Category: Type 2 Diabetes

The Complex Challenge of Smoking Cessation for Individuals with Type 2 Diabetes

Introduction

This article discusses the dangers to individuals with type 2 diabetes due to smoking and factors that cause a hindrance or fully prohibit these individuals from quitting. Regardless of the information proving these dangers, there are still many people with type 2 diabetes who continue to smoke. The information in this study is meant to discuss the reasons these individuals continue to smoke and the types of obstacles that may prevent them from quitting smoking or that may help them quit smoking. It is also meant to explore the concept that living with diabetes and gender may play a role in how difficult it is for those with type 2 diabetes to quit smoking.

The Nexus of Type 2 Diabetes and Smoking

The article is a report of an explorative qualitative study done based on two focus groups. The research was gathered by interviewing a number of people who either continued to smoke or used to smoke while living with type 2 diabetes. Researchers first noted details about each participant’s specific habits and relationships with tobacco and smoking. The information was gathered after a series of ten interviews was conducted with the participants, followed by a series of more focused interviews in order to compare and contrast findings. The target audience for this article was individuals in their mid-to late-forties who live with type 2 diabetes and smoke regularly. Participants were either still smokers or had been smokers in the past and had all been diagnosed with type two diabetes within the last nine years. On average, they were fifty-nine years old, and both men and women were included in the study.

It is informative because the participants may be unaware of the consequences directly related to type two diabetes that come from smoking. Continued use of tobacco can cause changes in blood sugar levels that may require more or less insulin than usual. (Source?) This effect may be unknown to those recently diagnosed with type two diabetes, and, therefore, they are at high risk for [insert health risk (idk what happens when you have low/high insulin)] as opposed to those without type two diabetes who may only have the typical risks related to tobacco use.

Insights from an Explorative Qualitative Study

One interesting fact was about how much habit and association can factor into the difficulty that comes with quitting smoking. Certain times of day or activities become hard to get through without having the cigarette that usually goes along with them. Half of the participants, both men and women, mentioned that refraining from smoking after lunch or dinner was the most difficult part of an attempt to quit or reduce smoking (Georges et al., 2019). The differences in awareness and patterns between men and women were surprising. For example, “Women tend to pay greater attention to avoiding smoking in front of non-smokers than men.

However, certain men showed more concern if smoking increased health problems for their partner, for example an asthmatic partner.” (Georges et al., 2019, p.9). Additionally, both males and females felt having a grandchild would motivate them to stop smoking. (source?) The birth of a new family member influenced both males and females to quit in order to reach a level of better health that allowed them to be active in the child’s life. (Source?) There were many differences between genders throughout this study; however, certain aspects revealed similarities. (How does this relate to type 2 diabetes, though?)

Impact on Clinical Practice and Patient Care

The information found in this study will be helpful in my clinical practice. If I have a patient with type two diabetes who struggles with smoking, I will be better equipped to understand their underlying needs. Ultimately, I plan to help them find ways of quitting and suggest the right methods that may adhere to their specific needs. I will also have a better idea of what types of questions to ask them and things to look out for as they continue treatment.

Beyond the assistance I can provide relating to quitting smoking, it is also important for me to know what risks stem from smoking. Seeing how closely the habit of smoking can truly affect someone’s life and routine reminds me that it may affect patients who may even be treated for something unrelated to smoking. Keeping this in mind allows me to provide well-rounded care to those I am treating. I would recommend this article to other students because I believe this information could be helpful to them as well.

This study did inspire me to want to learn more regarding this topic because it mentioned many factors that I was previously unaware of as someone who does not directly have personal experience with a tobacco addiction or type two diabetes. It was interesting to learn that while most participants knew the general dangers of smoking, not many knew about the effects and connections between diabetes and tobacco use. (Source?) Myself and many others may know the common dangers that come from tobacco use, but it is eye-opening to consider how it may affect people with other underlying health conditions.

Conclusion

Ultimately, this study was about smoking while living with type two diabetes and the differences between males and females when it comes to quitting smoking in these situations. Daily routines, social encounters and influences, self-image, and other stressors all contribute to the struggles of quitting smoking for each gender. No cure or solution to quitting was learned from the study, likely because they all were living under different conditions with different motivations and stressors in their lives. The balance of lifestyle and health extends beyond medical treatment, even though they are largely related to one another. Although no specific solution was obtained, the study was still very useful and informative for both those with type two diabetes and those without. (There was no comparison to those without type 2 diabetes.)

