Type 2 Diabetes Mellitus: A Case Study on Patient Management

This essay presents a case study of Mr. Robert Chase, a 47-year-old patient diagnosed with Type 2 Diabetes Mellitus and obesity. The essay explores the pathophysiology of the disease, including insulin resistance, metabolic syndrome, and the impact on various body systems. It details Mr. Chase's symptoms, diagnostic test results, and the factors affecting his physical, mental, and social well-being. The core of the essay focuses on developing SMART goals for self-management, including weight reduction, increased physical activity, and dietary modifications. It also discusses the importance of nursing support in diabetes management, emphasizing the role of nurses in patient education, encouragement, and collaboration with other healthcare professionals to improve patient outcomes. The essay highlights the significance of self-care practices, such as blood glucose monitoring, diet, exercise, and medication adherence, in controlling the chronic condition and enhancing the overall quality of life for individuals with Type 2 Diabetes.

TYPE 2
DIABETES MELLITUS

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The particular essay is about a patient named Mr. Robert Chase who is 47 year old, is
suffering from Type 2 Diabetes Mellitus and obesity. Resistance to insulin mainly due to obesity
and lack of physical activities results in diabetes type (Scirica and et.al., 2013). This is also
called metabolic syndrome, which means group of risk factors that causes the insulin resistance.
Resistance in insulin can be defined as the loss of ability of glucose to perform it biological
function at a given concentration. These two events of insulin resistance and metabolic syndrome
are linked to atherosclerosis and cardiovascular disease. This is the main cause of increasing
mortality in type 2 diabetes due to the increase in production of small and dense atherogenic Low
Density Lipoprotein (LDL) particles (Chen, Magliano and Zimmet, 2012).
Adipose tissues and skeletal muscles also face problem related to insulin resistance due to
the alternation in handling of glucose and fatty acids in the liver and these tissues. The hepatic
manifestation related to insulin resistance in diabetes mellitus type 2 is a non-alcoholic fatty liver
disease (NAFLD). In this disease, there is increase of fat in liver but it is not because of alcohol
use and can also cause liver inflammation and in severe cases it leads to cirrhosis.
In type 2 diabetes mellitus there is defect in the secretion of both insulin and glucagon. In
general the pathophysiology of diabetes mellitus type 2 can be summarized in 4 steps: a)
Increase in carbohydrate intake, b) Decrease in peripheral glucose intake, c) Increase in hepatic
glucose production and d) Decrease in insulin secretion. These four events contribute to the
overall rise in blood glucose level that results in type 2 diabetes (Stenlöf and et.al., 2013).
Problem of diabetes in 21st century create the biggest challenge for Australian heath
system. Around 280 people in Australia develop diabetes every day that means one person in
every 5 minutes. Around 1.7 million Australians have diabetes out of which 1.2 million are
known and rest are undiagnosed type 2 diabetes. The total annual cost on treatment of diabetes in
Australia estimates around $14.6 billion.
It can be easily observed from the tests that were performed and the signs and symptoms Mr.
Chase depicted from last couple of days that he may be suffering from diabetes. From the blood
reports it was seen that his fasting Plasma glucose level was 11.4 mmol/L and readings above 7
mmol/L is the clear indication of diabetes. Glycosylated haemoglobin, also called glycated
haemoglobin, is formed when the haemoglobin join glucose in the blood. It is considered that
people having more than 6% HbA1C are diabetic. Here in case of Mr. Chase, he had 9% HbA1C
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which indicated he is suffering from diabetes mellitus type 2. The cholesterol level were found
to be quite high this indicate the problem of obesity.
All the vital tests taken were normal except the Blood pressure which was found to be
145/90 that indicated the hypertension stage I problems. Mr. Chase was having the problem
related to frequent need to go in toilet to urinate and he was also feeling dizzy. His weight keep
on increasing and result in overweight. These symptoms were similar to the symptoms of
Diabetes mellitus type 2 which includes: increase in hunger, frequent urination, blurred vision
and dizziness.
