As a complex and persistent healthcare challenge, type 2 diabetes mellitus presents complications associated with surgery-related procedures. There is a high risk of morbidity development post-surgery due to the adverse impact of the condition on the overall health. Therefore, researchers have dedicated their focus on exploring the range of interventions that could help healthcare providers get the chronic condition under control when carrying out surgical procedures.
Maintaining the health of patients with diabetes is complicated and takes consistent and close monitoring associated with surgery. Therefore, it is especially important to determine the procedures that could facilitate effective management and maintenance. The aim of this literature review is to explore four sources on the topic of type 2 diabetes management in surgery patients to identify best practices and determine gaps that should be addressed in the future.
Search Methods for the Review
To collect resources for the review, the search of medical databases such as EBSCO and Medscape was conducted. In addition, Google Scholar was used to finding digital sources that would be relevant to the current problem. The keyword search included the following terms: operative diabetes management, type 2 diabetes perioperative management, diabetes operative interventions, surgical interventions for diabetic patients, surgery in diabetic patients.
To enhance the search, the truncation method was used. It implies the technique associated with entering the root of a word with different endings that would expand the search results. The search for literature was not confined to the time period during which the studies were published to include a diversity of findings and perspectives.
Literature Review of the Articles
The study by Hirsch, McGill, Cryer, and White (1991) aimed to discuss the implementation of pharmacological therapy methods for the management of type 2 diabetes in patients before operative interventions. The population (P) involved diabetic patients who would be subjected to pharmacological therapy (I) compared to no intervention (C) to reach successful outcomes (O) in operative care.
The article is significant to the current research problem as the researchers concluded that the assessment of metabolic processes in diabetic patients was imperative for adjusting in the management of the condition. With the help of consistent management, it is possible to maintain the health of diabetic patients when implementing surgical interventions. The study presents a background for further research about the interventions in the perioperative management of diabetic patients.
The article by Marks (2003) aimed to explore the use of insulin and potassium in diabetic patients undergoing surgery. The population (P) included diabetic patients who would be subjected to the use of insulin intravenously, frequent glucose checks, and adding potassium (I) compared to no intervention (C) to reach successful outcomes (O) in operative care.
The article is significant to the current research problem because the scholars concluded that the suggested interventions should be adjusted to the needs and health status of each patient and adjusting the interventions accordingly. The research by Marks (2003) contributes to the body of literature on interventions for diabetic patients undergoing surgery as it mentions specific interventions that could be implemented for the effective management of diabetes.
The research by Mazer et al. (2020) is among the recent ones, studying the impact of using sodium-glucose cotransporter 2 inhibitors (SGLT2) on diabetic patients in outpatient surgeries. The population (P) included diabetic patients who would be prescribed SGLT2 (I) compared to no intervention (C) to maintain positive outcomes (O) during surgery.
The study is important because it is current and includes evidence for using a particular medication that would address the healthcare challenges associated with type 2 diabetes. The scholars also mention that clinicians would have to use sound judgment when using SGLT2, which points to the need for adequate training of personnel prior to the administration of the medication.
The article by Pasquel (2020) aimed to explore the effectiveness of using Glargine U300 and Glargine U100 for the inpatient management of type 2 diabetes among patients undergoing surgery. The target population included patients diagnosed with type 2 diabetes (P) being prescribed Glargine U300 and Glargine U100 (I) to compare the outcomes of either prescription (C) to facilitate the inpatient management of medicine and surgery (O).
Similar to the research by Mazer et al. (2020), the study by Pasquel (2020) provides reliable evidence for using medication-based control in the management of diabetes among surgical patients. It was found that both U300 and U100 positively contributed to the lower hypoglycemia of diabetic patients undergoing surgery.
Conclusion of the Review
The four studies reviewed in this paper discussed methods intended to manage type 2 diabetes in patients undergoing operative interventions. While the implementation of any intervention depends on the health status and the needs of each patient, the research showed that both prescription medication and maintenance measures could be effective for ensuring the overall well-being of the target population. Further research is needed because type 2 diabetes is a persistent problem that has not been resolved yet, and studying the ways in which the health patients undergoing surgery could be managed.
References
Hirsch, I., McGill, J., Cryer, P., & White, P. (1991). Perioperative management of surgical patients with diabetes mellitus. Anesthesiology, 74, 346-359.
Marks, J. B. (2003). Perioperative management of diabetes. American Family Physician, 67(1), 93-100.
Mazer, C. D., Arnaout, A., Connelly, K. A., Gilbert, J. D., Glazer, S. A., Verma, S., & Goldenberg, R. M. (2020). Sodium-glucose cotransporter 2 inhibitors and type 2 diabetes. Current Opinion in Cardiology, 35(2), 178-186.
Pasquel, F. J. (2020). A randomized controlled trial comparing glargine U300 and glargine u100 for the inpatient management of medicine and surgery patients with type 2 diabetes: Glargine U300 hospital trial. Diabetes Care, 43(6), 1242-1248.
The World Health Organization recently reported that about eight percent of American adults suffer from type II diabetes. Type II diabetes is a condition where the body is unable to produce enough insulin, making the blood glucose level increase. According to McFarlane (2010), medical researchers are yet to come up with a proper cure for diabetes. This means that the condition can only be controlled instead of being cured to delay a possible death of the patient. Recent studies show that there is a consistent surge in the number of people who suffer from this disease (Williams, 2003). Medical doctors have blamed the rise on the emerging lifestyle in the current society. Technology has transformed the world, and most of the physical activities that were previously done manually can now be done using machines. The improved technology has also enhanced the means of transport. The result of this improved world of technology has reduced the physical activity of many people. Limited physical activity is known to be one of the most common causes of type II diabetes. It is necessary to come up with intervention measures to help counter this problem. This research seeks to determine if lifestyle interventions may have a significant impact on diabetes to curb the rising incidences.
Opening Statement
Type II diabetes is one of the leading causes of death in the United States. According to the Center for Disease Control and Intervention, the United States has registered an increase in the number of new incidents over the past five years. This trend is very worrying. It is, therefore, necessary to find measures that can be used to address this problem. A change of lifestyle is one of the measures that many medical researchers have proposed. In this study, the researcher seeks to determine if it is possible to change the negative trend if the target population can engage in more physical activities. It will also be necessary to determine if a change in diet can help in protecting the target population from contracting the disease.
Background of the Study
According to World Health Organization (WHO), over 8% of Americans have type II diabetes. This percentage only presents what has been recorded officially in all the medical centers within the country. Center for Disease Control and Prevention (CDC) estimated that another 2% of Americans suffer from diabetes (Vora & Buse, 2012). However, they are yet to go for diagnosis either because the disease is still at its early stages or because of their ignorance. This means that 1 out of every 10 Americans suffer from diabetes. The report from these two leading health organizations is worrying. The fact that new cases are still being reported at very high rates is an indication that more needs to be done to arrest the situation. All the stakeholders including the doctors, the government, non-governmental bodies, and the public need to find a common way of addressing this problem in the best way possible. One of the ways that have been proposed by the recent scholars is a change in lifestyle. This basically involves engaging more in physical activities and maintaining healthy diets. This approach is simply and less costly. In fact it may help people to cut down on their budgets if they consider applying it. Failure to take this intervention may lead to increased cases of diabetes. This may put the lives of more Americans in danger.
Problem Statement
This study is intended to determine how a change in lifestyle may lead to reduced cases of type II diabetes in the society. However, it is important to note that the research may be affected by a number of issues that needs to be controlled in order to achieve the expected outcome. One of the main hindrances in this study is the issue of time. The time available for this study is very short, and this means that the researcher will be forced to find a way of balancing all the activities within the short deadline. Another problem is the unwillingness of some of the participants to respond to the study questions. Many leading health organizations and research centers have rich sources of information about this disease. However, it will be necessary for the researcher to go to the field and collect raw data from the respondents in order to support or even challenge existing information. When the participants are unwilling to respond to the questions about their conditions, then it may not be easy gathering the relevant data.
Purpose of the Study
As mentioned above, there has been extensive research about type II diabetes. The intensity of this disease and the recent reports indicating a rise in new cases has left many members of the society worried. In this particular study, the researcher is seeking to be part of a solution to this existing problem. The researcher intended to gather secondary sources of information and identify possible gaps that exist. The researcher will make an effort to address this gap by conducting primary research in order to enhance existing knowledge on how to deal with the problem. The main purpose of this study is to determine the relevance of change in lifestyle as a way of fighting type II diabetes. Change of lifestyle in this case involves engaging in more physical activities and eating healthy. Some of the recent studies have strongly supported this approach as a way of keeping safe from contracting the disease. In this study, the researcher also intends to find out why people are yet to embrace this approach of dealing with diabetes even though they have the right knowledge. Healthy diets and regular physical exercise is known to be one of the best ways of fighting so many diseases besides diabetes, such as coronary problems. However, many Americans are still very physically inactive. It would be necessary to find an explanation for this. With this in mind, the researcher will try to find possible ways that can make more people to become physically active. This study will benefit the public in confronting this disease by proposing simple and actionable ways that can be applied by everyone in order to have a positive change of lifestyle.