References

Georges, J. M., Galbatti, M., & Claire, C. (2019). Gender differences in quitting smoking among individuals with type 2 diabetes: An explorative qualitative study. Journal of Diabetes Research, 2019, 123456

The Complex Factors Influencing Type 2 Diabetes in Women

Introduction

Diabetes, formerly known as diabetes mellitus, is a disease in which the body loses its ability to produce or respond to the hormone insulin. Insulin is a hormone produced by your pancreas when glucose levels rise in the blood. When insulin works properly, it stores the excess glucose from the blood and lowers the glucose levels. When the hormone insulin isn’t produced or does not respond well, it leads to hyperglycemia and high glucose levels. Diabetes is a serious illness that affects both genders and can lead to chronic health conditions such as kidney damage, strokes, heart attacks, loss of limbs, or blindness.

Body

Demographic and Social Factors

A person diagnosed with diabetes can have type 1 diabetes, type 2 diabetes, or gestational diabetes. Type 1 diabetes is an autoimmune disease in which the immune system destroys insulin cells made by the pancreas. Type 1 diabetes is more prevalent in children and young adults and is treated by taking insulin. Type 2 diabetes is the most common form of diabetes, and people diagnosed are unable to make enough insulin or do not respond to insulin.

This form of diabetes can affect both genders and all age groups, but it is more common in adults. Gestational diabetes only occurs in women during the time of pregnancy and can cause harm to the baby and mother if it’s not monitored. Gestational diabetes tends to go away after pregnancy, but women who have gestational diabetes are at a higher risk of getting type 2 diabetes later in life. Any form of diabetes has huge health risks if left untreated.

Economic Factors

Demographic and social factors contribute to type 2 diabetes in both men and women. Type 2 diabetes is slightly more prevalent in men than women. There are mixed findings on which gender is more prevalent in developing type 2 diabetes, but in the United States, about 10.9 men and 9.7 percent women are diagnosed with type 2 diabetes. However, gender plays little to no significance because multiple factors contribute to this condition. Race and ethnicity are positively correlated with type 2 diabetes. Studies indicate that White Americans are less likely to acquire type 2 diabetes due to regular checkups, whereas Hispanics and African Americans are more likely to get diabetes due to a lack of education and self-care cite here.

Hispanics, for example, are less likely to manage their diabetes or check blood glucose levels. The lack of education and poor self-care contributed to sixty- sixty-three percent of non-Hispanic Black women who developed diabetes. Between 2007-2010 the prevalence of women diagnosed with diabetes was highest amongst Black and Hispanic Women, making these ethnicity groups the highest developers of this condition. Cultural barriers also contributed to the prevalence of type 2 diabetes. In the United States, Hispanic and Asian patients had poor glycemic control due to language barriers, lack of education, and low income. Within the Hispanic population, twenty-six percent reported that they do not speak English very well, and fourteen percent spoke no English.

Language barriers also contributed to poor communication with physicians and also led to little understanding of how to manage their glycemic levels. Marital status also plays a significant role in the management of glycemic levels. Spouses who show interest in patient’s glycemic levels help improve their partner’s overall self-care. Religion is also correlated with type 2 diabetes because it provides a sense of support, reducing the chances of depression by increasing emotional support. Overall, these factors weave together in order to show that Hispanic women tend to have the highest rates of type 2 diabetes.

Economic factors also play a significant role in preventing and controlling type 2 diabetes in women. Families with low incomes tend to face the greatest health challenges due to stress and poor diets. It’s a vicious cycle that follows one problem and leads to another because low income, food insecurity, and type 2 diabetes are all linked together. Studies show that a low income contributes to food insecurity, triggering people to overconsume unhealthy foods. Furthermore, weight gain causes obesity, which is the leading cause of type 2 diabetes.

Food insecurity provokes unhealthy choices because women in America are more likely to purchase energy-dense food. Due to low family incomes, dense food is more affordable. Although energy-dense food is cheaper, it is filled with fat and sugars, causing obesity and eventually diabetes. The environment and the lack of physical activity also contribute to obesity because low-income families live in harsh and unsafe conditions. While eliminating the risk of being safe in a poor environment by staying indoors and sacrificing physical activity, Americans put their health at risk. The lack of exercise contributes to health issues and overall increases the chances of people developing type 2 diabetes. The level of education also has a strong influence on diabetes.

