Causes, Symptoms, and Treatment for Type 2 Diabetes Mellitus
Type 2 Diabetes Mellitus results due to the body resistance to insulin or when there is less production of insulin by the pancreas due to the defects in the beta cells which disrupts the normal glucose homeostasis. These defects in the beta cells may be due to bad communication between the beta cells and broken beta cells. Enough insulin may be produced but the body cells may have reduced sensitivity to insulin. Insulin resistance, deficiency and glucose toxicity leads to the development of T2DM (Nowotny, Jung, Höhn, Weber & Grune, 2015). This is because the sugar levels builds up in the bloodstream since the cells are unable to take it hence leading to the development of the disorder (DeFronzo, 2015).
- Overweight – Being overweight like in Melanie’s case is the main risk for the disease. Fat makes cells to be resistant to insulin.
- Fat distribution – When the body stores fat in the abdomen, there is a greater risk for T2DM.
- Family history – The risk for T2DM rises if a sibling or a parent has type 2 diabetes. Melanie’s mother and her older sister were diagnosed with this illness.
- Age – The risk of this disorder increases with age particularly after the age of 45 years. The risk for Melanie is high since she is 63 years old.
- Prediabetes – This is a state in which the blood sugar is high but not high enough to be called diabetes. But when left unattended, it can develop to type 2 diabetes mellitus. This could be the case in our scenario since we are told that Melanie is not taking any specific medication for her diabetes (DeFronzo, 2015).
- Heart and blood vessel illnesses – T2DM increases the occurrence of cardiovascular diseases such as the coronary heart illness that is accompanied by angina, high blood pressure, stroke, heart attack and atherosclerosis.
- Alzheimer’s disease – Diabetes elevates the chance of the development of the Alzheimer’s disease and this is greater when the blood sugar control is very poor. However, there is no clear connection between these two conditions.
- Diabetic foot (Foot damage) – Diabetes causes nerve damage in the feet and also leads to poor blood flow to the feet which rises the risk of development of diabetic foot which is one of the main complications. If the diabetic foot is left untreated, blisters and even cuts can become infected and cause a serious problem due to poor healing and the damage may require the foot or leg being amputated (Zaccardi, Webb, Yates & Davies, 2015).
- Nerve damage (neuropathy) – Excessive sugar in the bloodstream can damage the nerve cells hence leading to the loss of feeling in the limbs that are affected. The damage that is cause in the nerve cells in the digestive system causes problems with constipation, diarrhea, nausea and vomiting. For the men, there is an additional problem of erectile dysfunction.
- Hearing Impairment – Type 2 diabetes leads to hearing problems in people with diabetes
- Kidney Impairment – Diabetes damages the most subtle sifting system in the kidneys which can result into kidney failure and permanent kidney illness that may require dialysis or even renal transplant (American Diabetes Association, 2014).
- Eye injury – This type of diabetes damages the blood vessels found in the retina hence causes diabetic retinopathy which leads to blindness. Diabetes also elevates the risk of numerous somber vision situations such as glaucoma and cataracts.
- Skin conditions – Type 2 diabetes mellitus makes one more liable to skin complications such as fungal and bacterial infections (DeFronzo, 2015).
The 3 Levels Of Treatment Options For Type 2 Diabetes Mellitus
There are three levels in which Diabetes medications target. Which include;
- Treatment of Insulin resistance – To ensure cells are sensitive to insulin.
- Insulin deficiency – To stimulate beta cells to produce insulin.
- Glucose toxicity – To encourage glucose uptake by cells to maintain glucose homeostasis.
1) T1DM is insulin-dependent while T2DM is insulin-independence.
2) T1DM has a juvenile onset while T2DM develops later in life that is its onset is in adulthood.
3) People with T1DM experience mood changes and irritability while individuals with T2DM have numbness and tingling in their feet and hands.
4) T1DM have a rapid onset while T2DM has a gradual onset and develops slowly over the course of time.
5) T2DM may not show any symptoms for a long period until complications occur while symptoms for T1DM are present from the beginning.
6) T1DM arises when the immune system destroys the beta cells that yield insulin hence the body not able to synthesis insulin while in T2DM the beta cells produce insulin but the body cannot use it effectively.
7) T1DM is treated with insulin injection while T2DM is treated without medication.
8) T1DM is usually not associated with excess body weight while T2DM is commonly associated with excess body weight (DeFronzo, 2015).