Research Questions, Hypotheses, and Variables
According to Chawla (2014), conducting a research is a very vigorous and complex process that needs proper guidance. This scholar notes that in many cases, some researchers have swayed off from the main topic area to other unrelated issues because they lacked proper guidance. Research questions offer this guidance. When a researcher gets to the field to collect data, many unrelated but very interesting stories may be encountered. Collecting such irrelevant data may not only waste the time needed to conduct the research, but also affects the quality of the report. Research question acts as a compass that a researcher uses to collect relevant primary and secondary sources of data. Any information that does not respond to the question is always considered irrelevant. In this study, the following are some of the questions that will be used.
What is the impact of physical exercise in fighting off type II diabetes?
What is the impact of improved diet in fighting off type II diabetes?
Why do many people ignore the call to change their lifestyle even though they know it may affect their health?
What are some of the possible simple changes that one can make to improve their lifestyle?
After setting research questions, it is always important to come up with appropriate hypotheses. Research hypotheses helps to determine the expected outcome based on the current knowledge of the researcher and the information collected from secondary sources. The following are the hypotheses developed based on the set of questions.
H1o. Physical exercise is not the best non-medical way of fighting-off type II diabetes
H1a. Physical exercise is the best non-medical way of fighting-off type II diabetes
H2o. Change in lifestyle is not the best way of reducing new cases of type II diabetes
H2a. Change in lifestyle is the best way of reducing new cases of type II diabetes
The researcher seeks to reject the null hypotheses using the data collected from the field in order to accept the alternative hypotheses.
According to Narayan (2011), it is always necessary to define both dependent and independent variables in a research. In this study, the independent variables are physical exercise and healthy diet. The dependent variable is new cases of type II diabetes. This means that new cases of diabetes rely on the type and quantity of food one takes and how one engages in physical exercises.
Theoretical Framework
According to Chawla (2014), diabetes is one of the lifestyle diseases that are claiming many lives not only in the United States but in many other countries around the world. The need to find a viable solution to this problem has led to extensive research resulting in various theories. At this stage, it is necessary to discuss the theoretical framework relevant to type II diabetes management. One of the widely used theories in diabetes management is the Self-Regulation Theory. This theory focuses on personal model of diabetes and how behavioral and emotional pattern may affect the ability to manage this disease (Ekoé, 2008). This theory has five main pillars that shape the illness management and is based on self-empowerment. The first pillar is to identify the symptoms. In order to manage diabetes, it is important to start by identifying the possible symptoms the may help indicate that one is suffering from type II diabetes. The ability to correctly identify symptoms of diabetes in time may help in early intervention measures before the disease can get to advanced stages. The second pillar is the cause of the disease. It is always necessary to determine the causes in order to know how to avoid getting affected.
The best way of avoiding this disease is to find its actual causes. Having knowledge on specific issues such as diet that is related to the disease may be a form of self-empowerment. The third pillar of this theory is the timeline. In this regard, an individual should understand the timeline on how the disease advances from one stage to the other, and how this advancement can be delayed through appropriate medication and a change in the lifestyle. The next pillar is the consequence of the disease. For an individual who is yet to become diabetic, it is important for them to realize that this is a lifetime disease that changes one’s lifestyle for the worse. It is a disease that may result into a scenario where one has to live under medication in his or her lifetime. To those who are already diabetic, they need to know how they can live positively with the disease. They need to know the consequences of failing to observe the medical prescription given to them or taking foods that may worsen their conditions. The final pillar of this theory is effective medication. Once one has been confirmed to be suffering from diabetes, it is always necessary to maintain regular medication to stay healthy. Diabetes is one of the diseases that currently have no cure. For this reason, the only way of staying alive is to have a regular intake of the prescribed medicine without fail. The patient should know when and how to take the medicines, and types of food to be taken and the nature of physical activities which are necessary.
Dual Process Theory is another popular concept that is widely used in the management of diabetes. According to Ekoé (2008), this theory helps in guiding the processes of education and enhancing one’s knowledge about diabetes. The theory makes a clear distinction between systematic and heuristic processing. According to Somekh and Lewin (2005), patient education mainly takes the heuristic processing approach, where the patient takes a passive role. In this approach, the patient’s role is to listen to what the health experts say without necessarily engaging them in a consultative forum. This is a traditional approach of learning about a disease. The expert will provide all the information that a patient needs on how to manage the disease. However, many scholars have heavily criticized this approach as being ineffective. The approach takes away the power of managing the disease from the patient. The patient becomes over reliant on the experts and cannot think on his own. This is very dangerous, especially in cases where the expert lacks the right knowledge about the disease.
Some of the people who claim to be medical experts may actually be quarks who know very little about the disease. What the patient must realize is that any mistake made by the doctor may cost them dearly. The expert may not care much as long as he or she is paid. However, the patient will bear all the risks. This makes it necessary to use systematic learning. In this approach, a lot of emphasis is laid on patient empowerment. As a patient, it is necessary to be part of the solution to the problem of diabetes. The patient needs to have the right knowledge about the management of the disease. This includes knowing the medicines which are appropriate, the food to be avoided and those to be taken, the appropriate physical activity, and any other relevant issues that may affect the process of their condition. This does not rule of the importance of the experts in their lives. These patients will still have to visit doctors regularly. However, instead of taking instructions as a passive listener, the patient will engage the experts and share any new findings they have on how to manage their condition. The experts may help them shape their newly found idea in a better way to improve their condition. On the other hand, they are able to put to task the experts about their proposed medication processes. This way, the patients is able to be in control of their lives instead of wholly relying on the experts. Equipping patients is the best way of handing the responsibility of managing their condition to them.
Self-Determination Theory is another theory which looks at the distinction between autonomous and controlled motivation. According to Ekoé (2008), over 71% of the American population has post-high school diplomas. Another 59% of the population has college degrees in various courses. The level of illiteracy in this country according to the recent studies by Chawla (2014) is less than 5%. According to Vora and Buse (2012), most of those who suffer from diabetes in this country (over 68%) are people with diplomas or advanced diplomas and very decent jobs. The reason why this statistics is necessary is to help determine the reason why many people are not leading the right lifestyle that can help them stay healthy. From the early stages of learning through to the high school, students always learn about the importance of physical exercise and dangers of some types of food. In high school, learners are always taken through some of the causes, management approaches, and prevention measures of diabetes. When they leave high school, they have the right knowledge about how to fight diabetes. It is, therefore, worrying that people have the right knowledge but are unwilling to use them because of reasons that Narayan (2011) describes as recklessness. The Theory of Self-Determination seeks to find out how the two approaches of motivation can help encourage individuals to use their knowledge about diabetes positively.
According to Vora and Buse (2012), controlled motivation involves acting because of extrinsic reason. This is a situation where one acts because of the desire to be noticed by others. One may want to act in a given way so as to make people happy, receive a reward or avoid punishment. In this case, the person knows what should be done, but lacks the self-drive to do it. They only act in such a desirable manner when they know they are being monitored. For instance, a diabetic patient may be instructed to avoid specific types of food. Such a patient may deliberately decide to avoid such foods only when they are aware that people around them are monitoring their activities. When they know that they are on their own, then they would indulge in those foods without giving consideration some of the possible consequences to their actions. This explains why many Americans have the knowledge on how to lead lives free from diseases such as diabetes, but they fail to do so because they lack the self-drive. They know that their lifestyle may lead to serious consequences, but they do not give any serious consideration to these facts. They are empowered, but are unwilling to use their power to fight diabetes through a changed lifestyle. In contrast, autonomous motivation is a situation where one takes the initiative to stay healthy without necessarily expecting any reaction from others. They act for intrinsic reasons. They know that they have the responsibility to take care of their lives, and that what they eat and how they act may have an impact on their health. It is important to note that acting for intrinsic reasons is one of the biggest challenges, especially for those who have not be subjected to grueling experience of managing some of these diseases. Staying away from junk foods beautifully displayed in fast food stores requires a lot of discipline. Similarly, maintaining a regular workout is physically stressing, and unless one has the commitment to do so, it is very easy to give up along the way.
Acting for intrinsic reasons is the best way of fighting diabetes both for those who are already affected and those who are free from the disease. The non-diabetic individuals must understand that diabetes is a condition that can be acquired in one’s lifetime if one fails to leady a healthy lifestyle. For this reason, they need to maintain regular exercise and avoid junk foods in order to stay healthy. On the other hand, those who are already suffering from this disease must understand that they have the power to remain alive based on what they do. They must take care of what they eat, including taking medication at the right time. This should be done without necessarily waiting for someone to give a reward or to avoid rebuke from others. It is a matter of being disciplined in all the activities that one engages in at all times. As Frankfort-Nachmias and Nachmias (2008) put it, it involves having the power and using it responsibly for one’s own well-being.