2.
There are many factors that effect the physical, mental and social well-being of diabetic
patients (Inzucchi and et.al., 2012). These factors can have both positive and negative impact on
the patients. Management of diabetes require the strict self care procedures like blood glucose
testing, proper diet, medicines and adequate exercises. This create a stress over patients
regarding their health and affect the interpersonal relationships. This is the major factor that
effect the social well being of patients. Peers support plays a major role in aspects of self care
and non supportive behaviour of family can worse the blood glucose level.
Many factors hinder the mental well-being of diabetes related patients that as a result
arises worries and create the emotional burdens over patients (Meier, 2012). These factors
include: distress regarding the complication of diabetes, feeling of guilt and anxiousness when
the management of diabetes is sub optimal, get stressed up regarding the type of food and eating
and a feeling of worry regarding the hypoglycaemia. In case of Mr. Chase stress also play a
major role that effect the mental wellness, because release of stress hormone have direct impact
on blood glucose level.
Factors that affect the physical well-being of patients is chronic distress related to
diabetes related complications. There are many diabetic complication that Mr. Chase was facing
from past few days. He was feeling dizzy and was bothered by the need to go to toilet at night to
urinate. His weight was increasing noticeably because of his eating and drinking habits resulting
in over weight complications. Obesity is the key factor that further complicates the state of
diabetes by resisting the effect of insulin of glucose (Singh and et.al., 2013).
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3.
In the instance of diabetes it is necessary to build health goals to self manage the chronic
conditions. These goals can be built on the basis of SMART goals in which: S stands for
specific, M stands for measurable and meaningful; A stand for, achievable; R stands for,
relevant, result oriented, and at last T stands for time based and trackable (Wilding and et.al.,
2012).
Three main goals that Mr. Chase could peruse to self-manage his condition are:
a) To reduce 5% body weight within a tenure of 1 month with the guidance of trainer.
b) To undertake 30 minutes of physical activity on a daily basis for 3 months.
c) To consume breakfast containing only 40-45 gram of carbohydrates for the next three weeks.
According to the first goal there is need to decrease the body weight by 5% i.e. 4 kg in a
month. In this trainer can help in decreasing the weight by providing training for performing
cardio activities. It also includes the appropriate intake of water and diet mentioned by trainer in
order to achieve the targeted goal. Mr. Chase can reduce the blood pressure by including the dash
diet that contain the food high in potassium, calcium and magnesium content that lower down the
elevated blood pressure. Also, eating food with low sodium along with reducing the weight can
help efficiently in reducing the blood pressure along with blood glucose level (Brethauer and
et.al., 2013).
Second goal is to do exercise for 30 minutes on the daily basis. It includes the yoga
exercises, jogging, walking, playing sports like tennis and bicycling. By preparing the plan chart
we can perform all the mentioned activities on the daily basis to reduce the effect of increasing
the blood pressure on the body. Mr. Chase can reduce the risk of hypertension by performing the
yoga exercises and can balance the level of blood pressure. He should devote his more time on
taking walk and jogging thus in turn reduce the blood pressure and help in maintaining the
cholesterol.
Third goal is regarding the proper intake of carbohydrate which is the major source of
glucose that increase the blood glucose level in body. So it is important to consume only 40-45
gram of carbohydrate in breakfast (Olokoba, Obateru and Olokoba, 2012). It may include 30
grams of oatmeal, half banana having 15 grams of carbohydrate, boiled egg and black coffee. To
achieve this target of 40-45 grams Mr. Chase should also include proteins and fats in addition to
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carbohydrate in the meal. This goal will be focused for 3 weeks and will help in maintaining the
blood glucose levels in the body.
4.
