Category: Diabetes

Introduction

The symptoms experienced by Mrs Possingham over the last two weeks are the typical case of diabetes. From the case study, it is revealed that Mrs Possingham had shown some symptoms that can be linked with the complication of diabetes mellitus.

The objective of this paper is to confirm that the symptoms manifested on Mrs Possingham is the complication resulted from diabetes. The confirmation of her diabetes condition was because of the signs and symptoms experienced by Mrs Possingham over the last few weeks at home.

The paper also presents reasons for her immediate clinical diabetic condition and the complications related to her diabetic condition.

Typically, the symptoms of diabetes usually appear on people of any age. Although type 2 diabetes is very common among adults aged 40 and above.

The rest of the paper is structure as follows:

• First, the paper identifies shortcoming of current management, and provide recommendations of additional management that can aid Mrs Possingham from diabetic condition.
• In addition, the paper identifies patients educational needs, and this is linked with management guideline.
• Finally, the paper identifies planning needs to alleviate the case of Mrs Possingham.

Confirmation of Diabetes in the Case of Mrs Possingham

There are several evidences to confirm the evidence of diabetes in the case of Mrs Possingham.

First, it was tested that Mrs Possingham had too much glucose in her blood stream with high-level glucose. According to Normal (2009), one of the major symptoms of diabetes is when there is elevated glucose in the blood stream of a patient, and excessive glucose in the blood stream lead to complication of diabetes.

Cyrer (2005) also argued that the syndrome of defective glucose which leads to glucose concentration is typical symptom of diabetes. It is essential to realize the high concentration of glucose in the blood can lead to advance cases of type 2 diabetes.

It should also be noted that when there is increase in the blood glucose, this will lead to a situation where cell will not able to function normally, and the complications will lead to nervousness, confusion, cool skin, and headache. From the test examination conducted on Mrs Possingham, it is revealed that there was high level of glucose in her blood stream, which confirms the symptom of diabetes on Mrs Possingham.

Moreover, from the medication such as Aspirin of 100mg daily prescribed to Mrs Possingham, this is shown to be essential for diabetic patients. Typically, Aspirin therapy is one of the medications for people with diabetes, and Aspirin is effective to reduce cardiovascular events by 15% and myocardial infarction by 36%, which have one of the symptoms of diabetic patients. (American Diabetes Association, 2004).

Essentially, the case study revealed that Mrs Possingham did not enjoy exercise, all her exercise was only to take family dog around the block for the dogs exercise. However, it is revealed that people who partake in little or no exercise such as Mrs Possingham possess the high risk of developing diabetes. With people of her age, exercise is very essential. There is need to partake in physical exercise in order to prevent diabetes especially type 2 diabetes. Meanwhile, people partaking with little or no physical exercise are at higher risk of developing type 2 diabetes. The research paper presented by Sigal et al (2006) confirmed this assertion that there is high importance on the effect of structured intervention of physical exercise in the prevention of diabetes, and the exercise is beneficial on glycemic control.

The author further argued that adults are beneficial in exercise because it improves insulin resistance. Since, Mrs Possingham had been tested for diabetes three years ago; the type of exercise recommended by World Health Organization (2002) is aerobic exercise that includes swimming, walking, or stationary cycling for at least 30 minutes a day. Thus, by not partaking in this type of exercise will aggravate her diabetes condition. It should be noted that Mrs Possingham habitual exercise was only to take the family dog around the block for the dogs exercise 4 times a week, which is contrary to WHO recommendation of physical exercise.

In addition, Mrs Possingham takes excessive intake of food and alcohol. Fox, Kilvert(2007) argued that alcohol contains calories, and carbohydrate are higher in alcohol, and may contain lot of sugar. Taking excessive alcohol can lead to diabetic occurrence on individual. Thus, there is evidence that Mrs Possingham suffers from diabetes.

Finally, Mrs Possingham showed sign of increase thirst, which is one of the symptoms of diabetes. According to Watkins (2003), thirst is one of the symptoms of diabetes.

Fox, Kilvert(2007) also argued that thirst is the most common signs of diabetes. It should be noted that people with diabetes regularly pass out urine, which lead to constant thirst, and effect will eventually lead to dry skin.

Having confirmed that Mrs Possingham is suffering from diabetes, the paper identifies the shortcoming of current management, and provides recommendations of additional management that can aid Mrs Possingham from her diabetic condition.

Additional Suggested Diagnoses, and Shortcoming of Current Management, and Recommendations of Additional Management

Apart from the diagnoses in the case study, additional supported diagnose for Mrs Possingham should be conducted with relevance to guideline provided by National Institute of Health (2008). The following test should be used for additional diagnosis of Mrs Possingham.

• Fasting Plasma Glucose (FPG) Test: This is the test to measure the blood glucose. This test should be conducted before eating for at least 8 hours. This test is conducted to detect diabetes in patients.
• Oral Glucose Tolerance Test (OGTT): This is another test to measure the blood glucose. The test is conducted between 2 and 8 hours that a person drinks glucose-containing beverage.
• Random Plasma Glucose Test: Another major test to detect diabetes is to measure blood glucose to show whether blood glucose level is 200 mg/dL or higher. The test reveals that a person has diabetes if there increased thirst, increased urination, and unexplained weight loss.

However, there is shortcoming in the management plan in the case. Apart from prescribing medication for Mrs Possingham, there is need to educate her on the appropriate method to manage her diabetes. From indication, Mrs Possingham has diabetes, and there is need to include including the procedure on how to manage her diabetes. Apart from symptom of diabetes, Mrs Possingham was at high risks of diabetes because of her age. She is 48 years, and adult from the age of 40 and above could develop type 2 diabetes if they eat high calorie of carbohydrate or glucose.

Management diabetes is essential because it is revealed that diabetes patients can live normal life if properly managed.

For instance, Hays, Clarks (1999) argued that physical activity is an integral for managing diabetes among adult. Adult of 40 and above have high risks of developing diabetes if not partaking in physical exercise. It should be noted that 30 minute a day of physical exercise is recommended for diabetes patients in order to manage their case. The benefit of physical exercise should not be underestimated. Regular physical activity improves glycemic control among adults with diabetes. Moreover, physical activity with moderate intensity provides additional benefits for cardiovascular health, as well as increasing life span to about 3 to 9 years (Tucker et al 2000).

Thus, the management of diabetes that Mrs Possingham should partake is physical activity. Essentially, Mrs Possingham could partake in 150 min/week of moderate-intensity aerobic physical activity. She could also partake in 90 min/week of vigorous aerobic exercise. These type of exercises increase heat beat rate by 70%. Typically, exercise is very advantageous for diabetic patients because of its CVD risk reduction. (Sigal et al 2006).

Meanwhile, from the indication of the advantage of physical exercise in the management of diabetes, there is need for proper education for the patient.

Patient Education Identified from the Scenario

As indicated by Davis and Rebecca (2007)

Diabetes patients who have no outpatient education have more than a fourfold increased risk of developing complications than those who do receive education. Early referral to an RD soon after diagnosis can help patients achieve better glucose control, decrease their risk of complications, and develop positive self-management behaviors at the outset (p.103).

From the case, it is revealed that the patient works as an accountant and has business lunches/dinners several days a week, which makes it difficult for her to avoid excessive intake of food and alcohol. It is essential to realise that people with obese body have high risks of developing diabetes. Thus, from indication, the patient take excessive of food and alcohol, and this made her to develop obese body. Fox, Kilvert (2007) argued that excessive alcohol contain calorie that make a person to develop weight.

Thus, there is need for the patient to reduce the amount of beer taken. Typically, there is approximately 180 calories in a pint of beer, and this is equivalent to a large roll of bread. Thus, there is strong indication that the patient should reduce the amount of beer taken. Moreover, Mrs Possingham should avoid strong brew that contain high calorie of carbohydrate. In addition, the patient should avoid taken beer that contains lot of sugar.

The excessive food taking by the patient should also be discouraged. Davis and Rebecca (2007) pointed excessive intake of carbohydrate may increase postprandial glucose excursions, and high postprandial blood glucose has been identified as an independent risk factor that can lead to cardiovascular disease. Thus, there is need to educate the patient to reduce the calories intake of her food. There is need for the patient to improve blood glucose control. Thus, to, provide guidance on the type of food that should be taking, Mrs Possingham should ensure taking non-starchy vegetables, and there should be decrease in intake of her food calories. Moreover, the patient should decrease the volume of fat and food that contain large amount of sodium.

Although, this paper is not discouraging the patient from taking carbohydrates, since carbohydrates are vital part of a healthful diet. As indicated Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with additional insulin or glucose-lowering medications. Care should be taken to avoid excess energy intake. A dietary pattern that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health. (Davis and Rebecca (2007, p101).

In addition, the case also reveals that the patient smokes 10 cigarettes per day. According Fox, Kilvert(2007) Smoking is a danger, both to the lungs, and because risk of increased arterial disease, which effects anyone who smokes. Someone with long-standing diabetes is at risks of problems with poor blood circulation, and it is unwise to increase this risk by continue to smoke. (p 179).