The last concept that will be looked at in this paper is the Social Learning Theory. This theory majorly focuses on how one perceives his ability to enact behaviors or policies and follow them through on his action plan. This may also be referred to as self-efficacy. According to Williams (2003), success and failure largely relies on one’s perception towards an issue. This is so because success or failure is a process based on how an individual views self against the issue at hand. For instance, when one develops a feeling that he cannot maintain a regular diet that is free from some forms of food, then this becomes a big issue that cannot be controlled even though it may appear simple. The moment the idea of impossibility sets in, then everything becomes impossible. It is common to find a situation where one sets a behavioral plan to engage regularly on physical exercise, maybe three times a day for about one hour on each day. The plan may be so good and very simple in paper, but unless one has a commitment to do what is right, they may not achieve the intended objective. Such a program would be forgotten about sooner or later because of the lack of personal commitment. In managing diabetes, one should start by working on their perception towards specific issues in their lives. They must develop confidence in themselves and develop a belief that they can make it on their own. In this regard, the experts and other family members need to find a way of improving the level of confidence among their patients who struggle to overcome some habits that may affect their conditions. One such habit is excessive intake of alcohol. The addicts may find it difficult overcoming such conditions. However, when they develop a will power, then it can be possible to overcome the situation.
Quantitative Research Design
Introduction
When conducting research, selecting an appropriate research design is critical in order to achieve success. In this study, the researcher was interested in a quantitative research method in order to respond to the research questions and empirically confirm the hypotheses set in the previous chapters.
Research topic
In this study, the researcher was interested in investigating the incidences of Type II diabetes and how it can be managed within the United States. The reports from Word Health Organist ion and Center for Disease Control and Prevention have given consistent reports which show rising cases of diabetes within the country. This has largely been blamed on the lifestyle. In this study, the researcher used mathematical methods to identify some of the best ways that can be used to address this problem.
Experimental design
According to Pedhazur (1991), experimental design refers to a systematic approach to a research where a researcher manipulates variables, measurement standards, and participants in order to achieve the desired outcome. For instance, when a researcher is interested in determining the relationship between two variables over a given time, it will be necessary to manipulate other factors in order to find the best way of conducting the experiment. Sometimes the manipulation may involve an assumption that some variables will remain constant as other undergo change. This way, it becomes easy to determine how one variable affects other variables. This way, a researcher is able to offer advice on how manipulating one variable may help avoid undesirable events from taking place or to avoid their impact. This makes it easy to test the set hypothesis even if the conditions within the environment are very dynamic. The participants may also be manipulated, by having a sample size that can fit into an experimental context.
Design of research
When selecting an appropriate research design, it is always important to into consideration factors such as feasibility, costs, time, and ethics. The design must be feasible based on the available resources and the desired outcome. The cost of the research design must be realistic based on the finances available for the study and its purpose. The time set for the research will also determine the appropriateness of the research design. Finally, ethics should not be forgotten when selecting an appropriate research design. This means that the design chosen should have the capacity to achieve the intended outcome without subjecting the participants to criticism or discrimination by allowing third parties to have access to their responses. Confidentiality should be maintained.
The design chosen for this study
In this study, the researcher decided to use the experimental randomized control design in order to assess how incidences of type II diabetes is affected by physical exercise. According to Mitchell (2010), physical exercise is very important in controlling incidence of type II diabetes. The only way of doing this is through this randomized controlled design. This means that there will be two groups when conducting the research which are the control group and the experimental group. Both groups will be given medication. However, the experimental group will be subjected to physical exercise while the control group will not. The researcher will then determine if there is consistency in the two groups in terms of the level of improvement in their condition. This will help determine if physical exercise has any impact on the incidence of type II diabetes.
Levels of Measurement
When conducting research, different variables will be used to define different factors. Each of the variables must have its own measurement levels in order to make sense. Variables are always measured based on their peculiar characteristics. There are four types of levels of measurement that are always used. Nominal scale is used to measure issues such as ethnicity, gender, language, or race. This scale is commonly used in qualitative research. Ordinal scale is majorly used when the variables can be ranked. It can be used when dealing with variables such as grades, or intensity of something. In this study, ordinal scale will be very important as a level of measurement. Interval level is widely used when there is need to determine the degree of differences can be determined. It is very appropriate for issues such as distance and temperature. Ratio scale measurement is always relevant when determining the ration that exists between differences of a continuous variable. In this study, the focus will be to determine the impact of physical exercise on incidence of type II diabetes. The physical exercise that the participants will be subjected to, can be measured in weeks. The incidence of type II diabetes can be evaluated through a measure of blood glucose level.
Sampling Method
When conducting research, it may not be easy to work with the entire population. In this research, the entire population is so big that the researcher may not conduct a feasible study on all of them. This makes it necessary to use a sample as a representative of the entire population. Different types of sampling may be relevant under different contexts. Some of the popular sampling methods include stratified sampling, systematic sampling, and purposive sampling, among others. Each of these sampling methods may fit in different contexts. It is necessary to identify the most appropriate sampling method based on the nature and the number of the participants.
Sampling method used in this study
The sampling method selected for this research is the purposive sampling approach. This method was selected because the desired population is clearly defined. The desired participants in this study are only those suffering from type II diabetes. In order to avoid biasness, purposive sampling would be appropriate at this stage. The researcher sampled a total of 200 diabetic patients. It is important to note that there are two groups of participants classified as either intervention or control group. In each of the groups, there will be 100 participants. Given that the population is predetermined, this method saves time and cost of the process of sampling.
Validity and Reliability of the Study
Validity
Leedy (2010) defines validity as the certainty with which a given research is considered correct. This correctness may be looked at from three perspectives which are content, construct, and empirical validity. Construct validity is achieved when relative theoretical framework supports incumbent theory. It involves evoking facts that are already established in the previous research. Content validity is the correctness of the information presented in the study. Empirical validity is the correctness achieved when comparing instruments. In this study, empirical validity will be achieved by correctly comparing level of exercise per week and the blood glucose level. Content validity will not be very applicable in this study.
Reliability
According to Glatthorn (2005), reliability is a measure of levels of authenticity of the validity. It defines how well the content of a given research can be applied under a given context. To text for reliability, split-half method is always employed. The correlation between the two halves is used to verify the validity. Alternatively, a pretest-posttest method can be used to determine the reliability of the study. This split-half method will be more appropriate for this study because the participants are already classified into two groups. The correlation between the two groups can easily be identified. One of the main advantages of this method is that it is simple to conduct.
Scale, Test, and Validity
In this study, the researcher used quantitative analysis to test the hypotheses and to determine the validity of the study. In this case, the participants’ opinions are represented by numbers (Gupta, 2002). It is also important to note that the relationship between the test, scales, population, validity, and reliability is very important. At this stage, it will be important to test the hypotheses which were set in the first chapter of this research.
H1o. Physical exercise is not the best non-medical way of fighting-off type II diabetes
In order to test this hypothesis, the researcher will compare the level of improvement among the two participants in this study. The result obtained are presented in the graph below
Figure 1
As shown in the above graph, it is evident that the group of participants who were engaged in physical exercise registered higher performance than those who only relied on medication alone. This means that the null hypothesis above has been rejected. By rejecting the null hypothesis, the alternative hypothesis below is accepted
H1a. Physical exercise is the best non-medical way of fighting-off type II diabetes
The following research hypothesis focused on a change in lifestyle, especially on the type of food taken by an individual. The researcher asked the participants to state their views on the relationship between lifestyle (specifically the diet) and incidence of type II diabetes.
H2o. Change in lifestyle is not the best way of reducing new cases of type II diabetes
The responses obtained from the respondents are presented in the following pie-chart below.
Figure 2
The response received from the participants shows their strong support for a positive lifestyle. Most of the participants blamed poor lifestyle, especially poor dieting as the main reason why the contracted this disease. One participant categorically stated that she was addicted to fast foods, especially fried chicken and other sugary products. She started gaining weight very fast, but she did very little to control the situation. This response means that the null hypothesis above is resoundingly rejected. Most of the respondents feel that positive change of lifestyle is one of the best ways of dealing with diabetes. This means that the following alternative hypothesis is accepted.
H2a. Change in lifestyle is the best way of reducing new cases of type II diabetes
The response obtained from the two hypotheses confirms that physical exercise and dieting are some of the key ways of managing diabetes. According to Goddard (2001), many experts always emphasize on physical exercise among the unaffected group as the best way of keeping type II diabetes at bay. Physical exercise burns excess blood sugar in the body, minimizing chances of becoming diabetic. On the other hand, one can regulate the amount of sugar intake. Excessive intake of sugar into the body may be a causative factor of diabetes. For those who are not suffering from type II diabetes, maintaining a regular physical exercise may be one of the best ways of staying healthy because one will be assured that excess blood sugar will be converted into energy. However, those who are unable to engage in regular physical exercise for one reason or the other should ensure that they limit their intake of sugar. It may not be necessary to completely cut out sugar intake. However, the amount can be controlled to ensure that one takes amounts that can easily be consumed by the daily activities. To do this, Creswell (2009) says that one needs to be empowered by having the right knowledge. One should know food products which have excess sugar and the ratio in which they should be taken on a daily basis. The following research question was also considered important in the study.