Each of the above mentioned goals have their main component of self management to
control the chronic conditions to gain the best quality of life. On the basis of first goal by
decreasing the weight Mr. Chase can feel more energetic. By decreasing the weight sugar comes
in right balance in our body which also help to decrease the anxiousness regarding the risk of
increasing blood sugar level (Liu and et.al., 2013). Reduction in weight also has its positive
effects over cardiovascular factor and metabolism control. It is recommended to Mr. Chase to
take care of his diet and indulge more in physical activities in order to reduce weight. Thus, it
will help Mr. Chase to live a healthy lifestyle and can restore the body health to the normal
conditions.
By performing the exercise on daily basis Mr. Chase can avoid the development of
hypertension stage II. The main component of this self-management support is performing the
exercises like yoga, doing cycling, jogging, running, swimming can help in reducing the blood
glucose level, blood pressure and cholesterol from the body (Arterburn and et.al., 2013).
Duration of exercise plays the major role in reduction of blood glucose level from the body.
During the initial time while performing exercise the glycogen provide energy to the body.
Following this, the glycogen support in finished muscles increases the use of blood glucose. The
long duration physical exercise also help in enhancing the insulin action after the reduction of
blood glucose from the body (Steinsbekk, Rygg, Lisulo, Rise and Fretheim, 2012). It is
recommended to Mr. Chase to start walking and jogging as it will help him to reduce the blood
glucose along with reduction in fasting plasma glucose. This will further help him by reducing
the stress and hence improve his life style.
Major reason for taking only 40-45 grams of carbohydrate in breakfast is to reduce the
level of sugar. Carbohydrate is the main component that result in the formation of sugar as a
result it increases the blood glucose level (Copeland and et.al., 2013). Main reason for Mr. Chase
to take particular amount of carbohydrates in breakfast is that the glucose produced in body by
intake of carbohydrates can be completely utilized while performing various activities in whole
day. Thus, it will help in maintain the proper amount of blood glucose level in body and reduce
the factors that affect the physical well-being of Mr. Chase.
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5.
Nurses support patients by paying attention to their diet and encouraging the exercise to
reduce the body weight. Main reason behind this is to maintain the normoglycaemia, improving
the nutrition and reducing the cardiovascular risks to further reduce further complication in
diabetic patients (Kaczmarczyk, Miller and Freund, 2012).
Nurse plays an important role in providing good care and promoting the approach of self-
care management among the patients. There are some nurses who completely work in the
diabetic care department and are employed at variety of care settings. Nurses plays the role of
first person who come in contact with diabetic patients and refer them to particular specialist on
the basis of their problems. They also play major role in proving the training, education and
support to all non professional nurses general practitioners and nurse in primary, secondary and
community care homes. Thus, they help non trained members of team and prepare them for
delivering the highly effective care thereby improving the outcome of patients (Bhatt, Thomas
and Nanjan, 2012).
Nurses along with general practitioner works with patients for encouraging them to
maintain the level of blood pressure, blood glucose, cholesterol and microalbium by using
different types of therapies (Patil and et.al., 2012). They also work with diabetic patients and
dieticians to prepare the suitable diet chart for patients that include the meal planning and
exercises to promote good lifestyle. Practice nurses and general practitioners prepare a schedule
for timely screening of patient having high complications. Nurses also support and encourage the
patients' participation in the weekly organised self management class related to diabetes.
Nurses also support the importance of patients as a decision maker for their own care
along with guidance of healthcare professionals. They also perform the routine vital test of
cholesterol, blood pressure, Glycosylated haemoglobin, pulse rate, respiration rate along with
urine and blood glucose monitoring confirm the status of disease. Nurses also take guidance
from senior nurses and practitioners for proper identification of hyperglycaemia and
hypoglycaemia and their treatment (Bode, Stenlöf, Sullivan, Fung and Usiskin, 2013). Nurses
also provide patients with all the information regarding tools and methods to successfully
manage the diabetes when they are at home. Major goal of entire multidisciplinary team is for
patients to achieve their target and not the perfection.
