admissions. However, some patients are also
allowed and can be able to manage their condition outside hospital. This is normal for diabetes
disease because of its serious and adverse symptoms and effects to the body and health condition
of the patients. This means that it is a disease that causes many other body functionality failures
like stroke, kidney disease and liver failure among others. From the four case studies, it is clear
that diabetes is mostly caused by high blood sugar levels which is as a result of low or nor
insulin production. However, diabetes can also be caused when the body hinders insulin action or
performance towards the glucose in the body. However, it is clear that the most common
practices that can reduce diabetes occurrence is healthy eating and body exercise. On the other
hand, once a person is diagnosed with diabetes, the best way to manage it is also through healthy
eating and body exercise. However, the diabetic patients certainly require expert advice and
treatment which is basically provided by palliative care givers through the provision of end-of-
life care practices. These practices involved educating, physically and emotionally supporting the
patients and their relatives especially when the patient is near death. Through palliative care
provision, the patients are provided with comfortable and friendly environment which is capable
of reducing pain and symptoms associated with the disease. The relatives are given physical and
emotional support to give courage them courage as they watch their loved ones pass on.

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