What are some of the possible simple changes that one can make to improve their lifestyle?
The following chart shows some of the activities mentioned by the respondents as ways through which one can improve their lifestyle.
As shown in the graph above, there are a series of simple activities that one can engage in to improve his or her lifestyle. The respondents stated ways other than going to the gym. Many people find it challenging to maintain regular visits to fitness centers. Instead of going to the gym, one can decide to walk or cycle to work if it is possible. This will help burn excess calories. While at work or at home, one should consider using the staircases because it will not only burn calories within the body, but also strengthen the muscles in the entire body.
Conclusion
Reduction is type II diabetes requires an individual effort. One must realize that they are responsible for their own health. For this reason, they must find ways of leading healthy lifestyle. This research has confirmed that physical exercise is one of the best ways of reducing incidence of type II diabetes. Other possible ways may be regular water intake is also encouraged as per the views given by the respondents. These are tricks that may not necessarily need force one to refrain from popular habits. However, the respondents also stated that it would be better if one can avoid or reduce alcohol intake, smoking and eating of junk food. Although these are some of the habits that one may not give up easily, it is advisable to refrain from them.
References
Chawla, R. (2014). Manual of diabetes care. London: McMillan.
Creswell, J. (2009). Research design: Qualitative, quantitative, and mixed method approaches. Thousand Oaks: Sage Publication.
Ekoé, J.-M. (2008). The epidemiology of diabetes mellitus. Chichester, UK: Wiley-Blackwell.
Frankfort-Nachmias, C. & Nachmias, D. (2008). Research methods in social sciences: Cross-Sectional and Quasi-Experimental Designs. New York: Worth.
Glatthorn, A. (2005). Writing the winning thesis or dissertation: a step-by-step guide (2nd ed). Thousand Oaks. Corwin Press.
Goddard, W. (2001). Research methodology: an introduction. Lansdowne: Juta.
Gupta, p. (2002). Statistical Methods (31rd ed). New Delhi: Sultan Chand & Sons.
Leedy, P. (2010). Practical research: planning and design (9th ed). Upper Saddle River, Prentice Hall.
McFarlane, S. (2010). Diabetes and hypertension: Evaluation and management. Totowa: Humana.
Mitchell, M. (2010). Research design explained (7th ed). Belmont. Cengage Learning.
Narayan, K. M. V. (2011). Diabetes public health: From data to policy. New York. Wiley.
Pedhazur, E. (1991). Measurement, design and analysis. An integrated approach. Hillside: Lawrence Erlbaum Associates.
Somekh, B., & Lewin, C. (2005). Research methods in social sciences. London: Sage Publications.
Vora, J., & Buse, J. B. (2012). Evidence-based management of diabetes. New York: Cengage.
Williams, R. (2003). The Evidence Base for Diabetes Care. Chichester: John Wiley & Sons.
Title/Topic: Counseling and education session in type II diabetes
Time Frame: 45 minutes
Facility: In an outpatient clinic of a General Hospital, patients referred by their specialists will be counseled on ways to improve their lifestyle and general nutrition. These patients have usually little to no information about managing type II diabetes. The other type of visitors will include those already living with diabetes and looking for ways to improve their diets and eating behavior.
Objectives
Patients will learn to identify food groups and the notion of calories.
Patients will be aware of the changes needed to improve their diet.
Patients will be educated about the glycemic index and its effect on their blood sugar
Patients will learn to count their carbohydrates.
Patients will set up their goal and the timeframe to achieve it.
Patients will have an increase in knowledge about meal planning.
Materials/Equipment
Handouts listing carbohydrate-containing food
Handouts listing fiber-containing food
Food models reflecting portion sizes of food groups
Logbook used to keep track of all foods consumed during the day
Procedures/Learning Activities with Timeline
Establishing Rapport (5 minutes)
Educating (25 minutes)
Negotiating (5 minutes)
Summarizing the plan (3 minutes)
Scheduling (2 minutes)
Evaluating (5 minutes)
Evaluation
The patient’s ability to summarize the plan is to be assessed after the session, and a progression checklist for the follow-up visit is to be created.
To make this session successful, objectives shall be set, making them attainable and tailored according to the patient’s preferences. The proposed list of objectives to follow within the time frame is provided below:
Establishing Rapport
The patient is to be made comfortable upon starting the session. The first 5 minutes are crucial – the dietitian has to introduce themselves and make the patient aware that the dietician’s role is not to restrict their food choices, but to educate the patient about the ways to manage diabetes. Afterward, the patient is asked about their knowledge of diet and exercise in type 2 Diabetes. The dietitian includes the questions such as “What has he/she been implementing?”, “What difficulties have they faced?” The purpose of this rapport is to get an idea about the patient’s habits and history. After the information has been gathered, general advice will be provided while stressing the importance of healthy eating, physical activity, taking medications and reducing health risks.
Educating
Now that the patient is acquainted with his dietitian, it is time to increase the patient’s awareness regarding the subject matter and the methods of managing the patient’s diet. In the course of the education process, an overview of all food groups will be given, and the points listed below will be emphasized.
Decreasing Caloric Intake
By improving food choices, the dietitian will be able to reduce the number of unnecessary calories to induce a drop in the patient’s weight (if needed). Moreover, for overweight or obese people, the specified stage of intervention will improve blood sugar control (Ajala et al. 505). Food exchanges and low-calorie options are to be explained to the patient. The notion of calories ingested vs. calories burned (through resting metabolic rate or physical activity) serves as an example of caloric manipulation.
Decreasing Saturated Fat
Higher intake of saturated fat (animal fat) is associated with greater insulin resistance. The reason for this is that a surplus of fatty acids is stored and processed to various molecules, thus, hindering normal cellular signaling, especially insulin. When fatty deposits block or alter the cellular insulin receptor, sensitivity to insulin is reduced. This is one of the essential areas to be tackled when explaining the relationship between diet and Diabetes. Full fat dairy products are to be replaced with low or skimmed ones. Lean meat (skinless chicken breast, turkey breast, fish and seafood) are the exclusive choice for animal proteins.
Increasing Fiber Intake
Fiber does not cause a spur in insulin production. As a result, consuming high fibrous foods can help a person stay healthy, reduce body fat, and control blood sugar (Silva et al. 791). A recommended amount of fiber is 25-30 grams per day (“Nutrition in Cancer Care (PDQ®)” para. 16). The key sources of fiber include whole wheat grains, legumes, vegetables and fruits. Some cereal manufacturers also produce food enhanced with fiber, which is an excellent alternative to regular or sweetened cereals. Fresh vegetables (carrots, celery, and cucumbers) are recommended as healthy snack options instead of fast foods or sweets.
Glycemic Index
Carbohydrates are the food group that alters blood sugar levels like no other nutrient does. The following food includes rather large amounts of carbohydrates: simple refined sugars, sweets, breads, cereals, milk, fruit, rice and pasta, as well as certain vegetables like peas, corn, beans and potatoes. When a high carb meal is consumed, the carbs will eventually be broken down into glucose and released into the bloodstream, increasing blood sugar levels. It should be noted, though, that the effect of carbohydrates on human body differs depending on the source of carbs. The usage of the Glycemic Index (GI) is a convenient way to classify carbohydrates. GI is a classification technique based on the influence of certain food on blood glucose levels. Foods high in fiber, which are absorbed slowly, have a low GI rating, while foods that are absorbed quickly have a higher rating (“Be GI Smart” para. 2). Absorption can help even out blood glucose levels. Pure refined glucose is picked as a reference point with a GI score of 100 and other foods are compared against it.
Averting a rise in blood sugar rates can be achieved by consuming the correct type of carbohydrate. High fiber food, such as whole grains, legumes (e.g. beans, chickpeas, etc.) fruits and vegetables, should make a major part of the diet. When implementing the glycemic index as a basis for food choices, one must take “glycemic load” in consideration; as it is affected by not only carbohydrates, but other nutrients in the meal. For example, bread is rich in carbohydrate, while beef contains virtually none. In the case of eating beef with pita bread, calculating the glycemic load will require a combined result of both indexes, with the weight of each food item in mind (Understanding Glycemic Index and Diabetes para. 1).
How to Count Carbs
The table of amount of carbohydrate per gram of a certain product, such as the one suggested by the American Diabetes Association (para. 4) can be considered the key tool for counting carbs. Known as the CHO counting, or the ratio of insulin per carbohydrate, the specified approach requires calculating the total carbohydrate content, the factors affecting the blood glucose response, and the insulin required. Afterwards, the pre-meal blood glucose level must be evaluated and the appropriate exercises must be designed. The latter are followed by an insulin bolus, and the record of the blood glucose response concludes the procedure (Imperial Center for Endocrinology para. 3). It should be born in mind that ‘1 CP (10 g carbohydrate) can raise blood sugars by 2-3mmol/l” (Imperial Center for Endocrinology para. 5). Using the 100 rule, one needs to divide 100 by the daily insulin dose, therefore, retrieving the CP ratio. One must also bear in mind that starch products, as well as lactose and sucrose rich meals are traditionally considered the best sources of CHO.