Watkins (2003) also support the argument of Fox et al by stating smoking exacerbates all complication of diabetes, both micro vascular, and macro vascular.(P.44). Thus, from indication, smoking is dangerous for the patient, and the patient should be properly educated on the disadvantages of smoking of her health. As a diabetic patient, smoking is dangerous for her health.

Thus, the patient should desist from smoking since it has been indicated from medical literatures that smoking is dangerous to health. Smoking, apart aggravating lung disease, the diabetic patient can develop the risk of cardiovascular disease.

Meanwhile to ensure that Mrs Possingham is able to come out from its diabetic complication, there is need to discharge care planning for her diabetic management.

Discharge Planning Needs for the Patient Case

The discharge care plan is essential to for the diabetic patient. Essentially, the patient needs have adequate plan to manage diabetes in order to ensure that the diabetes does not lead to complication. Thus, the following care plan needs to be implemented in the case of Mrs Possingham.

First, the patient needs to take the all the medication. Essentially, in the case, the medication prescribed for Mrs Possingham, and all the medications recommended by doctor should only be given to patient. There should be precautionary measure that the patient is taking the right medication, and the nurse should only administer all dosage. The medicine such as insulin should be stored in the refrigerator and be taken out 20 minutes before being given to the patient. (Buzz.com, 2009).

In addition, the glucose level of the patient should be taken regularly, and the level of the glucose should be controlled to prevent complication. It should be noted that high glucose in the bloodstream could result to complication of patient. The blood glucose of the patient should be taken every 3 or 4 hours. In addition, the urine of the patient should be taken regularly to detect the amount of glucose in the blood stream.

The regular test is essential because there can be increase of blood glucose of diabetic patients at every hour. Thus, it is essential to test for the glucose in the urine at every interval. The checking of glucose is also to examine whether blood glucose is 240 mg/dL or higher. It the blood glucose is higher, this can lead to diabetic complication of the patient. The patient should be monitored for 7 days after the patient has been admitted into the hospital. The area to be well monitored is the glucose in the blood by using blood glucose monitors to check the level of glucose in the patients blood. In addition, there should be foot care test as well as dietary program for the patient.

Moreover, it should be ensured that patient takes lot of liquid in order to manage thirst. It should be noted that increased thirst is part of symptom of diabetes.

To ensure that the diabetes condition of the patients is controlled, the blood pressure of the patient should be regularly controlled. It is revealed from the case that the patient smoke 10 cigarettes a day. Thus, people with long history of smoking may develop high blood pressure. Thus, there is need to take her blood of pressure regularly.

Typically, part of the action plan should include counselling the patient the side effect of smoking. Being a diabetic patient, smoking cigarette can aggravate the patients diabetic problems.

In addition, there should be plan for the patient to take regularly exercise each day. Typically, physical exercise is one of the potent methods to manage diabetes; there should be a plan for the patient to take regular physical exercise of minimum of 30 minutes a day.

Moreover, diet control is very essential for diabetes patients. The food eating by the patient should be monitored to ensure that the patient does not eat food that contains high level of calories. In addition, the patient should be discouraged to take food that contains high content of glucose and sugar. The food such as cereals, rice, potatoes should be encouraged for the patient. The patient should be encouraged to consult competent dietician before embarking on dietary plan. There should be monitoring of basal metabolic index of the patient. This should be done on monthly basis for the regular references.

It should be noted that charming and friendly attitude to the patient is very essential to the care plan of diabetic patient. The attitude of a nurse towards the patient can aid the patient to recover from the disease as early as possible. Thus, effective care plan is very essential to achieve a potent health for the patient. (Buzz.com, 2009).

Conclusion

Diabetes is one of the diseases that can cause several complications on patients. Evidence has revealed that diabetic complication range from stroke, heart disease or death. Thus, there is need to manage disease before it leads to complication. This paper examines the case of Mrs Possingham, and confirmed suffering from diabetes. From the symptom developed by the patient, it is revealed that the patient is suffering from diabetes. Thus, the paper provides methods that can be used to diagnosis the patient in order to confirm her diabetic condition. The paper also provides recommendation for patient to manage diabetes.

Part of the recommendations provided is physical exercises. Typically, physical exercise is an essential tool to manage diabetes. Several complications leading to diabetes can be easily managed if the patient is partaking in regular physical exercise. In addition, the paper identifies patients education on which to manage diabetes. Finally, the paper discharges plan for patients case. The plan is essential to ensure that the patient is properly treated in the hospital, and the education that will be provided for the patient will help the patient to live a normal life.

List of References

American Diabetes Association, (2004) Aspirin Therapy in Diabetes Diabetes Care, 27(1) pp s72-s73.

Buzz. (2009) Nursing Care Plan For Diabetes, Buzz Limited.

Cyrer, P.E. (2005) Mechanisms of Hypoglycemia-Associated Autonomic Failure and Its Component Syndromes in Diabetes, A journal of the American Diabetes Association, 54 (12), pp 3592-3601.

Davis, D.L. Rebecca, P.G. (2007) Nutrition 911: The First Responders Guide to Food and Diabetes Clinical Diabetes, 25(3), pp.101-103.

Fox, C. Kilvert, A. (2007) Type 2 Diabetes, UK, Class Publishing (London) Ltd.

Hays, L. Clark, D. (1999) Correlates of physical activity in a sample of older adults with type 2 diabetes, Diabetes Care, 22, (5), pp.706-712.

National Institute of Health (2008) Diagnosis of Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases.

Normal, J. (2009) Diagnosing Diabetes The two primary tests and their results, which combine to make the diagnosis of diabetes, Edocrine Web.

Sigal, R. et al (2006) Physical Activity/Exercise and Type 2 Diabetes, Diabetes Care 29 (6), pp 1433-1438.

Tucker, K. Bermudez, O. Casteneda C (2000) Type 2 diabetes is prevalent and poorly controlled among Hispanic elders of Carribean origin, American Journal of Public Health, 90(8), pp. 1288-1293.

World Health Organisation (2002) Keep fit for life, Meeting the nutritional needs of older persons, Tufts University School of Nutrition and Policy.

Watkins, J. (2003) ABC of Diabetes, UK. Wiley-Blackwell.

The patient who referred to Sabatia Health Center for medical treatment was diagnosed with diabetes. The clinical assessment of the patient revealed a low insulin level and poor response to the insulin injections which resulted in the constant thirst, feeling of hunger, and urinary incontinence. Along with the physiological problems, the disease provoked the psycho-emotional disturbance as the patient gained weight and became more diffident due to the poor health condition.

The desired outcomes for the identified physiological problems include stabilization of insulin level, normalization of eating habits, loss of excess weight gained throughout disease progression, and elimination of the consequent symptoms such as permanent hunger and involuntary urination. Stabilization of insulin level is the basic goal of the intervention because the hormonal misbalance may be regarded as the cause of all other identified health problems (Dunning, 2009). It is possible to say that the improvement of hormonal functioning will lead to the reduction of complications such as kidney failures, eating disorders, and gain excess weight.

The desired outcomes for the intervention of the psychological condition are the reduction of stress and depressive symptoms that will be manifested in the social-emotional well-being of the patient and the development of a positive mindset. The intervention of psycho-emotional condition is important because mental health and the adopted positive mental structures and beliefs may substantially facilitate the course of medical treatment and impact the patients social performance in a good way (Goh, Rusli, & Khalid, 2014).

Holistic Nursing Intervention

It is observed that diabetes is associated with a high risk for the development of mental health problems and vice versa, and the diagnosed individuals are prone to the occurrence of mental problems in two times more often than those without diabetes (Patterson & Moxham, 2016). The findings make it clear that the holistic approach to treatment is required.

The nurse-led diabetes intervention and care management is an effective method of treatment for the acute problems caused by the illness and prevention of the potential adverse outcomes such as the development of heart disease, blindness, and lower-limb amputations (Beecher & Apple, 2013). The holistic nursing intervention includes the patients support in managing the medication intake, adoption of healthier dietary habits, coordination of physical activity, and weight loss.

The intervention should involve cognitive-behavioral therapy aimed to improve the psychological condition of the patient and increase his awareness regarding diabetes-related issues. Through participation in the course of cognitive therapy, patients practice the stress management activities that may help to achieve the long-term reduction of distress and anxiety and stimulate the behavioral changes increasing the efficiency of medical treatment (Iordache, Cioca, & Popa-Velea, 2014).

It is important to apply the culturally sensitive approach as well. Since the patient strongly identifies himself with Christianity, addressing his religious needs during the intervention may have favorable impacts on the outcomes of self-care management. Social and cultural backgrounds are regarded as essential sources of support in coping with illness (Cattich & Knudson-Martin, 2009). Through communication within the religious community and family, the patient may increase his confidence and decrease depressive symptoms and distress.

Evaluation Criteria

The short-term criteria for the evaluation of intervention effectiveness include the level of patient involvement in the cooperation with a nurse during treatment. Based on the patients attitude towards the implementation of the treatment plan it will be possible to predict his readiness for changes and improvement. The long-term criteria are the reduction of negative psychological symptoms stimulated by the change of lifestyle and practice of stress management activities.

