Case Study: Managing Diabetes Patients and Related Complications

This report presents a case study focused on managing diabetes in an elderly patient, Violet, who is diagnosed with type 2 diabetes, osteoarthritis, and a foot ulcer. The report explores the prevalence of type 2 diabetes in older adults, examining factors like pancreatic islet malfunction and insulin resistance. It delves into the qualitative aspects of Violet's condition, analyzing the impact of her health issues and living situation. The report uses a structured search strategy utilizing Google Scholar to find relevant literature, including articles from the American Diabetes Association, to support its analysis. It also discusses the importance of proper diabetes management in reducing illness progression, emphasizing the need for self-care, psychological support, and appropriate dietary habits. The report highlights the challenges faced by elderly diabetic patients and stresses the need for comprehensive care to improve their quality of life. References include articles related to diabetes management, depression, and psychological conditions in diabetic patients.

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MANAGING DIABETES PATIENTS
By (Name)
Course
Institution
Instructor
City and State
Date

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Introduction
Recent research indicates that diabetes has become a significant health global concern,
where more than 200 million people are affected by the epidemic disease. In most countries,
diabetes affects more than 30 % of the total population aged over seventy years, excluding
people with Impaired Glucose Tolerance (IGT). Diabetes disease is a cause of life miseries and
substantial poor economic standards among older people. Diabetes infected people may
encounter various body complications such as cardiovascular diseases, kidney failure, hearing
impairment, neuropathies, retinopathy, osteoarthritis, and walking problems (Yakaryılmaz and
Öztürk, 2017, p. 278). Poor diabetes management, therefore, extends diabetes progression.
Primarily it is therefore essential to have adequate control measures to recede diabetes
complications. Diabetes can be controlled by providing intensive care to the people living with
diabetes, along with proper education to the caregivers.
Violet’s Health Issue
Violet is an old lady who has been approved for residential aged care, and she has been
waiting for a nursing home bed. She has been diagnosed with type two diabetes and facing
osteoarthritis and lower left leg ulcer complications. Furthermore, she needs dairy dressing and
BSL attendance. Currently Violet lives together with her daughter Gemma who is married to
Mathew. Gemma is the breadwinner of the family since Mathew is presently unemployed but
alcoholic, the reason for continuous augment with Violet. Like many older adults, Violet is
among millions of patients who undergo hardships in coping with diabetes type two and needs

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diabetes management. Diabetes two is a chronic disorder caused by either inadequate insulin
secretion or malfunctioning of the insulin secreted in the body.
The infection is characterized by chronic hyperglycemia which may impair other body organ
systems causing health-related complications such as osteoarthritis, retinopathy, and neuropathy
(Goyal and Jialal, 2018 p 212). Like Violet, many old diabetic patients are susceptible to
osteoarthritis. Osteoarthritis shares the same risk factors as T2DM. Aging is also associated with
pancreas malfunction since the beta cells' functioning reduces as the age increases. According to
Anderson and Loeser (2011), Osteoarthritis is an aging disorder. Age changes the
musculoskeletal system, which later leads to change in cell tissues and senescence in the joints
causing Osteoarthritis, explaining why Violet is infected with arthritis.
Moreover, Violet is infected with a foot ulcer, which a common complication among diabetes
patients. It may appear like a thick lesion at the foot ankle caused by tissue damage due to foot
trauma or mechanical weight pressed against the foot. Consequently, Violet needs a dairy
dressing of the wound, which will help her in quick recovery (Younis et al., 2018).
Quantitative Aspect
Why is Diabetes type II more prevalent to the age individuals above 65 years compared to young
people below the same age?
The qualitative question may help us understand why Violet was diagnosed with diabetes type
two and why the disease is more prevalent old people compared to young people.
Searching Strategy