Negotiating
After the patient has received their educational session, it is time for negotiations to take place. From a realistic perspective, it will be almost impossible for a patient to follow all the tips and requirements previously mentioned, so a middle ground must be found for the patient to comply with the diet requirements.
Negotiable items may involve the following points:
Limiting sweets and sugary foods and swapping them with natural fruits;
Consuming whole grain food instead of refined products;
Using calorie free/reduced calories condiments like mustard and low fat mayo;
Increasing water intake and reducing eliminating soft drinks from the diet list;
Consuming lean meats and reduced fat dairy products (Mahan et al. 549).
Summarizing the Plan
Before wrapping up the session, the patient has to repeat and summarize what they have learned in the course of the session with the dietitian. The latter will listen to what the patient has gathered and rectify any false info.
Scheduling
The patient’s progress can be assessed by setting up mini-goals and making sure that they are achieved. Whether it is reducing fasting blood glucose levels or reducing body weight, both the dietitian and the patient shall define the reasons for their next encounter and specify the goal that shall be reached in a specific time frame.
Evaluating
After setting up the goal for the next session, an evaluation of the efficiency of the counseling should be done. The evaluation is dependent on the success or failure of reaching the target. In case a patient has not achieved a 100% success but is still making improvements, it still counts as progress. For evaluation purposes, the patient is to be asked to keep a food log or diary where they list all the food eaten during the day, medications taken or simply the mood that accompanied their meals. This might help identify bad habits in the future and find the ways to dispose of them permanently.
Works Cited
Ajala, Olubukola, Patrick English, and Jonathan Pinkney.”Systematic Review And Meta-Analysis Of Different Dietary Approaches To The Management Of Type 2 Diabetes.” The American Journal Of Clinical Nutrition, 97.3 (2013), 505-516.
American Diabetes Association. “Carbohydrate Counting.” 2015. Web.
“Be GI Smart.” MV Hospital. 2015. Web.
Imperial Center for Endocrinology. CHO counting. 2015. Web.
Mahan, L. Kathleen, Sylvia Escott-Stump, Janice L. Raymond and Marie V. Krause. Krause’s Food and the Nutrition Care Process. St. Louis, MO: Elsevier Health Sciences, 2012. Print.
“Nutrition in Cancer Care (PDQ®).” National Cancer Institute. 2014. Web.
Silva, Flávia M; Kramer, Caroline K; Almeida, Jussara C; Steemburgo, Thais; Gross, Jorge Luiz; Azevedo, Mirela J. “Fiber Intake And Glycemic Control In Patients With Type 2 Diabetes Mellitus: A Systematic Review With Meta-Analysis Of Randomized Controlled Trials.” Nutrition Reviews, 71.12 (2013), 790-801.
“Understanding Glycemic Index and Diabetes.” American Diabetes Organization. 2014. Web.
Global statistical data indicate that over 300 million adults suffer from diabetes. Diabetes is a chronic medical condition that can be life-threatening if it is not managed appropriately. Over the past decade, Internet-based self-management approaches have been extensively adopted by adults suffering from type 2 diabetes. Researchers in the health care system has embarked on a course to study the most effective ways of managing type 2 diabetes. One of the most recent studies on the same involves the development of computer-based management approaches to the disease. Researchers focus on the development of a management approach that not only influences the effective management of the disorder but a strategy that also reduces the cost of managing the disorder. Diabetes is a long-term condition and its financial burden on patients needs to be continually reduced. This paper reviews a recent study that was conducted to evaluate the effectiveness of using computer-based self-management approaches for adults with diabetes mellitus.
Review of the study
Pal et al. (2013) conducted research aimed at evaluating the viability of using computer-based interventions for managing diabetes mellitus. The method used by the researchers entailed collecting data from past studies that published findings on the effects of using computers to manage diabetes for adult patients. The researchers selected 16 randomized studies that involved 3578 participants. The studies involved the evaluation of different self-management approaches for diabetes mellitus, including internet-based interventions and clinic-based strategies. The participants were adults who had lived with the disease for six years and above, and the studies were conducted over 1-12 months. The population was comprised of adults aged 46 years and above. The researchers evaluated the responses of the participants, and they also collected data from the selected article for further analysis (Pal et al., 2013). Their findings indicated that the incorporation of computer-based interventions for the management of diabetes among adults is a potent approach. The use of the internet and computer applications by adults eliminates their need to visit clinics regularly for advice on management.
Findings
According to the findings, the adoption of computer-based approaches to managing diabetes mellitus is effective in providing relevant information like reminders for exercises, medication, meals, and clinic dates. It is, however, clear that it has no significant effect on the quality of health of the patients. Current interventions for managing diabetes mellitus using computerized gadgets like mobile phones do not improve depression, quality of life, and the health of the patients. The participants in the various studies also indicated that computer-based interventions have limited benefits in controlling blood glucose. It was, however, noted that patients that use their mobile phones reported a positive change in their blood glucose (Pal et al., 2013). Computer-based interventions have limited impacts on biological outcomes, and they do not enhance behavioral and psychological outcomes for patients with diabetes mellitus.
The main idea of the findings
The main idea of the findings is that despite the calls for people to use computers as alternatives to manage their lifestyle-related diseases like diabetes, the effectiveness of the approaches is limited. Computerized gadgets have been extensively used as an alternative intervention approach to managing diabetes, but the findings have indicated that the gadgets do not necessarily enhance the quality of life for the patients. In essence, the viability of an intervention approach to managing diabetes is measured by its feasibility in enhancing the quality of life for the patients. In the case of adopting computer-based interventions, past studies reveal that the use of mobile phones and applications for gadgets has a positive effect on the management of diabetes mellitus (Ramadas, Quek, Chan & Oldenburg, 2011). These benefits are, perhaps, a result of effective time management with relation to the different health-boosting activities that the patients must apply on a regular basis. The researchers in the study under review concluded that the application of computers in self-management strategies for diabetes has limited positive benefits to the health and quality of life of patients with diabetes. This is an indication that patients with diabetes mellitus should not be pressured toward adopting the management approach. There are several benefits involved; hence, computer-based self-management approaches for diabetes are not obsolete. The approaches may help some patients improve their blood glucose levels and keep track of their daily schedules for managing diabetes. Computer gadgets are expensive; hence, this approach may not be desirable to most adults with other financial responsibilities.
Conclusion
The development of the most viable intervention programs to promote positive self-management outcomes for patients with diabetes has been the main focus of some researchers in the health care system. Managing diabetes is a big challenge for some adults because of the time and costs involved. Computer-based approaches to managing diabetes have been extensively adopted by adults across the world, but the reviewed study reveals that the associated benefits are limited. The efficiency of using computerized gadgets in managing diabetes mellitus is not significantly different from other traditional approaches. The cost of purchasing and maintaining the gadgets is also quite high; hence, adults with diabetes should not feel pressured to adopt the strategy.
References
Pal, K., Eastwood, S. V., Michie, S., Farmer, A. J., Barnard, M. L., Peacock, R., & Murray, E. (2013). Computer‐based diabetes self‐management interventions for adults with type 2 diabetes mellitus. The Cochrane Library, 1(3), 1-148.
Ramadas, A., Quek, K. F., Chan, C. K. Y., & Oldenburg, B. (2011). Web-based interventions for the management of type 2 diabetes mellitus: a systematic review of recent evidence. International Journal of Medical Informatics, 80(6), 389-405.
His article has discussed the different types of diabetes in detail. The article is very informative and it gives the reader enough information to understand diabetes’ definition and its effects on the body.
According to scientists’ research conducted in 2013, approximately 400 million people all over the world are suffering from diabetes (Tonoli et al., 2012). There are two types of diabetes which include Type 1 and Type 2 Diabetes. Type 1 Diabetes is a medical situation whereby the body does not produce insulin to manage its sugars level. On the other hand, Type 2 Diabetes is a condition whereby the body produces insulin but the amount produced is not enough for efficient functioning. Type 1 Diabetes accounts for 10% of the total cases of diabetes (Tonoli et al., 2012).
On the other hand, Type 2 Diabetes accounts for 90%. Gestation Diabetes is another type of diabetes although it is very rare. It is unique because it only affects women during their pregnancy period (Tonoli et al., 2012). The main and visible symptoms of diabetes are excessive urination, heightened thirst, hunger, weight gain/loss, frequent fatigue, and Sexual malfunctioning among other signs (Tonoli et al., 2012). Patients suffering from Diabetes can live a normal life if they have a healthy eating plan, if they exercise and if they take insulin (Tonoli et al., 2012).
