Pathophysiology
Glucose is the main energy source for the cells of the body, and levels in the blood are usually kept stable by the regulatory actions of hormones, primarily insulin, which triggers the movement of glucose from the blood stream into the cells, thus lowering blood glucose levels, while another hormone, glucagon, stimulates the release of glucose from the liver in order to raise blood glucose levels (Bannister 2016). A major cause of Type 2 diabetes is insulin resistance; a reduced response of tissues to the action of insulin, which is further exacerbated by obesity, and a lack of physical activity. When insulin resistance first develops, the body compensates by producing extra insulin. However, as the disease progresses, the pancreas is unable to maintain this, and insulin secretion also becomes impaired, leading to a further deterioration in blood glucose levels. There may also be an increased level of glucagon in patients with Type 2 diabetes, resulting in excess glucose being produced by the liver, and resistant hyperglycaemia (Lippincot Williams & Wilkins 2010; Brashers, Jones & Heuther 2015).
Signs and symptoms
The signs, and symptoms, of Type 2 diabetes are directly related to hyperglycaemia. Increased thirst, and polyuria, occur when the kidneys are unable to reabsorb the excess glucose, altering the osmotic pressure in the tubules, and leading to excess urine production. To counter dehydration, the body stimulates thirst (Ashalatha & Deepa 2011; Bannister 2016). The altered metabolism of glucose, fats, and protein, leads to poor use of ingested food, which results in lethargy, and fatigue. Symptoms such as poor wound healing, and recurrent infections, occur due to the high glucose levels in the body stimulating the growth of microorganisms, and impairing blood supply. Genital itching, and thrush, are caused by glucose being present in the urine, which encourages fungal growth (Brashers, Jones & Heuther 2015).The Nursing Management of Type 2 Diabetes Mellitus Essay
The nurse’s role in the management of Type 2 diabetes
Type 2 diabetes is a complex condition, for which most of the management is done by the patient themselves (Yu, et al. 2014). Self-management behaviours, such as eating a healthy diet, taking regular exercise, self-monitoring blood glucose levels, and taking prescribed medications, are all associated with good glycaemic control, and so should be encouraged (Houle, et al. 2015). Traditionally diabetes care has been prescriptive, and check-list driven, but promoting self-management requires a more co-operative, shared approach, where the patient has an active role in their care, and their autonomy and personal preferences are recognised (den Ouden 2015). This is also in line with the Nursing and Midwifery Council (2015), who state that the nurse should act in partnership with the patient, and encourage, and empower people to share decisions about their care, and treatment. However, this approach works best when both the nurse, and the patient, wish to embrace empowerment, and it may require a change in practice from the nurse, towards a more communicative approach, where the entire focus is on the patient’s needs. The nurse should take a holistic approach, recognising the barriers the patient may have to self-management, and seek to address these (Bostrom 2014).The Nursing Management of Type 2 Diabetes Mellitus Essay
Dietary advice
NICE (2015) advise that providing dietary advice for patients with Type 2 diabetes should be an integral part of their care, and that each patient should receive individual, ongoing, support with their nutritional needs. Although, ideally, every patient should see a dietician, services are often limited, and so the main responsibility for providing dietary advice usually falls on the nurse, particularly practice nurses (Parry Strong 2013).
The nurse must ensure a patient-centred approach is taken, and that consideration is given to the patient’s age, social situation, culture, beliefs, eating patterns, and any comorbidities that may have an impact on their diet. However, it has been noted that nurses may be less confident in providing dietary advice for patients whose culture differs to their own. This can be overcome by assessing the patient’s current diet, and determining their individual eating habits, to avoid stereotyping, and making assumptions about diet based on culture (Parry Strong 2013; NMC 2015). The patient’s willingness to change should also be considered, and the nurse should identify the challenges, and barriers to change, that the patient may have, and assist them with techniques to overcome these (Robertson 2012; NICE 2015).The Nursing Management of Type 2 Diabetes Mellitus Essay
As obesity is a major risk factor for Type 2 diabetes, the focus of much of the dietary advice will be weight loss, which can lead to improve