Cultural Factors

Between 2013 and 2015, women who attended less than high school had a prevalence rate of 9.3%, women who attended high school had a 12.4% prevalence rate, and women more than high school had a 10.4% prevalence rate of diabetes. The level of education affects the prevalence rates in women because with education comes change. Women who have completed more than High school have lower prevalence rates than women who attended high school. Education affects prevalence rates because those of higher education know the health risks and have been exposed to prevention methods when it comes to common diseases such as diabetes.

Diabetes affects women of all ages and ethnicities, but American Indian, Hispanic, and Black women are at greater risk. Women who are forty-five-five and older are at higher risk of getting type 2 diabetes. Between 2013-2015 American Indian Women had a 15.3% prevalence rate, followed by Black (nonhispanic) women with a 13.2% prevalence rate, Hispanic women with a prevalence rate of 11.7%, and Asians with a prevalence rate of 7.3%. Type 2 diabetes in women is primarily determined by diet and obesity. A family history of diabetes also increases the risk of women getting type 2 diabetes.

The prevalence rate is also higher amongst women with gestational diabetes, women with high blood pressure and high cholesterol, and those with a history of heart disease. Women with gestational diabetes have a fifty percent chance of getting type 2 diabetes later on in life. Studies have shown that being overweight or obese is the greatest predictor of diabetes. Lack of exercise, drinking, smoking, and having conditions such as high blood pressure are all signs of type 2 diabetes. Prediabetes is a strong indicator of type 2 diabetes; if left untreated, pre-diabetes leads to type 2 diabetes.

Type 2 diabetes is preventable if women get regular glaucoma checkups and if they monitor their diet with the increase in physical activity. Studies have shown that a diet with high fiber, low unsaturated fats, and trans fats can help moderate glucose levels. Regular exercise, moderation of drinking, and abstinence from smoking can also help moderate glucose levels. Patients who have trouble moderating glucose levels with lifestyle changes can take insulin, which helps control the amount of glucose in the bloodstream.

Most physicians advise patients to lose weight, monitor diet, and increase physical activity, but patients can also take insulin to treat type 2 diabetes. Type 2 diabetes typically affects women later in life. Women forty- five and older are at the greatest risk. Women typically diagnosed with type 2 diabetes lose an average of 6.8 years of life, and overall, there is a 15% mortality risk with type 2 diabetes. The mortality risk is lowered with proper blood glucose monitoring and with yearly screenings.

The type of food consumed can increase the risk of getting type 2 diabetes. Highly processed foods that contain an abundance of carbohydrates, sugars, and saturated and trans fats all contribute to type 2 diabetes. A well-balanced diet with fruits, vegetables, and whole grains is the first step in managing diabetes. The recommended foods for diabetics are healthy carbohydrates, fiber-rich food, fish, and good fats. Incorporating healthy foods helps manage glucose levels and also makes each calorie count. Eating foods high in sugars and fats has little to no nutrition, but it contains empty- calories, which only lead to obesity and weight gain. Healthy foods such as vegetables, fruits, whole grains, beans, lentils, fish, or avocados are essential in a diabetic diet.

Women can choose several plans, including the plate method, counting carbohydrates, or a glycemic index method to monitor blood glucose levels efficiently. The plate method incorporates half a plate with nonstarchy vegetables, a quarter of a whole grain, and a serving of fruit or dairy. Diabetics can also count carbohydrates since they have the greatest impact on glucose levels. This process involves eating the same and the right amount of carbohydrates. Dieticians also recommend the glycemic index method, which focuses on foods that affect blood glucose levels. Not only do these methods help maintain healthy glucose, but they also help prevent other chronic diseases such as heart disease, high cholesterol, or kidney failures.

Government Policies and Programs

Culture has a significant impact on the type of foods which is consumed. Type 2 diabetes is highly prevalent in African Americans and Hispanics, mostly due to their diet. Studies have shown that traditional African American food, which includes starchy vegetables, grains, and fried foods such as meat, contributes to high cholesterol and fat. These foods also lead to weight gain because they are full of unhealthy carbs and are high in calories. Whole milk and buttermilk are common ingredients found in many African-American dishes, and they also contribute to the development of type 2 diabetes.

Fried meat and overconsumption of pork also lead to type 2 diabetes amongst African Americans. It has been found that simply modifying meals can help prevent type 2 diabetes. Cutting down on greasy foods, foods with high saturated fats, and eating baked meat are examples of some modifications. Type 2 diabetes is also high amongst Hispanics but mostly Mexican Americans. Traditional foods such as tacos and burritos are high in calories and can be fattening, based on recipes. Studies have shown that traditional Mexican food is healthy because it contains low fat and is high in fiber.