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In determining the literature to use in our case study, we have to use simple keywords in our
Google search to get the relevant journals and scholarly articles that will help us answer the
question. The best website to use for our search is Google scholar. Google scholar gives
prevalence's in searching in that one can control the search as desired, according to date, Journal
Author, and the desired subject. Once we open the browser, chrome, we search the keyword
Google scholar. The browser gives various options for Google scholar but getting the best
search, and we select the term Google scholar. In the top left corner of the webpage, we press the
button made of horizontal lines to open a new menu. We directly go to the advanced search
which has eight ways of searching which later are broken down into three broad sections; all,
exact phrase, at least one and without. We click on the option exact phrase. We can then type one
of our qualitative research questions in the correct phrase box using specific keywords. Typing
our qualitative question directly to the web page may give us many various options. Therefore,
we have to refine our search by searching by using specific keywords. We can use the phrase
‘Diabetes in Older People.' From that angle, we can now select the aging of desired journals.
Either between 5-10 years old or 1-5 years old. Furthermore, in terms of article selection, we
have to choose articles that are Evidence-based Practice which will help us answer the question.
Literature Review
From our search, we get the article “Diabetes in Old Age," which is published from
American Diabetes Association. The item will provide literature evidence of why older adults are
more likely to suffer from diabetes illness. From the article, the old individual's immune system
gradually decreases with age as due to insufficient production of B and T cells in the bone
marrow, consequently reducing the number of lymphocytes that can fight against the antigens.
Unlike older people, the bone marrow from young individuals can produce more T and B cells

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that are required for adaptive immune responses. T and B cells are secrets antibodies that can
protect the body against disease; therefore, young people have a high potential for disease
resistance compared to older adults. To add to that, older people have a high prevalence of
diabetes type two infections resulting from pancreatic Islet malfunction and Insulin resistance
among older people (Kirkman et al. 2012 p2650). Insulin resistance among the aged can also be
brought by increased density, reduction in lean muscle weight, and changes in dietary habits. All
this may result in deficient glucose oxidation that helps in insulin secretion. Insulin is very
crucial as it is responsible for balancing the blood sugar in the body, stimulating lipogenesis, and
transporting amino acids to the cells. For this reason, the failure of insulin secretion among old
people leads to diabetes type II (Gunasekaran and Gannon 2011, p. 565). Young individuals are
less insulin resistant and have a standard glucose tolerance compared to aged people hence
reducing the risk of diabetes disease. Violet could be experiencing low production of T and B
cells in the body; therefore, the body is unable to respond earnestly to incoming infections.
Additionally, there could be deficient secretion of insulin by the pancreas in resulting in impaired
glucose regulation in Violet's blood leading to diabetes.
Qualitative Aspect
Can proper management of diabetes among aged people reduce illness Progression?
The quantitative question will help us identify various ways on how to care for old diabetic
patients. From our case study, Violet needs a lot of care, the reason why she stays with her
daughter Gemma.
Searching Strategy
In this case, we will use the PICO evidence strategy.

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We have to identify the keyword in our PICO question
Can proper management of diabetes among the aged reduce illness Progression
(C) (I) (P) (O)
We shall use the keyword "Diabetes management for 65+ years.
We shall use the Google scholar to get the best scholarly articles.
To refine our research, we have to use Advanced Search in Google scholar. We can use the exact
phrase box to get precise results. Moreover, we can limit the effect we get by customizing on the
aging, either ten or 5-year-old articles. Then we restrict it by typing Evidence-based practice.
What we expect is that materials generated through our search will be Evidence-based between
1-10 years old and gives information on diabetes management among older adults over 65 years.
Typing "Diabetes management for 65+ years" on Google scholar offers a variety of results;
however, we have to select the best article which relates to our case. After the search, we arrive
at the item"Diabetes Management in the Elderly" published by the American Diabetes
Association. The article will help us identify various ways in which we can care for the aged
people who are diabetic such as Violet. Additionally, it helps us understand the multiple
difficulties diabetic people face (Researchguides.uic.edu, 2019).
Literature Review
A patient infected with diabetes two requires self-care and a favorable environment for their
healing process. People from a low economic background may face financial exposures such as
poverty, and depression which may compromise social health care and medical management for
diabetic people (Leung, Wongrakpanich and Munshi, 2018 p. 245). Hence diabetic patients may