Melanie’s blood glucose levels were high up to 22.9mmol/L. It is important to ensure that the BGL are near to the normal range which is 4-6mmol/L so as to prevent any complications. There are two main reasons why Melanie’s blood glucose levels (BGL) is high on admission that include;
- a) Lack of diabetes medication – The fact that Melanie was not using any specific diabetes medication is one of the reasons for her high BGL. T2DM is caused by insulin resistance and insulin deficiency hence insulin injections for Melanie would have made the cells be able to take up glucose hence reducing glucose levels in the bloodstream. However, the lack of insulin injections makes the cells not be able to take up glucose hence the rise in the blood glucose levels (Park, Pagnini, Reece, Phillips & Langer, 2016).
- b) Poor diet and Lack of exercise – Weight loss that comes about as a result of healthy diet and proper physical activities ensures that the muscle cells are able to effectively use glucose and insulin more efficiently hence reducing diabetes risk. Exercises require additional energy hence glucose is used which leads to lowering of the amount of glucose in the bloodstream. Proper diet ensures that only the required amount of glucose is ingested hence there is no excess blood glucose. In the case of Melanie, poor diet and lack of exercise makes the muscle cells lose their sensitivity to the insulin produced hence leading to increased blood glucose levels seen. Therefore, for Melanie to ensure normal blood glucose levels, she should eat a balanced diet and increase her physical activity.
- c) Emotional stress – Melanie blood glucose levels are high due to stress as she keeps stressing herself why this woman who is heavy and eats a lot of cake does not have diabetes. The body produces a surge of hormones when one is stressed. Which causes the blood sugars to go up since they hinder glucose uptake by the cells (Roy & Reang, 2018).
The Three Medications Melanie Is On
Cortisone Injections (Kentacort-A 40)
The drug alters the gene in the body cells to reduce the normal inflammation of the body and immune responses (Katzung, Masters & Trevor, 2012).
Complications/ Side Effects
ü Pain in the joints
The Three Medications Melanie Is On
ü Formation of abscesses
ü Pain, redness and irritation in the site of injection
ü Decreased or increased skin pigment
ü Heartburn
ü Causes increased susceptibility to infections for example thrush
ü Bone fractures and osteoporosis
ü Causes weakness of muscles
ü It causes delayed healing of wounds
ü Leads to depression
ü Gastro-intestinal effects such as nausea, abdominal pain, diarrhea and increased appetite
ü Musculoskeletal effects such as myalgia and tendon rupture
ü Nervous system adverse effects such as dizziness, irritability, cognitive dysfunction and anxiety
The nurse should be careful in administering Cortisone Injections (Kentacort-A 40) to Melanie due to her advanced age since the metabolism capacity of the drug by her body is reduced. Therefore, titrations should be made on Kentacort-A 40 to ensure tailored drug administration to avoid toxicity. The nurse should determine how the medication is to be given to Melanie, the duration of treatment and actions that she should take in case of an overdose.
Metformin medication is under the biguanides medicines. The drug reduces blood sugar by enabling the body to effectively utilize the insulin that is synthesized by the pancreas. Metformin reduces the amount of glucose produced, decreases the intestinal glucose absorption and increases insulin sensitivity through increasing the peripheral glucose uptake and its use (Katzung, Masters & Trevor, 2012).
ü Gastrointestinal adverse effects such as nausea, heartburn, abdominal pain and diarrhea.
ü Lactic acidosis which presents as sleepiness, dizziness, difficulty in breathing, weaknesses and tiredness.
ü Hypoglycemia hence one experiences sweating, drowsiness, confusion, hunger, fast heart rate, weakness and headache.
Nursing Considerations
The nurse should determine other drugs that the Melanie is taking since Metformin interacts with many drugs, vitamins and herbs. This will reduce drug interaction hence less adverse effects.
Minidiab belongs to the sulphonylureas family. Minidiab has antidiabetic actions in the patients who have non-insulin-dependent DM. This drug lowers high blood glucose by raising the insulin synthesized by the pancreas. Glipizide stimulates the production of insulin by the body’s beta cells found in the pancreatic islets and is dependent on the functioning beta cells.
ü Nausea
ü Gastrointestinal effects such as constipation and diarrhea
ü Dermatologic effects; itching, redness and skin rash
ü Drowsiness and dizziness
ü Hunger
ü Feeling anxious and shaky
ü Endocrine reactions that cause hyponatremia (Katzung, Masters & Trevor, 2012).
While administering Glipizide to Melanie the nurse should consider safety, efficacy, development of resistance, the method of drug administration and the cost of Glipizide (Minidiab Tablets). The nurse should ensure that Melanie is not allergic to minidiab. Dose adjustments should be done to the drug before being administered to Melanie since due to her advanced age she has reduced renal and hepatic capacity. The nurse should offer instructions that Melanie should follow in case of minidiab overdose to avoid poisoning.