The patient will also demonstrate the enhancement of physical health indicators manifested in the normalization of insulin level and weight loss. The ultimate positive result of intervention will be manifested in better health conditions and improvement of the psycho-emotional and social performance of the patient.

References

Beecher, G. P., & Appel, S. J. (2013). An algorithm for care: Managing type 2 diabetes. Nursing, 43(6), 14-17. Web.

Cattich, J., & Knudson-Martin, C. (2009). Spirituality and relationship: A holistic analysis of how couples cope with diabetes. Journal of Marital and Family Therapy, 35(1), 111-24. Web.

Dunning, T. (2009). Care of people with diabetes: A manual of nursing practice. Chichester, UK: Wiley-Blackwell Publishing.

Goh, S. G., Rusli, B. N., & Khalid, B. A. (2014). Diabetes quality of life perception in a multiethnic population. Quality of Life Research, 24(7), 1677-1686. Web.

Iordache, M., Cioca, I., & Popa-Velea, O. (2014). The impact of a cognitive-behavioral intervention on the relapse rate of type 2 diabetes depressive patients. Journal of Psychosomatic Research, 76(6), 506. Web.

Patterson, C., & Moxham, L. (2016). Diabetes and mental health: A holistic approach is needed. Australian Nursing and Midwifery Journal, 23(9), 42. Web.

The 2010 factsheet by the Centers for Disease Control (CDC) reveals that 10.9 million Americans of 65 years and above are suffering from type 2 diabetes mellitus. The same report estimates that in 2010, some 79 million Americans over the age of 20 years have pre-diabetes (Centers for Disease Control and Prevention, 2011).

Diabetes complications can be very costly to be managed as diabetic patients incur more than twice the medical expenses non-diabetic patients need. Eonta et al (2011) contend that smartphones can be used in searching for valuable health information and educational materials on the management of diabetes. The current scholarly paper is an attempt of examining the role of smartphones in type 2 diabetes mellitus self-management.

The dramatic rise in the number of individuals living with type 2 diabetes coupled with the escalation in the cost of managing this chronic condition shows that primary care practices are overwhelmed by the demand for diabetes services. Much of the diabetes management takes place outside the healthcare facilities, but still, patients are increasingly reliant on healthcare providers for support and counseling. Due to limitations in reimbursement and staffing exercise, counseling patients on diet and other crucial self-management behaviors rarely get accomplished as part of the routine primary care (King et al. 2012).

Research indicates that the use of in-person interventions may enhance biological and behavioral outcomes although it is still unclear whether the use of technology would help minimize the associated high cost without reducing their effectiveness. However, the use of well-designed patient-centered e-health technologies would be useful in promoting the dissemination and improving patients access to efficient and effective self-management programs.

Estimates by the American Diabetes Association revealed that the United States is faced with an annual economic burden to be spent on managing diabetes mellitus, which amounts to $ 174 billion (American Diabetes Association 2008). Further, the American Diabetes Association has advocated for the use of seven self-care behaviors that persons with diabetes mellitus need to practice to attain integrated management of this chronic condition.

One of these self-care behaviors is the periodic self-monitoring of the patients blood glucose levels. Bresnick (2012) has noted that patients self-monitoring of blood glucose levels was linked to crucially important improvements in glycemic control among patients with type 2 diabetes mellitus.

Data management tools are important since they facilitate in logging self-management blood glucose data, thereby enabling healthcare providers to easily recommend the most appropriate exercise, diet, as well as medication interventions. The final objective of data management is effective to facilitate the management of a patients diabetes conditions, controlling or minimizing glycated hemoglobin as well as delaying or preventing the complications that normally accompany it.

In a study conducted by Azar and Gabbay (2009), the researchers noted that those patients who shared self-management blood glucose data with their healthcare providers via Web-based tools, such as smartphones, both reduced the long-term costs of managing the chronic conditions and saved time as well.

Moreover, patients with type 2 diabetes mellitus demonstrated significant improvements in their HbA1c levels, unlike those with type 1diabates. Patients were supposed to log in to their accounts and upload their self-management results. Thereafter, healthcare providers would respond to the patients through text messages, via the internet, or their mobile phones (Bergenstal, 2005).

A regression trial study by Sevick et al (2008) revealed that the use of self-management blood glucose aided by a portable digital assistant (PDA) was both promising and useful in the management of diabetes mellitus. Forjuoh et al (2008) revealed that even as the use of PDA-assisted care was quite challenging, nonetheless, it resulted in a significant reduction in HbA1c. Azar and Gabbay (2009) discovered that patients who shared their self-management blood glucose data via the internet or mobile phones, along with the resultant feedback via in-person appointments, email, or text led to a decline in the number of hospitalizations while at the same time improving glycemic control.

Furthermore, the adoption of any kind of technology is reliant on the associated learning curve of the software or gadget, along with its underlying architectural and technical design (Årsand, Tatara & Hartvigsen, 2011). For instance, diabetes patients suffering from vision problems could find it hard to operate the mini-keyboard interface used in most smartphones.

Notwithstanding that, the push for the application of smartphone-based solutions in the self-management of type 2 diabetes gains prominence from a demographic point of view. Currently, the larger majority of individuals who own and use smartphones are between 25 and 44 years old (Nielsen Wire 2009).

These statistics are further supported by a factsheet released by the Centers for Disease Control and Prevention (2008) showing that individuals between 40 and 59 years of age have a higher chance (50%) of being diagnosed with diabetes for the first time. If we consider diabetes-risk and smartphone-using demographics remain constant, it means that majority of the current smartphone users are likely candidates for diabetes mellitus in the next decade.

Research findings by several quantitative studies reveal that the use of smartphones could be a valuable strategy in enabling type 2 diabetes patients to manage the condition. Arsand and Demiris (2008) have underscored the importance of mobile phone-based self-management of type 2 diabetes mellitus, have argued that in such endeavors, the patient ought to be an active player.

The researchers further revealed that the use of mobile phone-based self-management of type 2 diabetes results in enhanced lipids and glycemic control, not to mention improvements in lifestyle and self-care behaviors due to increased physical activity and improved dietary habits.

Based on the foregoing arguments, Arsand and Demiris (2008) contended that the use of mobile phones in the self-management of type 2 diabetes mellitus would result in a minimization of the overall risk for type 2 diabetes complications, such as a reduction in the prevalence of metabolic syndrome and absolute risk for coronary heart diseases. Type 2 diabetes mellitus requires sustainable and sufficient patient-initiated self-management (Piette, 2007).

On the other hand, it is not unusual to have poor adherence to type 2 diabetes mellitus (Sabaté, 2003). Therefore, several researchers considered the use of mobile phones a promising intervention strategy in supporting self-management of type 2 diabetes mellitus due to their ubiquity and pervasiveness (Blake 2008). The emergence of smartphones has led to a dramatic increase in the number of free as well as commercial self-management tools for type 2 diabetes mellitus (Chomutare et al., 2011).

The rapid increase in lifestyle-related conditions, such as type 2 diabetes mellitus, has seen many players designing tailored and low-cost information and communication technology (ICT) tools to aid in disease management as well as lifestyle changes. There is ample evidence in the literature to show that there is a growing importance to using an electronic tool in the management of type 2 diabetes mellitus, along with enhanced disease-related outcomes. Between 2001 and 2008, there had been a rise in publications on the use of mobile self-help tools, especially in the management of type 2 diabetes.

A study conducted by the University of Maryland revealed that mobile phone technology applications could result in tremendous improvements in control of blood sugar by type 2 diabetes mellitus patients (Quinn et al 2011). The researchers revealed that the use of an interactive computer software program mounted onto a mobile phone resulted in a 1.9 percent reduction in hemoglobin A1C levels over the 1 year period that the patients were monitored. Hemoglobin A1C is an important indicator of blood glucose control. The A1C test is a useful indicator of the average everyday blood glucose levels of a patient spread across 2-3 months.

According to the American Diabetes Association, an individual should ideally have an A1C level of below 7 percent. The majority of Americans diagnosed with type 2 diabetes report an average A1C level of 9 percent. Considering that this level of A1C increases the risk of the patients developing diabetes-related complications, we can then should value the crucial role of mobile phone applications in the management of type 2 diabetes mellitus.

The kind of technology applied in the study by Quinn et al (2011) along with other related works indicates the growing application of information and communication technologies (for example, mobile phones, the internet, as well as Bluetooth) is not only tracking, but also facilitating the transmission of blood glucose results to adult patients diagnosed with type 2 diabetes mellitus.

In the past, patient education programs have played a crucial role in reducing type-2 diabetes-related complications. However, it is important to note that not many individuals with type 2 diabetes mellitus were able to attend structured or formal education programs where they could learn more on how to take care of themselves, using self-management strategies. A better application of smartphone technology could give benefits to individuals with type 2 diabetes mellitus as far as self-management is concerned.

The California-based Palo Alto Medical Foundation conducted a randomized control trial and revealed that individuals proven hard to control type 2 diabetes benefited enormously from an online disease management program that entailed the use of a smartphone and a wireless blood glucose tool (Bresnick, 2012).