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be psychologically affected by these conditions. Violet is psychologically affected by the illness.
She may be experiencing depression though it is not vivid in the case. Violet may be
experiencing depression because she keeps arguing with Mathew, who is alcoholic yet jobless.
She may be worried due to economic pressures affecting the family, seeing that she needs a lot
for her medical needs, including dairy dressing; unfortunately, there is only one breadwinner in
the family, Gemma. The children are also forced to forego their bedrooms to help their
grandmother.
The Articles “Diabetes and Depression and Psychological conditions in Diabetes” will help us
know some of the methods that can be used to manage depression among old diabetic patients.
Psychological therapies should be administered to the patient on an individual basis since they
are proven to have positive feedback to the patients. Psychological interventions may include
problem solving, counseling, and therapy in cognitive behavior. Besides, educating the patients
on self-management skills in combination with diabetes education may be better (de Groot and
Golden, 2016, p. 552). Relatively the antidepressant medication may also be relevant for severe
cases. Antidepressant helps in reducing anxiety, obsessive disorder, and traumatic disorders.
Violet should have psychological therapy to reduce stress and depression. Psychological therapy
will help her have peace with Mathew though he is unemployed.
A proper management system should be as well be adopted in coping with diabetes. The
National Institute of Health publication helps us understand how diabetic patients should take
better lifestyles in dealing with diabetes. Old diabetic patients should adopt better dietary eating
habits that will enable them to fight the disease. Eating food with low calories and saturated fat
may help to reduce depression Grains such as cereals, pasta, rice that is rich in fiber is also
helpful in fighting diabetes. Taking physical regular physical exercises improves blood glucose

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control and reduces the risk of cardiovascular disorders in diabetic patients; therefore physical
activities and exercises are recommended for diabetes improvement (Information et al., 2019)
Older diabetic patients need tender care from their caregivers due to the complexity of their
health situation and are at risk of getting other old age-related diseases such as dementia, cancer,
and cardiovascular diseases. They may sometimes feel isolated and loneliness due to lack of
adequate support from their family members; causing depression in most of them. (Rustad et al.
2016 p. 269). Excellent personal care makes them feel accepted in the society and lowers
diabetes impact in their lives.
Conclusion
From our discussion and violets case, aged individuals are more vulnerable to infections due
to their low immunity making them unable to fight the incoming infections. Sometimes insulin
secretion in their bodies may below leading to diabetes infections. However, diabetes
progression may be mitigated when if well managed. Proper care for diabetic infected people
increases their life chances and live longer lives. Violet, if properly cared for; she may improve
her experience and live longer.

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Bibliography
De Groot, M., Golden, S., and Wagner, J. (2016). Psychological conditions in adults with
diabetes. American Psychologist, 71(7), pp.552-562.
Goyal, R., and Jialal, I., 2018. Diabetes mellitus, type 2. In StatPearls [Internet].
StatPearls Publishing.
Gunasekaran, U., and Gannon, M., 2011. Type 2 diabetes and the aging pancreatic beta-
cell.
Aging (Albany NY), 3(6), p.565).
Holt, R.I., De Groot, M., and Golden, S.H., 2014. Diabetes and depression. Current
diabetes reports, 14(6), p.491.
Information, H., Overview, D., Diabetes, M., Life, 4. Life, 4., Center, T., and Health, N.
(2019). 4 Steps to Manage Your Diabetes for Life | NIDDK. [Online] National Institute of
Diabetes and Digestive and Kidney Diseases. Available at:
https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/4-
steps [Accessed 2 Oct. 2019].
Kirkman, M.S., Briscoe, V.J., Clark, N., Florez, H., Haas, L.B., Halter, J.B., Huang, E.S.,
Korytkowski, M.T., Munshi, M.N., Odegard, P.S. and Pratley, R.E., 2012. Diabetes in
older adults. Diabetes care, 35(12), pp.2650-2664.

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Leung, E., Wongrakpanich, S., and Munshi, M.N., 2018. Diabetes management in the
elderly. Diabetes Spectrum, 31(3), pp.245-253.
Researchguides.uic.edu. (2019). Subject & Course Guides: Evidence Based Medicine:
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experiences during care transition. Patient preference and adherence, 10, p.769.
Shane Anderson, A., and Loeser, R. (2010). Why is osteoarthritis an age-related disease?.
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Yakaryılmaz, F.D., and Öztürk, Z.A., 2017. Treatment of type 2 diabetes mellitus in the
elderly. World journal of diabetes, 8(6), p.278.
Younis, B., Shahid, A., Arshad, R., Khurshid, S., Ahmad, M., and Yousaf, H. (2018).
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clinic at a Tertiary Care Hospital, Lahore, Pakistan. BMC Endocrine Disorders, 18(1).