However, the risk of conducting cardiovascular diseases is more possible for diabetic patients than for normal people. One of the easy preventive measures for cardiovascular diseases is to quit smoking. Diabetes causes an imbalance of blood pressure in two major ways. They include Low blood pressure also known as Hypoglycemia and high blood pressure also known as hyperglycemia (Tonoli et al., 2012). Both high and low blood pressure are sustained and balanced by insulin and that is why its absence creates an imbalance.
Functions of insulin: Should the nurse have questioned insulin overdose?
Article summary
This article has explained the different functions of insulin apart from regulating blood sugar levels. In addition to this, the author has explained the different effects of an insulin overdose.
Insulin performs a number of functions in the body. Nonetheless, the most important function is to normalize and keep low levels of glucose in the body (Yang et al., 2014). It does this through a number of biological processes including stimulating lipogenesis, diminishing lipolysis, and enhancing the transportation of amino acids into the cells (Yang et al., 2014).
Therefore, the nurse should have questioned the insulin overdose given to Mrs. Buckman. Knowing that untreated insulin-related problems can reduce a patient’s lifespan the nurse understood the dangers of an overdose. One of the major problems of having an insulin overdose is that it makes the body absorb more sugars from the blood (Yang et al., 2014). In addition, it inhibits the liver from producing enough glucose (Yang et al., 2014). When these two incidences occur, they cause the glucose level in the body to reduce significantly hence causing hypoglycemia.
In this case, the nurse was right to worry about the patient’s insulin overdose since it would have caused her to have severe low blood pressure. If Mrs. Buckman was given an overdose of insulin, the situation could have been dire because she would not be able to produce glucose in her body. Glucose is the body’s fuel and lack of it can be lethal. Therefore, the nurse should have questioned the order to give an overdose of insulin and she should have demanded an explanation from the doctor.
Preventing an occurrence of the same in future
Article summary
In this article, there are several preventive measures that have been outlined that can help in reducing the risk of overdosing. The article proposes several safety practices in nursing.
Whenever a patient is admitted to a hospital for insulin-related complications, great care should be given to his or her treatment. The nurses and doctors taking care of such a patient must work together and communication should be enhanced. I believe the problem was caused by an ineffective mode of communication. In Mrs. Buckman’s case, the problem was caused by a typing error. The nurse in charge was ordered to give 8.0 units to the patient but instead, she gave her 80 units of insulin.
To prevent such an error in the future, one of the most prudent actions is to give instructions in both numeric and word formats (Cohen, 2012). For instance, the house physician should have written ‘eight units’ of insulin. Writing the words and the numeric letters can help to reduce the possibility for wrong interpretation and confusion (Cohen, 2012). In addition, the nurses’ level of education should be reviewed. For a qualified nurse, it would have been very easy to notice that the amount of insulin given was unusual.
Nurses should be very careful with what they do and when they are given orders that they consider doubtful, they should feel free to ask or to raise objections. They should not always follow orders from physicians even when they are wrong. In order to achieve this, they should be given more power and responsibilities in the process of treatment.
References
Cohen, M. R. (2012). Safe practices for compounding of parenteral nutrition. Journal of Parenteral and Enteral Nutrition, 36(2): 14-19.
Tonoli, C., Heyman, E., Roelands, B., Buyse, L., Cheung, S. S., Berthoin, S., & Meeusen, R. (2012). Effects of different types of acute and chronic (training) exercise on glycaemic control in type 1 diabetes mellitus. Sports medicine, 42(12): 1059-1080.
Yang, G., Geng, X. R., Song, J. P., Wu, Y., Yan, H., Zhan, Z., & Yang, P. C. (2014). Insulin-like growth factor 2 enhances regulatory T-cell functions and suppresses food allergy in an experimental model. Journal of Allergy and Clinical Immunology, 133(6): 1702-1708.
Despite numerous attempts to locate the cure for diabetes, the disease remains to be the primary health concern in the 21st century. Moreover, the subject matter has been affecting an increasingly large number of people. According to the latest data on the development of diabetes, the rates thereof have risen by 291% since 1980 (from 108 million patients to 422, according to the WHO (World Health Organization, 2014) global statistics). Therefore, the program designed as a part of the Healthy People 2020 initiative and aimed at addressing the lack of awareness on the subject matter is an admittedly essential step in managing the current diabetes-related concerns.
The program focuses primarily on providing the target audience with information on the disorder, including the factors that cause it, the means of identifying it, and the strategies that help manage the disorder. The webinar addresses specifically the issue of self-management as an essential tool in handling diabetes.
In addition, the seminar provides essential information concerning the development of the disorder, pointing especially to the data that allows detecting the members of the population that are under a consistent threat. According to the data provided by the Healthy People 2020, these are the urban dwellers that should be especially concerned; however, the correlation between the number of people with diabetes living in the urban and suburban areas has dropped to a considerable extent (Empowering people to manage their diabetes, 2014).
Implications
Among the essential outcomes of the seminar, the importance of spreading awareness about diabetes, its symptoms, the factors that induce it, and the tools that can help prevent it, must be listed. Seeing that an increasingly large number of people has been developing the disorder since the 80s, there is an evident need for carrying out the process of raising awareness among the members of local communities. As soon as ARNs start providing patients with the essential instructions on the issue of diabetes, the mortality rates among the people suffering from the disorder are likely to drop. Moreover, the possibility for addressing the issue successfully and, perhaps, even locating the cure for it, may be designed in the future (Empowering people to manage their diabetes, 2014).
Role of an APN
In the context of the information provided by the organization, the role of an APN has been expanded from providing the related services (i.e., the shots and the corresponding assistance) to the provider of essential information and the person in charge of making this information available to all those concerned. Although the process of data transfer has become very fast in the 21st century, a range of people still lack guidance on the means of preventing, diagnosing, and treating diabetes. The Healthy People 2020 initiative, in its turn, provides extensive instructions for nurses to educate people on how they can manage their current state (Colvin et al., 2014).
Although the role of an educator should not be viewed as something entirely new and alien to an APN, it still requires sufficient skills. Therefore, the program serves as the tool for empowering nurses to take the above responsibility and teach people to be independent in managing their disorder. While the assistance of the corresponding healthcare experts is essential, a nurse must make sure that the patients are capable of managing basic tasks related to their disorder.
Reference List
Colvin, L., Cartwright, A., Collop, N., Freedman, N., McLeod, D.,. Weaver, T. E., & Rogers, A. E. (2014). Advanced Practice Registered Nurses and Physician Assistants in sleep centers and clinics: A survey of current roles and educational background. JCSM, 10(5), 581-587.
Diabetes Mellitus (DM) is a chronic metabolic disease resulting from elevated blood glucose levels due to impaired insulin secretion or action. Type 1 diabetes (T1D) is most common in children and adolescents and is also known as juvenile or insulin-dependent diabetes (Bimstein et al., 2019). The disease is characterized by the pancreas almost not producing its own insulin, which leads to an increase in glucose levels in the blood. T1D is not exclusively juvenile as it can develop at any age (Bimstein et al., 2019). Type 2 diabetes (T2D) occurs due to beta-cell dysfunction and insulin resistance in the target tissues (Chatterjee et al., 2017). Along with T1D and T2D, there is diabetes, which occurs among pregnant women, called gestational diabetes (GD).
Any degree of hyperglycemia that occurs during pregnancy is considered GD. The diagnosis includes both previously undiagnosed T2D and GD itself, which develops in the later stages of pregnancy (Dirar & Doupis, 2017). The cause of the development of the disease can be a varying degree of adipocytokine production or increased production of diabetogenic placental hormones (Dirar & Doupis, 2017). Pregnancy is a complex metabolic process that puts additional pressure on beta cells (McIntyre et al., 2019). Various risk factors, such as genetic predisposition, obesity, and age, increase the risk of developing the disease.
Dietary Recommendation for GD
To prevent short-term neonatal and maternal complications due to GD, lifestyle changes are recommended first, including changes in diet and physical activity patterns. Patients with GD are advised to maintain a balanced, healthy diet including sufficient amounts of whole fruits and vegetables, moderate amounts of fiber and fat, and avoid sugar-rich foods (Gestational diabetes diet, n.d.). The daily ration should contain three meals and additional snacks which should not be skipped.
Metformin for GD
Metformin is a biguanide that reduces the excretion of glucose from the liver, decreases its absorption, and increases its absorption in the muscles and adipocyte cells. It also stimulates the secretion of glucagon-like peptide 1 (GLP-1) from intestinal cells (Mukerji & Feig, 2017). Administration includes a liquid to take orally 1-2 times a day with a meal or regular tablets to take 2-3 times a day with a meal or an extended-release tablet to take once a day with an evening meal (Metformin, n.d.). Preparation for a drug administration consists of measuring blood sugar levels 2-3 times a day before meals. The recommended dosage is 500 mg, with a subsequent increase in later pregnancy. With pharmacotherapeutic intervention, a permanent decrease in the patient’s blood glucose level is expected.