Some 415 patients took part in this trial that was conducted for slightly over a year. Of the 415 patients taking part in the trial, 193 of them were beneficiaries of a wireless home glucometer implemented in a smartphone where it related to the patients diabetes readings. This enabled patients to see the diabetes information online. Moreover, the device also allowed them to view valuable information on diabetes management, such as blood pressure, insulin management, and tips on diet, weight control, and exercise, among others.

In addition, nurse managers and dieticians also made regular contact with the test group via secure messaging. On the other hand, participants benefitted from regular updates regarding the progress they were making. After six months, the researchers noted a significant improvement in the participants in their control of glycosylated hemoglobin levels as compared with the control group. Within 12 months, the overall A1C levels of the participants have significantly decreased.

The prevalence and incidence of Type 2 diabetes mellitus are increasing very fast, and this is putting a lot of strain on the existing primary healthcare providers (Boutati & Raptis 2009). As such, it would be worth embracing technology in the self-management of type 2 diabetes mellitus as a way of increasing adherence to the treatment regimens and also reducing the associated costs. Over the past several years, we have witnessed that such technologies as computers and mobile phones are not only educating the patients about the condition but also helping them monitor their glucose levels.

Several meta-analysis studies that have been conducted on this topic reveal that the use of smartphones allows patients to view important information on diabetes management, including insulin management, blood pressure, weight control, diet tips, as well as exercise. They also get important feedback from healthcare providers. The studies have also shown that such patients tend to have improved glycemic control and glycosylated hemoglobin levels as compared with the control group.

Reference List

American Diabetes Association. (2008). Economic costs of diabetes in the U.S. in 2007. Diabetes Care, 31, 596615.

Arsand, E., & Demiris, G. (2008). User-centered methods for designing patient-centric self-help tools. Inform Health Soc Care, 33(3),158-69.

Årsand, E., Tatara, N., & Hartvigsen, G. (2011). Wireless Mobile Technologies Improving Diabetes Self-Management. Handbook of Research on Mobility and Computing: Information Science Reference, 136-156.

Azar, M., & Gabbay R. (2009). Web-based management of diabetes through glucose uploads: has the time come for telemedicine? Diabetes Res Clin Pract., 83(1), 9 -17.

Bergenstal, R. M., Anderson, R. L., Bina, D. M., Johnson, M. L., Davidson, J. L., Solarz Johnson, B., & Kendall, D. M. (2005). Impact of modem-transferred blood glucose data on clinician work efficiency and patient glycemic control. Diabetes Technol Ther., 7(2),241247.

Blake, H. (2008). Mobile phone technology in chronic disease management. Nurs Stand., 23(12),43-46.

Boutati, E., & Raptis, S. (2009). Self-monitoring of blood glucose as part of integral care of type 2 diabetes. Diabetes Care, 32(2), 205-210.

Bresnick, J. (2012). Type 2 diabetics benefit from smartphone disease management. Web.

Centers for Disease Control and Prevention. (2008). National diabetes fact sheet: general information and national estimates on diabetes in the United States 2007. Atlanta: U.S. Department of Health and Human Services Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention. (2011). National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Chomutare, T., Fernandez-Luque, L., Arsand, E., & Hartvigsen, G. (2011). Features of mobile diabetes applications: review of the literature and analysis of current applications compared against evidence-based guidelines. J Med Internet Res., 13(3), e65.

Eonta, A., Christon, L., Houriga, S., Ravinran, N., Vrana, S. & Southam-Gerow (2011). Using everyday technology to enhance evidence-based treatments. Professional Psychology:Research and Practice, 42(6), 513-520.

Forjuoh, S. N., & Reis, M. D., Couchman, G. R., & Ory, M. G. (2008). Improving diabetes self-care with a PDA in ambulatory care. Telemed J E Health, 14(3),273-279.

King, D. K., Toobert, D. J., Portz, J. D., Stycker, L. A., Doty, A., Martin, C., Boggs, J. M., Faber, A. J., Geno, C. R., & Glasgow, R. E. (2012). What patients want: relevant health information technology for diabetes self-management. Health and Technology, 2(3), 147-157.

Nielsen Wire. (2009). The Nielsen Company Media blast: Nielsen Mobile provides smartphonstatistics. Web.

Piette, J. D. (2007). Interactive behavior change technology to support diabetes self management: where do we stand? Diabetes Care, 30(10), 2425-2432.

Quinn, C. C., Shartdell, M. D., Terrin, M. L., Barr, E. A., Ballew, S. H., & Gruber-Baldini, L. (2011). Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control. Diabetes Care, 34(9), 1934-42.

Sabaté, E. (2003). Adherence to Long-Term Therapies: Evidence for Action. Geneva: World Health Organization.

Sevick, M. A., Zickmund, S., Korytkowski, M., Piraino, B., Sereika, S., Mihalko, S., Snetselaar, L., Stumbo, P., Hausmann, L., Ren, D., Marsh, R., Sakraida, T., Gibson, J., Safaien, M., Starrett, T. J., & Burke, L. E. (2008). Design, feasibility, and acceptability of an intervention using personal digital assistant-based self monitoring in managing type 2 diabetes. Contemp Clin Trials. 29(3),396409.

Introduction

Diabetes insipidus is a type of diabetes that is characterized by a reduced production of the ADH (antidiuretic hormone) also known as vasopressin in the body. This type of diabetes is manifested in the form of water metabolism disorders. This means that a patient experiences excessive thirst and excretes a lot of severely diluted urine. There are two main types of diabetes insipidus. The first one is characterized by reduced secretion of vasopressin, and it is known as cranial diabetes insipidus. The second type is known as nephrogenic diabetes insipidus (Babey, Kopp & Robertson, 2011). This type is caused by the failure by the kidneys to respond to vasopressin. These are the most common types of diabetes. This essay will look into the pathophysiology, diagnosis, and treatment of these two conditions.

Pathophysiology of Nephrogenic Diabetes Insipidus

In this condition, the kidneys become insensitive to the antidiuretic effects of vasopressin. This may result in excessive production of dilute urine. Loss of body water prompts increased plasma osmolality. This triggers the thirst mechanism thereby increasing a patients water intake to compensate for the lost amount. Because of this, the plasma osmolality is stabilized at a higher level prompting the body to increase the thirst threshold. Polydisia and polyuria levels vary depending on various factors. These might include differences in solute load, thirst sensitivity, and vasopressin osmostats. For polyuria to occur, renal insensitivity does not have to be complete.

This is because the effects only need to be enough to hamper concentration of urine at vasopressin plasma levels. This level is achieved under normal conditions of water intake. In this case, the plasma osmolality is almost at the osmotic thirst threshold. According to vasopressin deficiency calculations, this level can only be reached after sensitivity to vasopressin has been reduced by tenfold. Practically, the levels of vasopressin in urine concentration have to be more than 5pg/mL. (Uyeki, Barry, Rosenthal & Mathias, 1993).

Urine osmolality and levels of plasma vasopressin are the main determinants of the severity of nephrogenic diabetes insipidus. Insensitivity to the vasopressin can be incomplete at times. This means patients suffering from this condition have the ability to concentrate their urine if they do not take much water. This may also occur when large doses of vasopressin are administered.

Pathophysiology of Cranial Diabetes Insipidus

When it comes to cranial diabetes insipidus, the main defect is lack of osmoregulated vasopressin production (Majzoub & Srivatsa, 2006). This means that the excreted renal water is solute free. To maintain a water and normonatraemia balance, a lot of fluid intake is required. In case a patient does not access water or he/she is not thirst sensitive, he/she develops hypernatraemia. High water intake makes plasma osmolality stabilize at higher levels. This is necessary for maintaining normal water balance.

Diagnosis

The first step in diagnosing diabetes insipidus is making sure that a patients urine volume is tracked in the course of a twenty-four hour period. This can positively indentify polyuria. Subsequent tests include blood tests to measure serum, glucose, calcium, and potassium levels. These tests are meant to rule out conditions that enable nephrogenic insipidus. Osmolality in urine samples is best determined from early morning samples. However, concomitant serum samples provide the best results.

One can also diagnose this condition by measuring plasma vasopressin in response to plasma osmolality (Ball, Vaidja & Baylis, 1997). A hypertonic saline is induced over a time of two hours for this to be accomplished. This continues until plasma osmolality of about 300mmol/kg is achieved.

Administering low dosage desmopressin can also be used as a diagnosis tool. This is particularly important in cases where there is no equipment to measure plasma vasopressin. In this diagnosis, the patients urine osmolality and volume, weight, and plasma sodium are recorded for the first three days. Then a small dose of intramuscular desmopressin is administered for the next eight to ten days. If there is a reduction of thirst indentified and reduced urine volumes within this period, then the patient may be suffering from nephrogenic insipidus.

Treatment

Cranial diabetes insipidus is mostly treated by introducing a synthetic hormone known as arginine vasopressin into the body. The drugs vasopressin molecule prolongs its antidiuretic ability. For diuresis to be fully controlled, several dosages are required. Daily oral doses vary from 100 to 1000¼g for two or three times a day. Sometimes, treatment may result in erratic changes in osmolality (Makaryus & McFarlane, 2006). This usually happens in the initial stages of treatment before the correct dosage has been figured out.

