Diabetes mellitus Type 2

1. Running Head: DIABETES MELLITUS Type 2 1
Diabetes Mellitus (Type 2)
Maribel Espinosa
Aileen Macuroy
Dave Manriquez
Vancouver Community College
Author Note:
This paper was prepared for Variation of Health taught by Lennox Griffith.

2. DIABETES MELLITUS 2
Introduction
Diabetes Mellitus. A heterogeneous group of disorders characterized by an elevation in the
level of glucose in the blood. In diabetes there may be a decrease in the body’s ability to respond
to insulin and or a decrease or absence of insulin produced by the pancreas. The resulting
hyperglycemia may lead to acute metabolic complications such as diabetic ketoacidosis and
hyperosmolar nonketotic syndrome. Long term hyperglycemia may contribute to chronic
microvascular complications, neuropathic complications and macrovascular diseases. A person is
diabetic if he urinate frequently, experience excessive thirst and experiencing sudden weight
loss. If casual blood sugar level is higher than 11 mmol/L, and if the fasting plasma glucose level
is more than 7 mmol/L. People who are children of diabetic parents, obese, hypertensive, has
high cholesterol level, and living in a sedentary lifestyle have higher risk of becoming diabetic.
Diabetes is the third leading cause of death by disease, mostly because of the high rate of
coronary artery disease among people with diabetes. Diabetes is the leading cause of new
blindness (among 25 to 74 years old) and non-traumatic amputations. 25% of patients on dialysis
have diabetes. Hispanics, Asians, African descents, and Aboriginal populations have a higher
rate of diabetes than the white populations. In Canada, about 1 in 16 Canadians (6.2%) are living
with diabetes and an additional 0.9% of the population (nearly 300,000) is estimated to be
undiagnosed (Barry, Goldsworthy, Goodridge, 2014).
DM Type 2. About 90% to 95% of people with diabetes. The most common form of
diabetes. Nearing epidemic proportions, due to increase number of older people, greater
occurrence of obesity and sedentary lifestyle. Cause by a decrease in the sensitivity of the cells to
insulin and the decrease in the amount of insulin produced. It can be treated with diet, oral

3. DIABETES MELLITUS 3
hypoglycemic agents and insulin injections. It occurs most frequently in people who are over 30
years of age (Barry, Goldsworthy, Goodridge, 2014).
Pathophysiology
In type 2 Diabetes Mellitus, the pancreas can still produce endogenous insulin. However,
due to various risk factors such as obesity, Hereditary, Ethnic Group, History of Gestational
Diabetes; the body’s metabolism was affected. Four major metabolic abnormalities have a role in
the development of DM 2. The first one is insulin resistance where the body tissue does not respond
to the action of insulin. Next, the pancreas decreases its ability to produce insulin, as the B-cells
becomes fatigue from the compensatory overproduction of insulin. In addition, the liver
inappropriately produces glucose even when the body doesn’t need it. Lastly, the production of
hormones and cytokines is being altered. All these metabolic abnormalities may result to increase
in blood sugar lever (hyperglycemia), thus DM type 2 is developed (Barry, Goldsworthy,
Goodridge, 2014).
Nursing Management of the Disease
Sign and Symptoms of Hyperglycemia
 Blood glucose level greater than 7 mmol/L
 Blurry Vision
 Difficulty concentrating
 Frequent urination
 Headache
 High blood glucose
 High levels of sugar in the urine
 Increase fatigue

4. DIABETES MELLITUS 4
 Nursing Intervention/Management
 Weigh the body weight per day or according to the indication.
 Determine the diet and eating patterns of patients and compare it with foods that can be
spent on patients.
 Auscultation bowel sounds, record the existence of abdominal pain / abdominal bloating,
nausea, vomit that has not had time to digest food, maintain a state of fasting according to
the indication.
 Give the liquid diet containing foods (nutrients) and the electrolyte immediately if the
patient has to tolerate it orally.
 Involve the patient's family at this meal digestion according to the indication.
 Observation of the signs of hypoglycemia, such as changes in level of consciousness,
skin moist / cold, rapid pulse, hunger, sensitive to stimuli, anxiety, headaches.
 Collaboration examination of blood sugar.
 Collaboration of insulin treatment.
 Collaboration with dietitians
Health Teachings
 Assessing learning needs
 Assessing physical, cognitive, and emotional limitations
 Counseling
 Psychosocial preparation
 Home care management

5. DIABETES MELLITUS 5
 Health care resources
 Complementary and alternative therapies
Expected Outcomes
 Patient verbalizes key elements of the therapeutic regimen, including knowledge of
disease and treatment plan.
 Describes self-care measures that may prevent or decrease progression of chronic
complications.
 Maintains a balance of nutrition, activity, and insulin availability that results in normal
blood glucose levels and optimum weight.
Nursing Diagnosis: Risk for injury related to sensory alterations.
Interventions and foot care practices:
 Cleanse and inspect the feet daily.
 Wear properly fitting shoes.
 Avoid walking barefoot.
 Trim toenails properly.
 Report non-healing breaks in the skin.
Non-Pharmacologic Interventions
Prevention of diabetes is crucial to lowering disease incidence, and thus minimizing the
individual, familial, and public health burden. Unhealthy diet and lifestyle can impose an
additional burden on good glycemic control in diabetes patients. Diets rich in whole-grain, cereal