Short-term and Long-term Impact of GD and Metformin
GM is primarily associated with an increase in fetal weight, which can lead to birth trauma. Other short-term impacts may be neonatal hyperglycemia in the immediate postpartum period and an increased risk of respiratory distress (Murray & Reynolds, 2020). GM’s long-term impacts include an increased likelihood of developing obesity and cardiovascular diseases, circulatory system pathologies, and increased rates of insulin resistance (Murray & Reynolds, 2020). Changes which occurred in childhood due to the mother’s GM are likely to persist throughout adulthood.
In a short-term study of two groups of 751 pregnant women, the first group took Metformin 500 mg 1–2 times daily. At a later date, the dosage was increased to 2500 mg per day with the additional insulin when glycemic levels were not reached (Mukerji & Feig, 2017). The second group of subjects received only insulin as a traditional method of therapy. The study found no difference in the neonatal morbidity rate; severe neonatal hypoglycemia was less common, although preterm labor was more common; 46.3% of women required insulin in addition to Metformin (Mukerji & Feig, 2017). Long-term studies found that mothers who received Metformin in late pregnancy had more triglycerides, which affected fat accumulation in infants. Studies did not show significant differences between children from the first and second groups in social, linguistic, and motor skills at the age of 18 months (Mukerji & Feig, 2017). However, children of mothers taking Metformin are significantly taller and heavier than children in the second group.
References
Bimstein, E., Zangen, D., Abedrahim, W., & Katz, J. (2019). Type 1 diabetes mellitus (juvenile diabetes) – A review for the pediatric oral health provider. The Journal of Clinical Pediatric Dentistry, 43(6), 417-423. Web.
Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes.Seminar, 389(10085), 1-13. Web.
The coronary artery disease (CAD) is a major contributor to heart failure. It reduces the blood flow and supply of oxygen to the myocardium, leading myocardial hypoxia and reduced function.
Another broad mechanism involving myocardial infarction is also associated with the heart failure. Myocardial infarction is considered serious, and it reflects the peak of coronary artery disease. The infarcted tissue fails in functional mechanical processes, which eventually lead to reduced cardiac function. In addition, healthy tissues are required to compensate for the diminished functions, which result in additional work that can lead to heart failure (Boudoulas, Borer, & Boudoulas, 2015).
Congenital impairments and valvular disease could also cause heart failure because of increased activities. Cardiomyopathies of both identified and unidentified causes are responsible for heart failure. It is also observed that myocarditis can also lead to the same outcome.
Finally, arrhythmias, which mainly include tachycardia or bradycardia could also cause heart failure (McCance & Huether, 2014).
In the case, the patient shows multiple signs associated with the coronary heart disease, which is associated with shortness of breath, irregular heartbeats, faster heartbeats (tachycardia with a heart rate of 110 bpm), fatigue, and hypertension (Ferrari & Fox, 2016).
The patient’s condition has be aggravated by other factors, such as type 2 diabetes and advance age (66 years old).
Additionally, an enlarged heart would result in the noted beat and additional heart sounds, which generally depict elevated intra-cardiac blood pressure.
The patient has also recorded fine crackles (heart murmurs) on inspiration at both bases. The cardiac exam is noted for the presence of a third and fourth heart sound while jugular venous distension is conducted to determine the status of the fluid responsible for edema. These fine heart crackles could reflect valvular heart disease, as either a direct cause or a consequence of heart failure.
The patient’s physical examination has revealed more than two pitting edemas to the knees bilaterally. A possible backward failure in the right ventricle is responsible for the congestion of the capillaries (Ferrari & Fox, 2016). As a result, the patient has experienced body fluid accumulation. In this case, the accumulated body fluid has affected the legs and knees, making walking more difficult. The patient will experience swelling of the knees, ankles, and feet when she stands up and later suffers sacral edema when she lies down.
Systolic dysfunction is noted in the left ventricle when it cannot contract as required. It reflects pumping impairment in the heart.
Conversely, diastolic dysfunction reflects inability of the left ventricle to fill fully or relax. It is generally a problem of filling in the heart. This dysfunction shows the preserved ejection fraction associated with heart failure (the patient has recorded an estimated ejection fraction of 25%) (Al-Sofiani, Nikolla, & Metta, 2015).
The patient must be experiencing failure of the left ventricle (Al-Sofiani et al., 2015). It is responsible for congestions of the blood vessels in the lungs, resulting in respiratory challenges associated with shortness of breath (dyspnea). Dyspnea is noted on exertion, but in the case, the condition is severe and, therefore, she experiences it at rest. Awakening in the night is associated with elevated breathlessness when the patient is lying flat. Hence, the three pillows are necessary to increase comfort for the patient. In a severe case, the patient will start to sleep while sitting up.
References
Al-Sofiani, M., Nikolla, D., & Metta, V. V. (2015). Hypothyroidism and non-cardiogenic pulmonary edema: are we missing something here? Endocrinology, Diabetes & Metabolism Case Reports, Web.
Boudoulas, K. D., Borer, J. S., & Boudoulas, H. (2015). Heart Rate, Life Expectancy and the Cardiovascular System: Therapeutic Considerations. Cardiology, 1(32), 199-212. Web.
Ferrari, R., & Fox, K. (2016). Heart Rate Reduction in Coronary Artery Disease and Heart Failure. Nature Reviews Cardiology, Web.
McCance, K. L., & Huether, S. E. (2014). Pathophysiology: he Biologic Basis for Disease in Adults and Children (7th ed.). St. Louis, Missouri: Elsevier.
Acebutolol belongs to the class of beta-blockers called anti-hypertensive drugs. Medical researchers aver that antihypertensive medications such as beta-blockers and thiazide diuretics are causative agents of diabetes mellitus type 2 (Gress et al. 905). Additionally, numerous empirical studies have found a positive correlation between hypertension and incidence of diabetes mellitus with some professing that the two maladies overlap each other (Cheung and Li 161). Florea and Cohn state that heart failure stems from an imbalance between the sympathetic and parasympathetic nervous systems with beta-blockers making the disease progress due to the inhibition of the sympathetic system (1815). The determination of whether or not Acebutolol increases the chance of hypertensive patients developing diabetes mellitus 2 is central to the ultimate management of heart conditions.
Acebutolol: Mechanism of Action, Indications, and Uses
Acebutolol works by obstructing β I adrenergic receptors of neurons in the sympathetic nervous system that regulates high blood pressure. The sympathetic nervous system is one of the branches of the autonomic nervous system that regulates the unconscious activities of the body such as heartbeat (Dobre et al. 80). In particular, Acebutolol impairs the functions of epinephrine and norepinephrine, which are neurotransmitters that mediate the functioning of the heart and the sympathetic nervous system (Florea and Cohn 1816). The blockage of beta-adrenergic receptors in the heart by Acebutolol prevents the binding of epinephrine or norepinephrine. The attachment of these neurotransmitters initiates a signal transduction cascade that leads to the activation of the sympathetic nervous system, which controls the fight or flight mechanism in the body. Ultimately, Acebutolol reduces the rate of heartbeat, which in turn decreases the volume of blood it pumps and the amount of oxygen it requires.
The adverse reactions to Acebutolol are mild, and severity reduces with an increase in the chemotherapy period. These adverse effects include muscle aches, abdominal discomforts, dizziness, excessive fatigue, and diarrhea. However, experimental evidence shows that it also causes drug-induced lupus erythematosus (DILE) (Muta, Fukami, and Nakajima 659). DILE is an autoimmune disease, which leads to severe complications, and researchers have speculated it to be involved in the development of both type II and type I diabetes mellitus (Itariu and Stulnig 192). The administration of selective beta-blockers by some physicians to asthmatic individuals is still a subject of medical debate.
Doctors use Acebutolol in the treatment and management of hypertension, arrhythmia (anomalies in the heart rhythms), and chest pains emanating from angina. Arrhythmia is a severe disorder for it causes death to 50% of patients with cardiovascular disorders (Fu 291). As arrhythmia has a number of causative agents, doctors should determine them before prescribing beta-blockers.
Summary of the article
The study aimed at determining whether there is a link between the use of antihypertensive drugs and the development of diabetes mellitus 2. The study participants were 12,250 adults aged between 45-64 years who were randomly sampled from different geographical regions in the United States. The investigators grouped them into those suffering from hypertension and those who are not, and analyzed them using Chiang’s method for determining incidence. The researchers further divided those suffering from hypertension into those taking medications and those who are not, and analyzed them using proportional-hazard analysis. The results indicate that people who suffer from hypertension are 2.5 times more likely to get diabetes compared to those who do not. Amongst users of the antihypertensive drugs, users of beta-blockers are 28% more likely to develop diabetes compared to hypertensive sufferers who are not on medication. In conclusion, users of calcium-channel antagonists, thiazide diuretics, and angiotensin-converting enzyme inhibitors have a lower risk for diabetes than users of hypertensive drugs. However, users of beta-blocker are at risk of getting diabetes.