Nephrogenic diabetes inspidus is harder to treat than cranial diabetes. Other than drug induced or metabolic related disorders, the rest involves lengthy treatments. Treatment involves salt restriction together with the administration of a thiazide diuretic. A potassium-sparing drug like amiloride should accompany this medication. Lately, the condition is being treated using a combination of indomethacin, thiazide, and desmopressin.

References

Babey, M., Kopp, P. & Robertson, G.L. (2011). Familial forms of diabetes insipidus: clinical and molecular characteristics. Nature reviews. Endocrinology, 7(12), 701-14.

Ball, S.G., Vaidja, B. & Baylis, P.H. (1997). Hypothalamic adipsic syndrome: diagnosis and management. Clin Endocrinol, 47,405409.

Makaryus, A.N. & McFarlane, S.I. (2006). Diabetes insipidus: diagnosis and treatment of a complex disease. Cleveland Clinic journal of medicine, 73(1), 65-71.

Majzoub, J.A. & Srivatsa, A. (2006). Diabetes insipidus: clinical and basic aspects. Pediatric endocrinology reviews, 1, 60-65.

Uyeki, M., Barry, F.L., Rosenthal, S.M. & Mathias, R.S. (1993). Successful treatment with hydrochlorothiazide and amiloride in an infant with congenital nephrogenic diabetes insipidus. Pediatr Nephrol, 7, 554556.

Obesity refers to a medical condition whereby a persons body structure is made up of excessive body fats to an extent that is detrimental to their health. More generally obesity and overweight are defined the same way as conditions where a person body fats are above normal levels (WHO.com). The official definition of World Health Organization (WHO) states that obesity is a condition where a person has abnormal or excessive fat accumulation that may impair health (WHO.com). A research study by Lostein et al indicates that worldwide approximately 10% of school going children aged between 5 years and 17 years can be described to be obese; a quarter of whom are at a heightened risk of developing type 2 diabetes (Lobstein, Baur and Uauy).

Based on the present trends, obesity among children is now regarded as one of the major risk factors of type II diabetes. Type II diabetes is generally regarded as a lifestyle disease that occurs later in life and which can largely be prevented with the right type of eating habits and change in lifestyle. This is certainly the main difference between type I diabetes and type II diabetes which is the reason it is most prevalent among obese children. In type II diabetes, the pancreas produces minimal levels of insulin which are not enough to sustain the body functions; an anomaly brought about by change in body systems (Lobstein et al).

Because type II diabetes is intricately related with obesity, lets briefly review the major risk factors of obesity which can be termed as indirect risk factors of type II diabetes. The major cause that is attributed to the high rate of obesity prevalence in the world today is mainly because of lifestyle changes. The term lifestyle when used in this context describes a particular way of living based on two forms of determinants; types of food eaten and physical activeness (Kim and Willis). One of the major factor that is attributed to overweight in both adults and children is dietary intake of food that are high in fats, sugars and carbohydrates which are more than the maximum amounts that the body requires for it sustenance. When high diets of fats, carbohydrates and sugars are consistently taken over time the result is accumulation of energy that is stored in form of fats within a persons body leading to excessive weight (Puhl and Heuer).

Lack of exercise is not a cause of obesity per se; rather it is a confounding factor that accelerates the process of obesity given that the body is not actively utilizing the excess energy that is stored in form of body fats. However recent research findings indicates that the cause of obesity or overweight in that case are hardly limited to the two factors mentioned above; obesity is now also determined to be influenced by a persons genetic makeup, frequency of eating, rate of metabolism, medications, psychological factors and certain diseases all of which varies among different people

Needless to say prevention and management of type II diabetes significantly depends with management and prevention of obesity and overweight. Since obesity is largely a factor of three key determinants; food intake, type of diet and level of physical activity any form of type II diabetes interventions must be structured along these determinants. A framework of addressing challenges caused by overweight and obese conditions has been outlined in WHO Global Strategy on Diet, Physical Activity and Health resolution (WHO.com).

References

Kim S., Willis L. Talking about Obesity: News Framing of who is Responsible for Causing and Fixing the Problem. J Health Communic, 12(1) 2007: 359376. Print

Lobstein, T., Baur, L. & Uauy, R. Obesity in children and young people: a crisis in public health. Obesity Reviews, 5.1 (2004): 4-85. Print

Puhl, R. & Heuer, C. The Stigma of Obesity: A Review and Update. Obesity, 17.5 (2009): 941- 964. Print

WHO.com. Obesity and Overweight: What are Obesity and Overweight? 2007. Web.

Gestational diabetes mellitus (GDM) is widely debated as one of the controversial and less-researched medical conditions. The prevalence of GDM is at an all-time high of 15%, which is expected to grow significantly due to the increasing amount of obese women of reproductive age (Mensah et al., 2019). The reason for such high numbers is the trend in urbanization in upper-middle-income countries, which has resulted in increased caloric supply (in general) and decreased employment of women in the agricultural industry (in particular). GDM has a negative impact on the economy and is associated with various pregnancy complications that put mothers and their unborn children at risk (Chiefari et al., 2017). However, the topic of GDM remains highly controversial since there are no uniform prevention strategies and care management plans. The latest studies (Carolan-Olah, 2016; Mensah et al., 2019) report that the future of GDM treatment lies in preventative care, which is why registered nurses (RN) become vital in the management of patient education and the supervision of healthcare interventions.

Overview of Gestational Diabetes Mellitus

There is a need to define the symptoms, health effects, and treatment options for GDM as the most common metabolic disorder of pregnancy. GDM is a type of glucose intolerance that develops in the second and third trimesters and results in numerous maternal complications. Mensah et al. (2019) identify hypertension, preeclampsia, cesarean section, infection and polyhydramnios as the most common complications (p. 79). GDM is categorized as a condition related to fetal morbidity in terms of macrosomia, birth trauma, hypoglycaemia, hypocalcaemia, hypomagnesemia, hyperbilirubinemia, respiratory distress syndrome and polycythemia (Mensah et al., 2019, p. 79). In addition, women with GDM are at a higher risk of developing type 2 diabetes and a range of cardiovascular conditions after pregnancy (Chiefari et al., 2017). At the moment, health professionals focus on early screening and diagnosis based on the known risk factors. Once diagnosed, women are subject to lifestyle modifications and routine screening (Mensah et al., 2019). However, the most severe cases of GDM are treated by means of metformin, glyburide, and insulin (Mensah et al., 2019). The increasing incidence and resulting short- and long-term health effects of GDM emphasize the importance of generating effective treatment strategies.

Relevance to Nursing

Nurses play an important role in the treatment of GDM. Since there is significant evidence supporting the implementation of health interventions and various forms of patient education (Carolan-Olah, 2016; Mensah et al., 2019), nursing professionals take on numerous responsibilities in planning and managing these initiatives. Women at high risk of developing GDM require medical advice on diet, physical exercise, and weight control, which often comes from primary care nurses. In addition, nursing practitioners are tasked with providing these women with all the necessary information regarding smoking and alcohol cessation, as well as the withdrawal of certain medications. Apart from behavioral interventions and educational programs, nurses are also involved in blood glucose tests and selective screening (Mensah et al., 2019). Both general physicians and RNs assist women diagnosed with GDM by monitoring and interpreting their blood glucose levels, and treating numerous possible health complications such as hypoglycemia and hypomagnesemia (Mensah et al., 2019). Therefore, it is crucial for nurses to have a strong theoretical framework in order to utilize the knowledge in practice.

Patient Education and Nursing Interventions

Preventative care is the primary focus of the latest academic research regarding GDM and possible complications associated with the disease, which puts nurses at the forefront of delivering vital health information to patients during pregnancy and postpartum. Since GDM is the most common metabolic condition experienced by pregnant women (Chiefari et al., 2017), nurses are obligated to consult patients and their families about the possibility of developing such a condition. In addition, high-risk individuals often require general physicians and RNs to provide them with the necessary medical insights regarding GDM symptoms, diagnosis, and treatment options. In order to gain informed consent from the patients, nurses have to explain the medical reasons for blood glucose testing and screening. Nursing professionals educate patients on the importance of self-monitoring of blood glucose (SMBG) levels focusing primarily on the positive outcomes of SMBG, including fewer oversized infants and a reduction in weekly maternal weight gain (Carolan-Olah, 2017, p. 111). Carolan-Olah (2017) concluded that such interventions were successful in reducing the risks of infant overgrowth, cesarean delivery, and high blood pressure (p. 111). It is crucial to acknowledge that nurses are crucial in the management of SMBG interventions.