This food becomes an issue when it is excessively fried and is full of saturated fats. There are foods in both cultures that have positive effects, but it is important to consume healthier foods rather than soul foods. Another process that contributes to unhealthy habits is assimilation. While trying to make a living and adapt to the American lifestyle, both these cultures have adopted American food habits. American food is filled with unhealthy options such as fast food. Fast food is high in calories, full of saturated fats, sugars, and trans fats, and is a major contributor to type 2 diabetes.

Prevention and Management

The government has implemented and continues to implement food policies that help people in the US. Food policies and programs such as SNAP and food distribution programs have decreased the prevalence rate of type 2 diabetes. The Supplemental Nutrition Assistance Program ( SNAP) offers assistance to low-income families. It is a program that provides food stamps to low-income families so they can have access to healthier foods. Over the years, SNAP has placed a ban on buying sugar-sweetened beverages and has encouraged families to purchase healthier foods. SNAP families get accredited thirty cents for every dollar spent on fruits or vegetables.

A study showed that after SNAP banned the purchasing of sweetened drinks, the overall calorie intake decreased, and obesity rates amongst SNAP families also declined. With the decrease in sugar consumption and a reduction in weight, the prevalence rate for obesity dropped by 2.4%. The study also illustrates that the new policies placed by SNAP have caused the largest decline in type 2 diabetes amongst adults between the ages of 18 and 65. Type 2 diabetes also declined by 2.3% in SNAP families after these policies were placed. The vegetable and fruit subsidy increased the number of fruits and vegetables purchased by SNAP members.

Findings also showed that these policies also decreased the glycemic load per person by 0.03 grams. Although this may not sound significant, it is a step in the right direction, and programs similar to SNAP help reduce conditions such as diseases by simply providing extra help. They allow families to access healthier foods, which is beneficial in preventing chronic diseases.

Consumption of sugary drinks is directly correlated to weight gain and type 2 diabetes. New York has taken action and passed policies to reduce sugar consumption. In 2009- 2009, the governor of New York proposed a tax on sugary drinks. The 18% sales tax and increase of 1 cent every year after that reduced the overall consumption of sugary beverages by 10 10. The reduction of sugar consumption leads to better health habits and reduces the risk of obesity and diabetes among children and adults. Between the years 2007- 2013, the percentage of sugar consumption in New York has decreased dramatically.

In the year 2007, the sugar consumption in youth was 56.7%, but it declined to 41.5% in 2013. The sugar consumption in adults was 35.9% in 2007 and 23.3% in 2013. The policies passed by the governor of New York City helped reduce sugar consumption significantly. Policies like these should be implemented by the US government or by Governors in all states. Policies that set a limit on the amount of sugar in beverages would also help decrease the prevalence rates of type 2 diabetes. Having policies on portion control can also help decrease health issues.

Conclusion

Many restaurants serve large quantities of foods filled with high calories and unhealthy fats. If all items served had a strict portion control, then that would help decrease the prevalence rate for many chronic diseases. Overall, if the government continued to implement stricter policies throughout the nation, then the prevalence rate for type 2 diabetes would decrease drastically.

References

1. [Source: National Center for Biotechnology Information] “Diabetes in Women” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5018496/
2. [Source: Maternal and Child Health Bureau] “Health Indicators for Women in the United States: Diabetes” https://mchb.hrsa.gov/whusa13/health-status/health-indicators/p/diabetes.html
3. [Source: Centers for Disease Control and Prevention] “Diabetes Social Media Infographics” https://www.cdc.gov/diabetes/library/socialMedia/infographics.html
4. [Source: American Diabetes Association] “National Diabetes Statistics Report, 2017” http://www.diabetes.org/assets/pdfs/basics/cdc-statistics-report-2017.pdf
5. [Source: National Center for Biotechnology Information] “Social Factors and Diabetes Prevalence in the US Women’s Health Study” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464757/

Type 2 Diabetes Management and Polycystic Ovarian Syndrome

Introduction

My Adult Case Study involved a 25-year-old Hispanic female who was seen on February 6, 2019, at one of my clinical sites, Texas Tech Physicians of the Permian Basin in Odessa, Texas. This clinical site primarily sees OBGYN patients from prenatal, post-partum, and women’s health. This particular female came in seeking a primary care provider. She recently moved to Odessa from El Paso, Texas, where she was newly diagnosed with Type 2 Diabetes and Cystic Ovarian Syndrome and needed to establish care with a new provider. The Patient is unfunded and applied for the grant program offered by the Texas Tech Clinic.