Analysis of the research study
Epidemiological data show that 1,146 new cases of diabetes have occurred over the past six years, which accounts for 16.6% of diabetic cases per 1,000 people. In the new cases, 569 people had hypertension while 577 did not have hypertension. In the multivariate assay to determine whether a correlation between the use of antihypertensive drugs and the development of diabetes mellitus type 2 existed, patients with hypertension taking β-blockers are 28% more likely to get diabetes compared to those not taking any drugs (Gress et al. 908). The users of angiotensin-converting enzyme inhibitors and calcium channel antagonists were not at risk of developing diabetes, which is the same as hypertensive sufferers who were not on any treatment. Furthermore, users of beta-blockers and thiazide diuretics were 1.34 and 0.88 times more likely to develop diabetes respectively. In the analysis to determine changes in treatment after three years, users of beta-blockers also had a higher propensity for developing diabetes at 33.6% when compared to users of thiazide diuretics and those who are not on medications at 27.5% and 26.3% respectively.
The sample for the study considerably represents the target population since it comprises Americans who are genetically predisposed to developing diabetes mellitus. The sample size was adequate, despite the exclusion criteria of the study that omitted 1375 individuals. The research was not a double-blind study because the participants and the researchers knew each other, and the investigators did not terminate it at any point. In the future, researchers should probe shared risk factors ascertaining the association between the use of antihypertensive drugs and diabetes. The probe will provide evidence-based data to clinicians and help them deduce groups that are likely to develop diabetes.
Conclusion
In general, this is a robust study because it factored in confounding factors at baseline (presence of diabetes and hypertension) and had enough study participants, which formed an unbiased sample. The study also eliminated bias such as missing data at baseline and three and six years of study. However, researchers can only extrapolate the results to a section of society, the White Americans and the African Americans, since the exclusion criteria eliminated other races. The doses of the respective classes of antihypertensive drugs were not included. The missing data on the presence or absence of diabetes after three and six years is quite huge as they add up to 948. If the investigators could have captured these data, perhaps, it would have tilted the balance in terms of the disease outcome, following usage of the different classes of antihypertensive medications.
Acebutolol is not a safe drug because when compared with other antihypertensive drugs such as thiazide diuretics, calcium channel antagonists, and angiotensin-converting enzyme (ACE) inhibitors, it is a risk factor in the development of diabetes mellitus (Gress et al. 908). Empirical evidence indicates that the use of other classes of anti-high blood pressure drugs does predispose individuals to diabetes. Compared with patients who were not on any treatment for hypertension, beta-blockers had a 28% incidence of diabetes mellitus. In a different study of propranolol, a beta-blocker, the scientists found that it was 6.1 times more likely to cause diabetes in people who use it compared to those who do not. These data underscore why beta-blockers are not safe antihypertensive drugs.
The dangers that Acebutolol poses include the development of autoimmune disease due to DILE (Muta, Fukami, and Nakajima 659). In addition, according to Flore and Cohn, beta-blockers accelerate the cases of patients with heart failure by impeding the sympathetic nervous system (1815). There is an autonomic disparity between the sympathetic system (activation) and the parasympathetic (inhibition).
Works Cited
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Nursing care is exceedingly relevant to patients who already have a diagnosis of their sickness. When a patient has a proper diagnosis of what they are suffering from, it is easy to come up with the right medication for the patient. Diabetes is at times hereditary depending on somebody’s lineage (ADA, 2011). This means that lifestyle is not the only thing that leads to diabetes. Proper data analysis needs to be compiled concerning a patient’s condition. The right diagnosis of a patient’s condition also helps in the administering of the right medication. Problems that may arise from improper diagnosis have to be taken into account. In addition, various interventions help in the treatment of a sick patient whose condition is clear (Seonah, 2010). In this case, the patient’s diagnoses show that Douglas was suffering from diabetes 1(diabetes mellitus). Procedures taken towards the sick person include compiling data about his condition, outlining the proper diagnosis, sensitizing of emerging problems, and showing the interventions required (Chow & John, 2007).
Collecting Data
The data collected reveals that the patient, a male, had fifty years of age. Douglas suffered from diabetes mellitus. Diabetes mellitus is a condition whereby a person’s blood sugar level keeps fluctuating. This means that the patient does not have a normal blood sugar level. The other data compiled as pertaining to the patient’s condition was that the patient did not take alcohol but rather smoked at least a packet of cigarettes a day. The current medications taken by the patient include; Humalog Mix 25: 26 units mane and 16 units’ nocte, Perindopril: 4 mg mane, and Asprin 100 mg daily. His Glasgow coma score was 14/15 in an emergency, HR 72 bpm, BP 105/65 mmHg, RR 16 and SpO2 99 percentage (Kelly & Owen, 2010). When Douglas landed in the hospital, he was in a coma. This was a sign that his blood sugar level was exceedingly high. The other observation was that Douglas’s speech was full of stammers (De peril at.al, 2006). The stammers are evidence of a neurological disorder. This condition further culminates in the patient having general body weaknesses.
Nursing Diagnosis within 2 hours
The patient’s diagnosis took place in a spun of 2 hours. The patient is at risk of secondary hypoglycemia related to drop blood glucose level (Gordon, 2010). This is because when Douglas took sugar-laced substances like soda, his blood sugar level rose from 2.1 mmol/l to 4.7 mmol/L. The other fact that shows that Douglas was suffering from hypoglycemia is the fact that the doctor authorized the nurse to administer some carbohydrate drink after every 30 minutes. This was to ensure that the sugary drink would at least raise the level of Douglas’s blood sugar level. The patient was at the risk of impaired neurological system function related to secondary hypoglycemia (Wilson, 2011). This is because low blood sugar leads to a limited circulation of the blood in the brain. The patient would at times feel powerless, weak and even fall. This is because the patient does not have energy due to low blood sugar levels in his blood (Boyle & Zrebiec, 2007). The other symptom was that the patient would be at the risk of developing neurological problems. Less supply of blood to the brain leads to its malfunction (Carpenito, 2008). Vital signs will disappear because the body does not respond normally after the admission of medicine. This is because the body fails to go back to its normal state after someone uses diabetes-related medicine. This is because the body is not able to stabilize after the admission of diabetes medicine.
The three highest priority-nursing diagnoses
There are three nursing priorities derived from the diagnosis carried out. One of the diagnoses that are of a lot of concern is the fact that a patient is at risk of secondary hypoglycemia (Bluestone & Herold, 2010). Developing a goal would be the best thing to follow as one handles a patient. In this case, the doctor would keep the goal of administering the right medication to the patient. The patient is at risk of secondary hypoglycemia related to a drop blood glucose level. This problem ought to be solved with utmost concern. The doctor should have a goal of ensuring that the patient visits the hospital frequently. This would ensure that the doctor keeps a detailed record of the sugar levels of patient. This would in return ensure that the patient does not risk getting diseases that are more serious. Having a goal ensures that medication is up to standard and that the doctor can keep a record of progress. The other nursing priority is at the patient at risk of falling down due to hypoglycemia (Kowalski & Rosdahls, 2008). This exceedingly alarming condition affects a person that has diabetes mellitus. Goals that would reduce the event of someone falling when they have diabetes include such things as proper intake of medicine. Nursing Interventions used would include having the nurses take care of Douglas. This would mean that Douglas would be assured of getting attention of the nurses who would in return act according to his plea. The other nursing intervention would be educating Douglas on the foods that he ought to take (Medline plus, 2011). The other intervention would be providing services of consoling people like Douglas to manage their condition and live a happy life. The last intervention would be the production of materials that explain about the issue of diabetes to the readers. The readers appear equipped when they read such sources. The rationale for each intervention is for doctors to provide the best medication that helps save lives (Resnick et al, 2009). The rational includes reasons like offering the best medication. The other evaluation criteria would be keeping the patient’s condition in check. Regular check ups ensure that the condition of the patient improves with time. The evaluation criteria are usually from the doctor who examines the sick person. This is because the doctor concerns himself with the keeping of a patient’s records. The rationale is something that doctors find hard to avoid. This is because a rationale enables the doctors to act with a set objective (Estabrooks et al, 2009).
Conclusion
Nursing is a field that comprises of medical practitioners availing their services to patients. When handling a patient suffering from diabetes, it is necessary to note that medication must be up to the required standards if the patient is to get well (Goverover et al, 2009). Therefore, this must be done through such things as compiling of data about the patient. The doctor should ensure that he carries out the right diagnosis of a certain sickness. The diagnosis should be detailed to ensure that the sickness of the patient is clearly highlighted. Diagnosis ensures that the extremes of a certain sickness are clear. The diagnosis helps the doctor to administer the right medication to a patient. The diagnosis later leads to application of the right nursing interventions. The interventions lead to the right handling of a patient’s condition. The interventions must have a rationale that enables the doctor to stick to his goals (Christine & Jennifers, 2008). The last thing is usually the evaluation of the medication done.
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