Apart from the general patient education that covers basic concepts and possible health complications, nurses are also involved in dietary interventions. Registered nurses are responsible for providing patients with necessary medical advice regarding their diet choices and physical activity. Based on the research conducted over the past decades, nurses are now equipped with comprehensive guidelines that help them navigate dietary and lifestyle (also known as behavioral) interventions (Carolan-Olah, 2017). Dietary recommendations include incorporating a nutrition plan that would keep blood glucose levels balanced. Nurses advice on increasing daily activity levels, which is an important part of a GDM-related intervention as well. According to Carolan-Olah (2017), registered nurses assist general physicians in improving health promotion behaviors by taking part in behavioral interventions and referring patients to counselors. Such interventions and counseling are often tailored to womens cultural and social backgrounds, which helps them get the support they need to implement necessary dietary and lifestyle changes.

Impact on the Health of Pregnant Women and Newborns

GDM is the reason for some of the most severe pregnancy complications for both mother and child. These complications include cesarean delivery, shoulder dystocia, macrosomia, and neonatal hypoglycemia (Chiefari et al., 2017, p. 899). In addition, women with GDM have a high risk of developing type 2 diabetes, while their offspring have a higher likelihood of becoming obese early in life (Mensah et al., 2019). According to Chiefari et al. (2017), women with prior GDM have a significantly higher rate of obesity, hypertension and metabolic syndrome, together with altered levels of circulating inflammatory markers (p. 902). All of the aforementioned conditions serve as primary risk factors for developing cardiovascular disease. The long-term effects of GDM affect children as well. The offspring of GDM mothers are more likely to show greater central adiposity, have abnormally high blood pressure and develop dyslipidemia (Chiefari et al., 2017). Such serious health implications of GDM emphasize the importance of developing comprehensive management and prevention frameworks for GDM.

Ethical and Legal Implications

The process of treating GDM and managing its preventative care implies a number of legal and ethical implications. Nurses are expected to conduct dietary, SMBG, and lifestyle interventions using the traditional ethical principles of beneficence, autonomy, and non-maleficence (Shandera, 2017). GDM, however, is a medical condition that often leads to additional stress since patients are not only concerned for themselves, but for their newborns as well. Nurses face the challenge of providing mothers with all the necessary medical information regarding GDM (informed consent) while minimizing the stress associated with pregnancy in the first place. The name of the disease that includes diabetes may mislead patients into thinking that they are obese when, in reality, there is an issue with their blood glucose levels. It is nurses ethical responsibility to provide patients and their families with a thorough explanation. Undiagnosed GDM can lead to legal battles since this medical condition might result in irreversible long-term health complications.

References

Carolan-Olah, M. C. (2016). Educational and intervention programmes for gestational diabetes mellitus (GDM) management: An integrative review. Collegian, 23(1), 103-114. 

Chiefari, E., Arcidiacono, B., Foti, D., & Brunetti, A. (2017). Gestational diabetes mellitus: an updated overview. Journal of Endocrinological Investigation, 40(9), 899-909. 

Mensah, G. P., ten Ham-Baloyi, W., van Rooyen, D., & Jardien-Baboo, S. (2019). Guidelines for the nursing management of gestational diabetes mellitus: An integrative literature review. Nursing Open, 7(1), 78-90. 

Shandera, W. X. (2017). Ethical issues attendant with the current pandemic of diabetes. Clinical Diabetes and Research, 1(1), 35-39. Web.

Problem Identification in the Professional Work Setting

The problem is diabetes mellitus: Many clients suffer from diabetes mellitus and the incidence of this disease has been on the increase in the past ten years.

A Description of the Importance of the Problem

Diabetes mellitus is a problem that needs urgent attention because of the complications it brings to the sufferers. Specifically, patients with diabetes mellitus have a high chance of developing diabetic foot which in turn causes additional and severe complications. Complications arising from diabetic foot are caused by deep infections and gangrene, which increase the risk of the amputation of the lower limb. It is argued that people with diabetes mellitus have a risk of lower limb amputation which is twenty times higher than that of the general population. In addition, patients with diabetes mellitus have a higher morbidity rate, disability rate, emotional and physical losses than the general population because of complications arising from the diabetic foot (Poljicanin, Pavlic-Renar, Metelko & Coce, 2005).

Reputable Sources that Support the Importance of the Problem

The importance of the complications brought about by diabetes mellitus has been highlighted by various research studies. These studies are discussed in this section. Poljicanin et al., 2005 argue that out of the total number of all lower limb amputations, 40%-60% are carried out in persons with diabetes mellitus, and more than 85% of them are the consequence of a diabetic foot (p. 43). Other studies argue that the early diagnosis and management of independent risk factors may hinder or delay the development of diabetic foot. The risk of ulcers and amputations is higher among persons who have had diabetes for more than 10 years. The risk is also higher in men, and in those with poor control of glycaemia and/or cardiovascular, retinal or renal problems (Rangnarson & Apelquist, 2001).

An increased risk of amputation is related to a number of conditions which include: peripheral neuropathy with loss of protective sensation, altered biomechanics (in the presence of neuropathy); evidence of increased pressure; bone deformity; peripheral vascular disease; a history of ulcers or amputation; and severe nail pathology (Rangnarson & Apelquist, 2001, p. 2079). Armstrong, Holtz-Neiderer, Wendel, Mohler, Kimbriel et al. (2007) argue that diabetic foot wounds are common among diabetic patients and are very costly. They assert that diabetic foot wounds are brought about by frequent strain to the feet that is caused by inflammation and skin breakdown. They argue that self-care is therefore important among the diabetic patients in the prevention of diabetic foot and its related complications.

Project Objective: Specific, Realistic and Measurable Objective

To reduce the incidence of diabetic foot by 50 percent among patients with diabetic mellitus within a period of two years

Proposed Solution that will Solve the Problem

Education of patients

Patient education is an important preventive strategy for diabetic foot. The program will be conducted in two different kinds. The first type of education will involve patients who attend the general clinics for the first time and who have not been identified as having a high risk of diabetic foot after screening. This group of patients will receive general education according to the practice executed. The second type of education will involve all other patients who have been identified through screening as having a high risk of developing diabetic foot. This group of patients will receive educational materials that have all the information that pertain to the care, prevention and treatment of diabetic foot. Extended education will be conducted on different occasions such as during the patients first visit, during screening and during subsequent visits. The education will be done using different techniques such as through chart demonstrations, through practical demonstrations and through normal dialogues between the patients and the healthcare professionals. After every education session, the healthcare professionals will assess the patients understanding, motivation and level competence in foot care.

Every education session will incorporate the following areas: daily foot inspection, including areas between the toes; if the patient cannot inspect the feet, someone else should do it; regular washing of the feet with careful drying, especially between the toes; temperature of the water should always be less than 37 °C; avoidance of walking barefoot in- or outdoors, and of wearing shoes without socks, avoidance of using chemical agents or plasters to remove corns and calluses; daily inspection and palpation of the inside of the shoes; in case of impaired vision, the patients should not try to treat the feet by themselves; the use of lubricating oils or creams for dry skin but not between the toes; daily change of stockings; wearing stockings with seams inside-out or preferably without any seams at all; cutting nails straight across; avoidance of cutting corns and calluses by patients but by a health care professional; ensuring that the feet are examined habitually by a health care professional; and the patient should notify the health care provider immediately if a blister, cut, scratch or sore develops (Ortegon, Redekop & Nissen, 2004).

Reference List

Armstrong, D., Holtz-Neiderer, K., Wendel, C., Mohler, M. J., Kimbriel, H. R., et al. (2007). Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. The American Journal of Medicine, 120, 1042-1046.

Ortegon, M., Redekop, W., & Nissen, L. (2004). Cost-effectiveness of prevention and treatment of diabetic foot: A Markov analysis. Diabetes Care, 27, 901-907.

Poljicanin, T., Pavlic-Renar, I., Metelko, Z., & Coce, F. (2005). Draft program of prevention of diabetic foot development and lower extremity amputation in persons with diabetes mellitus. Diabetologia Croatica, 34(2), 43-49.

Rangnarson, T., & Apelquist, J. (2001). Prevention of diabetes-related foot ulcers and amputations: a cost-utility analysis based on Markov model simulations. Diabetologia Croatica, 44, 2077-2087.

Introduction and Significance of the Study

Definition of Diabetes Type 2

Diabetes type 2 is a chronic disease that is characterised by high or low levels of sugar in the blood. The symptoms of this disease are frequent urination, excess thirst, constant hunger, and weight loss. The disease is mainly caused by genetic factors and a combination of lifestyle. Those that are caused by lifestyle can be controlled and include obesity, diet, and sometimes lack of sleep. People are advised to engage in physical activity, take balanced diet, avoid stress, and reduce food and drinks with high levels of sugar.

Health Effects of Type 2 Diabetes

Australia is the one of the first countries in the world that has good health. Nevertheless, diabetes mellitus has led to premature deaths, ill health, poor quality of life and disability in the country. This disease is also a major contributor to other diseases, such as coronary heart, kidney, vascular and stroke. An approximate of 13100 deaths in 2007 was from diabetes in Australia contributing 9.5% of all deaths to the country. Coronary heart disease has the highest number of deaths because of the diabetes.

Prevalence of Type 2 Diabetes in Australia among Aboriginal People

According to the estimates of prevalence of this disease in the indigenous people conducted by National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) and Australian Bureau of Statistics (ABS) showed that the ratio between indigenous to non-indigenous females 4.1 is higher than that of males 2.9. The reports also confirmed that prevalence of diabetes rises with age and the disease it is high in people with 45 years of age and more.