6. DIABETES MELLITUS 6
high fiber products, and non-oil-seed pulses are beneficial. Whereas, frequent meat consumption
has been shown to increase risk. Regarding non-alcoholic beverages, 4 cups/day of filtered
coffee or tea are associated with a reduced diabetes risk. In contrast, the consumption of
alcoholic beverages should not exceed 1-3 drinks/day. Intake of vitamin E, carotenoids, and
magnesium can be increased to counteract diabetes risk. Obesity is the most important factor
accounting for more than half of new diabetes' cases; even modest weight loss has a favorable
effect in preventing the appearance of diabetes. Also, physical exercise with or without diet
contributes to a healthier lifestyle, and is important for lowering risk. Finally, there is a positive
association between smoking and risk to develop type 2 diabetes. As far as secondary and
tertiary prevention is concerned, for persons already diagnosed with diabetes, there is limited
evidence of the effectiveness of diet or lifestyle modification on glycemic control, but further
studies are necessary (Psaltopoulou et al., 2010).
The role of the nurse in health promotion and maintenance relates to the identification,
the monitoring, and the education of the patient at risk for the development of DM. Obesity is the
number one predictor of type 2 DM. The diabetes prevention program found that a modest weigh
loss of 5% to 10% of body weight and regular exercise of 30 minutes five times a week lowered
the risk of developing type 2 DM up to 58%. It is recommended that screening of every 3 years
in individuals 40 years of age or older with no risk factors and more frequently in individuals
younger the 40 years with risk factors should be done. Both emotional and physical stress can
increase blood glucose level and result to in hyperglycemia. Because it is impossible to totally
avoid stress in life, certain situation may require more intense management. The potential for
microvascular complications and infections necessitates diligent skin and dental hygiene
practices on the part of the patient. Because of the susceptibility to periodontal disease, daily

7. DIABETES MELLITUS 7
brushing and flossing should be encouraged in addition to regular visits to the dentist. Routine
care should include an emphasis on foot care, including daily assessment of feet. If cuts, scrapes,
or burns occur, they should be washed, and a nonabrasive or nonirritating antiseptic ointment
may be applied. The area should be covered with a dry, sterile pad. If the injury does not begin to
heal within 24 hours, or no signs of infection develop, the health care provider should be notified
immediately. Providing patient and caregiver teaching is essential in the care of diabetes. The
patient should be involved in the decision making regarding care (Barry, Goldsworthy,
Goodridge, 2014).
Cultural Diversity and Traditional Healing Practices
It is very important that patients with diabetes consult with their health care provider before
using herbs or nutritional supplements. Patients who use herbs should monitor their blood
glucose levels carefully and regularly. The Canadian Diabetes Association does not recommend
the use of complementary and alternative medicine for the management of diabetes as there is
insufficient evidence regarding its safety and efficacy. Possible hypoglycemic herbs and
supplements are: aloe, fish oils, goldenseal, bilberry eleuthero, ginseng, milk thistle, Chinese
cinnamon and sage. While, possible hyperglycemic herbs and supplements are: St. John’s wort,
celery seeds, rosemary, and melatonin (Barry, Goldsworthy, Goodridge, 2014). Immigrants to a
new country face many challenges when diagnosed with type 2 diabetes, a chronic disease with a
complex treatment involving both medical and behavioral interventions. These challenges will
depend upon the extent to which the patient has adapted to the new country’s social and cultural
norms, as well as individual factors such as age, education, and gender. This adaptation is termed
acculturation. With respect to nutritional interventions for type 2 diabetes, uptake and adherence
over the long term will depend upon overall health literacy, the cultural acceptability of the

8. DIABETES MELLITUS 8
recommended diet. Changes in health status following immigration have been noted, with health
advantages disappearing over time and increasing prevalence of obesity and associated metabolic
diseases such as type 2 diabetes; this change over time is known as the “healthy immigrant
effect.” This suggests that adaptation to the new environment and culture is a risk factor for
diabetes. Immigrants may also face obstacles to optimized treatment of complex chronic diseases
due to many factors; lack of optimization of interventions based on culture may be a major
barrier. The need to recognize cultural diversity in diabetes treatment is recognized by the
International Diabetes Federation and countries with large immigrant populations and multi-
cultural societies. When optimizing dietary patterns in order to treat disease, the food culture of
the society and the individual should be considered in order to maximize the acceptability of the
treatment. Choosing unfamiliar foods from a different ethnic heritage might make dietary
adherence to diabetes guidelines more complicated and could contribute to low adherence rates,
while acceptability of a recommended diet could increase adherence. Therefore, understanding
the personal and cultural barriers that are associated with dietary adherence faced by people with
diabetes could contribute to a future intervention program (Deng, et al., 2013).

9. DIABETES MELLITUS 9
Bibliography
Psaltopoulou, T., Ilias, I., Alevizaki, M. (2010). The role of diet and lifestyle in primary,
secondary, and tertiary diabetes prevention: A review of meta-analysis. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923378/
Deng, F., Zhang, A., Chan, C. (2013). Acculturation, Dietary Acceptability, and Diabetes
Management among Chinese in North America. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753561/
Barry, M., Goldsworthy, S., Goodridge, D. (2014). Medical-Surgical Nursing in Canada:
Assessment and management of clinical problems. Third Canadian Edition. p. 1429-1432, 1448,
1453-1454.
Nanda Nursing Intervention. (2009). Nursing Intervention for Diabetes. Retrieved from
http://nanda-nursinginterventions.blogspot.ca/2011/05/nursing-intervention-for-diabetes.html