Cortisone Injections (Kentacort-A 40)
HbA1c is a haemoglobin measure that shows a three-month average glucose concentration in plasma and the normal is HbA1c:6%. Melanie high glycated haemoglobin of HbA1c: 11% on admission shows poor or no control of blood glucose levels associated with diabetes. After the surgery and use of diabetes medication glycated haemoglobin reduced to HbA1c: 8% which shows that the medication is working and that her diabetes is responding to the medication. BGL refers to the blood glucose levels and the normal range should be between 3.9 – 7.1 mmol/L. On admission, Melanie BGL is high (22.9mmol/L ) which reduced to 8.8mmol/L since the medication used increased insulin sensitivity when led to increasing uptake of glucose by the cells hence reducing the amount of glucose in the bloodstream. In general, the blood results before and after the surgery show improvement of Melanie diabetic condition due to the use of diabetes medication that has tried to correct the problem hence the glucose values are heading towards the normal mark. Proper use of these medications will ensure that both the BGL and HbA1c are corrected and that they fall under or close to the normal range (Tarvainen, Laitinen, Lipponen, Cornforth & Jelinek, 2014). Therefore, Melanie should be encouraged to use the diabetic medication properly to correct the situation.
The terms insulin dependent diabetes mellitus and non-insulin dependent DM are misleading since in both T1DM and T2DM, insulin deficiency or sensitivity is a common feature. T2DM results due to the body resistance to insulin or when there is less production of insulin by the pancreas due to the defects in the beta cells which disrupts the normal glucose homeostasis while T1DM is mostly due to lack of insulin. The terms mature/early onset are also misleading since T1DM can develop into T2DM hence these terms are not absolute. Therefore, due to the misleading nature of these terms, their use should be limited especially when explaining to the patient since they may confuse them.
Teach-back technique also referred to as show-me method is used by the healthcare professionals to teach patients or caretakers to help them understand the concept or issue being explained to them. If the patient or the caregiver understands the information being passed across can teach back or repeat the information accurately. This method improves health literacy (Tamura-Lis, 2013). I will use the teach back method to teach Melanie how to use the BGL by providing her the steps to follow. She will repeat the process to make sure she has gotten the right info and she understands.
Step By Step Use Of BGL Machine
- Step 1: Preparations– Set the date and time on the device and wash hands with warm water. Insert a new strip and the machine will turn on automatically.
- Step 2: Getting Test Results– Get a blood sample by use of the lancing machine that has a new lacent from the fingertip. Apply the drop of blood to the test strip when the blood droplet symbol appears on the meter window. Fill the channel in the strip completely with blood for accurate reading.
- Step 3: Reading The Results- The meter will count down and consequently display the results of the blood glucose level hence she will have used the BGL machine properly (Wood, O’neal, Furler & Ekinci, 2018).
References
American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes care, 37(Supplement 1), S81-S90.
DeFronzo, R. A., Ferrannini, E., Groop, L., Henry, R. R., Herman, W. H., Holst, J. J., … & Simonson, D. C. (2015). Type 2 diabetes mellitus. Nature reviews Disease primers, 1, 15019.
Katzung, B. G., Masters, S. B., & Trevor, A. J. (2012). Basic and Clinical Pharmacology (LANGE Basic Science). McGraw-Hill Education.
Nowotny, K., Jung, T., Höhn, A., Weber, D., & Grune, T. (2015). Advanced glycation end products and oxidative stress in type 2 diabetes mellitus. Biomolecules, 5(1), 194-222.
Park, C., Pagnini, F., Reece, A., Phillips, D., & Langer, E. (2016). Blood sugar level follows perceived time rather than actual time in people with type 2 diabetes. Proceedings of the National Academy of Sciences, 113(29), 8168-8170.
Roy, S., & Reang, T. (2018). Knowledge Of Diabetes Among Type 2 Diabetes Patients And Their Blood Glucose Level-A Cross-Sectional Study. Journal of Evolution of Medical and Dental Sciences, 7(5), 597-603.
Tamura-Lis, W. (2013). Teach-back for quality education and patient safety. Urologic Nursing, 33(6), 267.
Tarvainen, M. P., Laitinen, T. P., Lipponen, J. A., Cornforth, D. J., & Jelinek, H. F. (2014). Cardiac autonomic dysfunction in type 2 diabetes–effect of hyperglycemia and disease duration. Frontiers in endocrinology, 5, 130.
Wood, A., O’neal, D., Furler, J., & Ekinci, E. I. (2018). Continuous glucose monitoring: a review of the evidence, opportunities for future use and ongoing challenges. Internal medicine journal, 48(5), 499-508.
Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2015). Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective. Postgraduate medical journal, postgradmedj-2015.
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