Necessary of Doing Study among Australian Aboriginal people

This study is important because indigenous Australians are at higher risks of type 2diabetes compared to the non-indigenous Australians. This is most in the indigenous Australians living in the remote areas (Kavanagh 2004, p.1011).

Different Ways to Prevent Type 2 Diabetes Related to Behavioural Change

National diabetes strategies have created programs to create awareness of this disease, for instance, the Live Life Well program, the National Diabetes Service Scheme (SDSS), and healthy living NT. These programs demonstrate, motivate, and educate the audiences on living healthier lifestyles to reduce the risk of diabetes, maintaining healthy weight, and becoming active to control the normal levels of sugar in the body (Eleanor et al. 2003, p.421).

Culturally Tailored Intervention

There are high chances of type 2 diabetes among the indigenous populations and this is links to the thrifty genotype. Other causes crucial to high type 2 diabetes in the indigenous population are the diets and levels of physical activity. The people in the indigenous areas tend to replace the nutrient dense diet with the energy dense nutrients with refined sugar and high fat contents. This disease develops from obesity that is by increased consumption of foods and drinks, such as snack foods, sugar-sweetened cool drinks, canned meat, and white bread. These people have less involvement in physical activities leading to overweight. This overweight or obesity facilitates the risk for acquiring diabetes type 2. People in the indigenous population are to take the traditional kind of foods, especially natural foods that are not processes.

The Aim of the Study

The aim of this study is to undertake a random research on the social aetiology of type 2 diabetes mellitus among Indigenous Australians as reflected by the health education programs.

Objectives of the Study

This paper aims at establishing whether culturally appropriate education programs in indigenous Australian settings would substantially ease the diabetes mellitus burdens: an approach-orientated study. The study will also determine why there are higher numbers of indigenous people, especially adults with type 2 diabetes and the behavioural changes required to reduce the risks of acquiring the disease in Australia.

Literature Review

The Gap Created Among the Australian Aboriginals

The conditions of diabetes mellitus can reduce in Australia by focussing on the nutrition and financial literacy of the indigenous communities. The government and investors have to ensure availability of fresh foods and employment among the indigenous people, such as vegetables and fruits because the community lacks the need for such foods. These foods are essential in reducing the risk of diabetes. The improvement of infrastructure in the communities would improve the lifestyle of the people in the communities and improve physical exercises that are important in preventing and managing the disease (Clarke 1998, p. 1245). Health education programs receive funding from the government. Nevertheless, the government should increase these funds to cover most of the areas in the indigenous communities (Crotty 2003, p.124).

According to Carry et al. (2001, p.47), health education programs are essential in communication to people about the causes of the disease, the prevention measures, management of the disease, and the cure. The programs play the role of creating awareness and influencing people to adopt the new changes in their health. This programs target the indigenous people because they have limitations in healthy living, and physical exercise because of high poverty levels and culture. An estimate of more than 51% however has taken the health education programs seriously as the rate of death increases in those communities (Australian Institute of Health and Welfare 2011, p.65).

Hypothesis of the Study

• H1. There is high prevalence of diabetes type 2 among the Australian Aboriginals
• H2. Diabetes type 2 is by lack of nutrition and financial literacy of the indigenous communities
• H3. Health education programs are essential in communication to people about the causes and prevention of the disease

Methods

Kind of Study

As one of the most important components of Randomized Controlled Trial (RCT), a search of literature is not easy to undertake as it includes pre-test and post-test study (Glasziou 2001, p.124). A RCT involves searching all the evidence relevant to the research question. Key steps of the random literature search must deploy using appropriate keywords, searching all the databases, considering grey literature and unpublished articles while applying search filters (White & Schmidt 2005, p.45). Of course, starting with currently available RCT would be a worthwhile effort. Various biomedical databases should be considered and include PubMed, EMBASE and ScienceDirect (Higgins, Green & Cochrane Collaboration 2009, p.134).

To ensure a randomly research process with academic comprehensiveness, there are several rules to obey. First, randomly place questions into categories and to search further information on the topic is important. A tactical method is to utilise the conceptual framework diagram to cover every area as well as the overlapping parts (Egger et al.). Secondly, the manipulation with the possible keywords synonyms is essential, as biomedical terminologies could be interchangeable for some topics (Damin et al. 2007, p.15). Thirdly, the search of unpublished literature, ongoing studies and grey literature is critical in order to minimise the publication bias. Last, it is necessary to comply with the research protocol to avoid missing essential information and ensure completion of the research process within the time allocated.

This research will take a random approach that will entail the researcher working from a known hypothesis that culturally appropriate education programs in indigenous Australian settings would substantially ease the diabetes mellitus burdens. Therefore, the study takes a top down approach.

To realise the use, explanatory approach, RCT test efficacy tools of collective and analysing data like questionnaires and interviews were used. RCTtools were preferred because they enable the researcher to come up with facts like a hypothesis that culturally appropriate education programs in indigenous Australian settings would substantially ease the diabetes mellitus burdens and thereafter testing and confirming the hypothesis (Glasziou 2001, p.138). Lastly, data in RCT research are hard and reliable where data collected is rich and deep (Quinn, 2002, p.219).

In addition to the above, this study takes a test kind of philosophy that culturally appropriate education programs in indigenous Australian settings would substantially ease the diabetes mellitus burdens. A test approach will make us understand more the impact of culturally appropriate education programs in indigenous Australian settings on diabetes mellitus burdens. There are no biases in this research (Miles and Huberman 1994, p.12).

Sampling

Sample Plan

The population of study in this research will be the two groups of Indigenous and non-indigenous Regions across the country. Every element of the population is important and should be studied. As these are big areas, I thought I could choose the most populated local area of the two and that is Playford in Australia, and base my focus groups in this place. A response-adaptive randomization will select the groups in the research process. The choice of the two elements to be studied is by sampling techniques. Sampling enables the researcher to study a convenient size of the population depending on the research he is conducting and the constraints (Miles & Huberman 1994, p.27).

Due to the challenges for this study, the researcher chose to use response-adaptive randomization sampling technique to select his sample of study (Catherine et al. 2011, p.23). The Australian health sector under study is a large industry and it has several companies dealing with the information technology. That would give me areas across a few different states. And then I would run focus groups in each state until I reach saturation.

Reputable health organisations with good corporate governance that the researcher has ease of accessibility and ease of collecting data will be selected for the study. The researcher will book appointments with the top management from the company for conducting interviews concerning the effectiveness of culturally appropriate education programs in indigenous Australian settings diabetes mellitus. The interviews as a method of collecting data will be made more effective since the researcher with the aid of his research assistants will collect data (Craig, Hattersley & Donaghue 2009, p.211).

Sample Size

The sample population will comprise of 1,000 people and only 100 will participate in the study. The response-adaptive randomization will choose the sample size where the two groups under study will be covered. The groups will constitute of 50 people on each to eliminate any chances of bias in the study. G-power will divide the participants randomly.

Research Sit and Participants

Projection by 2025 shows that more than 12 million adults at the age of 25 years will be at risk of acquiring diabetes if no changes are made to address the issue. The rising number is because of increase in type 2 diabetes as the people have changed to poor diets, ageing of population increases, reduction of physical activity, and the increase in the epidemic of obesity. This disease will affect indigenous communities at most and the nations economy. The communities need to recognise the disease as preventable to maintain good health of the people. The people in Playford will make the potential participants for this study as the area contains remote and non-remote areas. The people there need education on the disease, as the ratio is 2.1. The participants will be randomly selected from those with the disease.

Implementation of the Study

Questionnaire

The question will be on:

1. What has been done to help curb the problem of diabetes in the indigenous communities?
2. Who funds these programs?
3. What are the main reasons for high numbers of people with type 2 diabetes in the communities?
4. What is the outlook to this disease in Australia and especially to the indigenous community?
5. What is the current situation of indigenous people in Australia and the rights they have to quality health care?

Data Collection Methods

Data collection is the precise, random gathering of information relevant to the research purpose or the specific objectives, questions, or hypothesis of a study (Canuto, McDermott, Cargo & Esterman 2011, p.133). The various methods of collecting data will vary depending on the approach that the study is using and they range from interviews, questionnaires, observations, documentation among others.

On the other hand, there are also primary and secondary methods of collecting data. Primary methods of data collection are the methods that collect data for the first time while secondary methods are those where the researcher uses data collected by other people. According to Bryman and Bell (2007, p. 10), secondary data collection methods refer to the ability of the researcher to carry out an analysis of the data that has already been prepared by other researchers. This research will use both primary and secondary methods to collect data for the study. The primary sources of data will come from interviews that will be conducted by the researcher using a questionnaire (Bruce, Davis, Cull & Davis 2003, p.85). Focus groups will be established and used to conduct the survey.