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REFERENCES
Arterburn, D. E., & et.al. (2013). A multisite study of long-term remission and relapse of type 2
diabetes mellitus following gastric bypass. Obesity surgery, 23(1), 93-102.
Bhatt, J. K., Thomas, S., & Nanjan, M. J. (2012). Resveratrol supplementation improves
glycemic control in type 2 diabetes mellitus. Nutrition research, 32(7), 537-541.
Bode, B., Stenlöf, K., Sullivan, D., Fung, A., & Usiskin, K. (2013). Efficacy and safety of
canagliflozin treatment in older subjects with type 2 diabetes mellitus: a randomized
trial. Hospital practice, 41(2), 72-84.
Brethauer, S. A., & et.al. (2013). Can diabetes be surgically cured?: Long-term metabolic effects
of bariatric surgery in obese patients with type 2 diabetes mellitus. Annals of surgery,
258(4), 628.
Chen, L., Magliano, D. J., & Zimmet, P. Z. (2012). The worldwide epidemiology of type 2
diabetes mellitus—present and future perspectives. Nature Reviews Endocrinology,
8(4), 228-236.
Copeland, K. C., & et.al. (2013). Management of newly diagnosed type 2 diabetes mellitus
(T2DM) in children and adolescents. Pediatrics, 131(2), 364-382.
Inzucchi, S. E., & et.al. (2012). Management of hyperglycaemia in type 2 diabetes: a patient-
centered approach. Position statement of the American Diabetes Association (ADA)
and the European Association for the Study of Diabetes (EASD). Diabetologia, 55(6),
1577-1596.
Kaczmarczyk, M. M., Miller, M. J., & Freund, G. G. (2012). The health benefits of dietary fiber:
beyond the usual suspects of type 2 diabetes mellitus, cardiovascular disease and colon
cancer. Metabolism, 61(8), 1058-1066.
Liu, J. J., & et.al. (2013). Lower circulating irisin is associated with type 2 diabetes mellitus.
Journal of Diabetes and its Complications, 27(4), 365-369.
Meier, J. J. (2012). GLP-1 receptor agonists for individualized treatment of type 2 diabetes
mellitus. Nature Reviews Endocrinology, 8(12), 728-742.
Olokoba, A. B., Obateru, O. A., & Olokoba, L. B. (2012). Type 2 diabetes mellitus: a review of
current trends. Oman medical journal, 27(4), 269.
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Patil, H. R., & et.al. (2012). Meta-analysis of effect of dipeptidyl peptidase-4 inhibitors on
cardiovascular risk in type 2 diabetes mellitus. The American journal of cardiology,
110(6), 826-833.
Scirica, B. M., & et.al. (2013). Saxagliptin and cardiovascular outcomes in patients with type 2
diabetes mellitus. New England Journal of Medicine, 369(14), 1317-1326.
Singh, S., & et.al. (2013). Glucagonlike peptide 1–based therapies and risk of hospitalization for
acute pancreatitis in type 2 diabetes mellitus: a population-based matched case-control
study. JAMA internal medicine, 173(7), 534-539.
Steinsbekk, A., Rygg, L., Lisulo, M., Rise, M. B., & Fretheim, A. (2012). Group based diabetes
self-management education compared to routine treatment for people with type 2
diabetes mellitus. A systematic review with meta-analysis. BMC health services
research, 12(1), 213.
Stenlöf, K., & et.al. (2013). Efficacy and safety of canagliflozin monotherapy in subjects with
type 2 diabetes mellitus inadequately controlled with diet and exercise. Diabetes,
Obesity and Metabolism, 15(4), 372-382.
Wilding, J. P., & et.al. (2012). Long-term efficacy of dapagliflozin in patients with type 2
diabetes mellitus receiving high doses of insulina randomized trial. Annals of internal
medicine, 156(6), 405-415.
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