The secondary sources will include review of both published and unpublished literature related to the implications of culturally appropriate education programs in indigenous Australian settings on diabetes mellitus, while the primary sources will include the review of the findings from the responses from the interview conducted by the researcher (Jankowicz, 2005). Through the interviews, the researcher collected data on the collaboration of the various departments in the health sector and the importance culturally appropriate education programs in indigenous Australian settings and their impacts on diabetes mellitus (Creswell 2007, p.49).

Data Analysis

Responses to the interviews and questionnaires will be analysed using thematic analysis. This tool is considered to be highly inductive, as themes are not imposed on data by the researcher but rather emerge from the data itself. In this method, data from different people are compared and contrasted, similarities and differences identified in a process that continues until the researcher is satisfied that no more new issues or themes are arising (Flick et al. 2004, p.35).

Thematic analysis was chosen because it allows rich, in-depth, and detailed meaning to be derived from the collected data. It involves coding of data according to the emerging themes (Miles & Huberman 1994, p. 56). This tool categorises the findings and conclusions from various sources, according to the emerging themes, making it possible to identify similarities in the meanings and explanations from the various respondents. The researcher is also able to highlight the main issues emerging from the responses. Line by line analysis allows the researcher to highlight matching patterns in the text from the different responses allowing quantification of data (Salkind 2008, p.67).

Ethical Issues

Finances, time, and uncooperative respondents will be the main limitations of the study. The respondents have high resistance of health education programs making it difficult to acquire clear evidence on the situation at the indigenous communities in Australia. Most of the information gathered is not sufficient to make analyses on the situation in the community. Overreliance on the secondary sources of information increases the chances of acquiring data that were not effectively evaluated limiting the reliability of the data. The use of secondary data is mainly because of financial and time limitations. Time, finances, and information available from the respondents also limit the primary data acquired.

Time Line

Budget

List of References

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Bruce, DG, Davis, WA, Cull, CA & Davis, TM 2003, Diabetes education and knowledge in patients with type 2 diabetes from the community: the Fremantle Diabetes Study, J. Diabetes Complications, vol. 17, no. 2, pp. 82-89.

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Metformin is an oral biguanide antihyperglycemic agent prescribed to patients suffering from type 2 diabetes mellitus (non-insulin-dependent diabetes mellitus), which rates among the first-line medications across the globe and can be used both as a monotherapy or combined with several other drugs used for treating diabetes. The medication can also assist in treating metabolic and reproductive problems associated with polycystic ovary syndrome (Inzucchi, Lipska, Mayo, Bailey, & McGuire, 2014).

As far as its pharmacodynamics is concerned, the agent is capable of lowering hepatic glucose production as well as its absorption while increasing insulin-mediated glucose uptake (Schernthaner et al., 2013). Metformin activates a liver enzyme AMPK (AMP-activated protein kinase) and increases its activity affecting glucose production and metabolism. It allows metformin to improve glycemic control of the body decreasing basal and postprandial plasma glucose (Inzucchi et al., 2015). The consumption of the drug may lead to weight loss in diabetes patients suffering from obesity.

Monotherapy does not bring about hypoglycemia or hyperinsulinemia since it does not affect the secretion of insulin (which makes its pharmacokinetics different from that of similar drugs); however, combination with insulin may produce hypoglycemic effects. Side effects, which include dyspepsia, nausea, unpleasant metallic taste, vomiting, abdominal bloating, and diarrhea, can be avoided through the use of smaller doses of the drug. The same measure is required in case of decreased renal function. When the drug is administered in combination with sulfonylureas, it is important to watch for such symptoms as abdominal pain, hunger, increase anxiety, weakness, tremor, and sweating (Pawlyk, Giacomini, McKeon, Shuldiner, & Florez, 2014).

The agent is administered orally and has an oral bioavailability of 50-60% under the condition that it is not consumed with meals as such administration may delay absorption through minimizing possible adverse reactions. Some researchers claim that the absorption of metformin does not depend on its dosage. On the contrary, an inverse relationship between the dose and the time of absorption has been hypothesized suggesting a saturable process of absorption (Santoro et al., 2016). However, the data that could allow making conclusions are limited. The complete absorption of metformin happens within six hours. The drug is subjected to renal excretion 6-8 hours after consumption (the period may be longer in patients suffering from renal problems) (Bolinder et al., 2014).

The peak concentration in plasma is supposed to be reached approximately 3 hours after the administration of the drug. However, the information about the relationship of its concentration in plasma and metabolic effects is rather insufficient: in the state of fasting, the levels may vary from 0.5 to 1.0 mg/L whereas after a meal they may increase up to 1.0-2.0 mg/L (Schernthaner et al., 2013). No particular figures can be obtained (as they vary from one patient to another), which implies that monitoring does not have real value. However, it is highly important to identify the concentration of the drug in plasma in case lactic acidosis is suspected as it is one of the few criteria that allow concluding whether the condition was caused by the agent (Goswami et al., 2014). If metformin is detected, forced diuresis or hemodialysis are required to eliminate it from the organism. All these consequences can be prevented if the patient follows the guidelines and contraindications (Inzucchi et al., 2015).

Metformin is not metabolized by the organism: research in patients shows that the drug is excreted unaltered in the urine with not metabolites identified. Almost 90% of metformin is eliminated in 24 hours in patients that do not have any complications (Santoro et al., 2016).

References

Bolinder, J., Ljunggren, Ö., Johansson, L., Wilding, J., Langkilde, A. M., Sjöström, C. D.,& Parikh, S. (2014). Dapagliflozin maintains glycaemic control while reducing weight and body fat mass over 2 years in patients with type 2 diabetes mellitus inadequately controlled on metformin. Diabetes, Obesity and Metabolism, 16(2), 159-169.

Goswami, S., Yee, S. W., Stocker, S., Mosley, J. D., Kubo, M., Castro, R.,& Brett, C. (2014). Genetic variants in transcription factors are associated with the pharmacokinetics and pharmacodynamics of metformin. Clinical Pharmacology & Therapeutics, 96(3), 370-379.

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M.,& Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach: Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 38(1), 140-149.

Inzucchi, S. E., Lipska, K. J., Mayo, H., Bailey, C. J., & McGuire, D. K. (2014). Metformin in patients with type 2 diabetes and kidney disease: A systematic review. Jama, 312(24), 2668-2675.

Pawlyk, A. C., Giacomini, K. M., McKeon, C., Shuldiner, A. R., & Florez, J. C. (2014). Metformin pharmacogenomics: Current status and future directions. Diabetes, 63(8), 2590-2599.

Santoro, A. B., Stage, T. B., Struchiner, C. J., Christensen, M. M. H., Brosen, K., & SuarezKurtz, G. (2016). Limited sampling strategy for determining metformin area under the plasma concentrationtime curve. British Journal of Clinical Pharmacology, 82(4), 1002-1010.

Schernthaner, G., Gross, J. L., Rosenstock, J., Guarisco, M., Fu, M., Yee, J.,& Meininger, G. (2013). Canagliflozin compared with sitagliptin for patients with type 2 diabetes who do not have adequate glycemic control with metformin plus sulfonylurea. Diabetes Care, 36(9), 2508-2515.

Diabetes is a serious and dangerous disease that, if untreated, can cause severe health problems or lead to death. There are several types of diabetes, with type one diabetes being caused by the bodys inability to produce insulin. The second type stems from the bodys developed resistance to insulin. Gestational diabetes is developed due to an organism being unable to produce enough insulin during pregnancy (Jwad, S. M., & AL-Fatlawi, 2022). Juvenile diabetes is another term for type one diabetes, with the name originating from the young age it develops.

Type two diabetes is a disease that is developed due to an organisms resistance to insulin or when not enough insulin is made to lower blood sugar levels. Metformin is a drug that is often used in the treatment of this disease. It is employed in combination with a diet and exercise regimen, such as eating at regular intervals and avoiding long periods of inactivity. Depending on the patients condition, the drug is taken one to three times a day with meals orally (Metformin uses, side effects, and more n.d). Preparations for initiating treatment with Metformin include gastroenterological evaluation since this drug can cause stomach issues, and, in case such problems are detected, the dosage needs to be increased gradually.

There are several long-term and short-term complications that come from this type of illness. Short-term include blurred vision, increased thirst, tiredness, and headaches. Long-term include heart diseases, neuropathy, kidney diseases, and eye problems (Type 2 diabetes, 2021). Metformin side effects include nausea, appetite loss, stomach ache (short-term), and vitamin B12 deficiency (long-term) (Metformin uses, side effects, and more n.d). As in the treatment of any disease, diabetes patients should be medicated in accordance with their general health state.

In conclusion, diabetes proves to be a highly severe illness whose variables make it difficult for a doctor to diagnose and treat it. The causes for various types of diabetes differ, and so do their treatments. For type two, the most commonly used drug is Metformin. To employ Metformin, the doctor needs to perform gastroenterological evaluation and be wary of its long- and short-term side effects.

References

Jwad, S. M., & AL-Fatlawi, H. Y. (2022). Types of Diabetes and their Effect on the Immune System. Journal of Advances in Pharmacy Practices (e-ISSN: 2582-4465), 21 30.

Metformin HCL  Uses, side effects, and more (n.d). Web.

Type 2 diabetes (2021). Mayoclinic. Web.