“I just moved to the Permian Basin, and I need a primary care provider. I moved here from El Paso, and the doctor I saw there told me I had high blood sugar and something was wrong with my ovaries. I didn’t bring my ultrasound report, but I do have my labs. I’ve been in Odessa for over one month, trying to get settled in my new job and apartment.

History of Present Illness

A 25-year-old female Hispanic patient presents today accompanied by her mother, who is here to establish care with the clinic. Recently moved to the Permian Basin from El Paso. The Patient states she was newly diagnosed with Type 2 Diabetes and “something wrong with her ovaries.” The Patient reports having polyuria, polydipsia, and abnormal weight gain since she was 21. The mother reports taking her to the ER years ago due to excessive nausea and vomiting and was told she had high blood sugar but failed to follow up with a provider.

The Patient has not seen a doctor since then due to insurance issues. He was originally seen for a work physical and was requesting oral contraceptives. During the initial work-up, the Patient was found to have a fasting blood glucose of 186 and a hemoglobin A1C of 8.1. Before she left El Paso, she was given a prescription to start Metformin 500 mg 1-tab BID but did not pick up the prescription from CVS. The Patient reports that she gets really thirsty at times, has excessive hunger, and has been gaining weight for the last three years. Other associated symptoms include irregular menstrual cycles and bilateral pelvic pain that has been an issue for one year. Prior treatment includes taking Tylenol and Motrin PRN for pain relief, and was requesting oral contraceptives back in El Paso.

No alleviating factors or radiation in pain. Aggravating factors include pain with intercourse. The Patient was told she had something wrong with her ovaries while she was over there. Had an ultrasound due to the pelvic pain and remembers the terminology “Polycystic Ovarian Syndrome” (PCOS), but did not bring her ultrasound report. Denies having chest pain, shortness of breath, nausea or vomiting. No numbness or tingling was reported. Reports an abnormal menstrual period, with menses lasting about 7-10 days with a moderate flow. The Patient is willing to re-do lab work and a possible ultrasound of the pelvis to re-evaluate her issues.

Past Medical History (PMH)

Allergies: NKDA

Current medications: No daily medications. The Patient denies the use of over-the-counter or herbal medications. No home remedies.

Age/Health status: 25-year-old obese female. Unmanaged Type 2 Diabetes and PCOS.

Immunization status: The Patient is up-to-date (UTD) on current immunizations for her age, including (Varicella et al., MCV4, IPV, and Tdap). Received influenza vaccine in December 2018. Gardasil was given at age 11.

Dates of illness during childhood: History of strep throat at age 10. He was seen in the ER in November 2016 for nausea/vomiting and hyperglycemia. No other illness was reported.

Injuries: None reported by the Patient.

Hospitalizations: None reported by the Patient.

Surgeries: Tonsillectomy and Adenoidectomy at age 11.

Current Health Maintenance

• Last well exam was at age 19.
• Dental visit in 2017. She has had three cavities and fillings. Brushes teeth twice a day.
• Patient reports good hygiene and showers twice a day.
• Unhealthy diet consisting of high carbohydrates and sugar. Rarely eats vegetables during her meals. Drink about 2-3 soft drinks per day. The Patient reports she has gained an abnormal amount of weight since age 21.
• Obtained a driver’s license when she was 18 and always wore a seatbelt when driving.
• Sexually active with one partner, uses condoms. No pregnancies were reported. No prior STD/STI’s. The last PAP Smear was in 2016 and was normal. Prefers to use tampons. No oral contraceptives were used.
• Oligomenorrhea reported for two consecutive years.
• Reports issues with abnormal hair growth on the upper lip and her nipples. Also has issues with acne on her back.
• Performs self-breast exams once a month.
• Does not take any daily multivitamins.
• Patient does not exercise or play sports. No extracurricular activities. Watches about 7-8 hours of television per day. The Patient graduated high school at age 19 and attended one year of college courses. Stopped going to college due to my job.
• Patient is fluent in both English and Spanish.

Family History (F.H.)

The Patient comes from a good-sized Hispanic family. Currently resides in Odessa, TX. I was born and raised in El Paso, Texas. Has one sister, age 15, and 2 younger brothers, ages 20 and 21. The parents are divorced and are both still alive. Mother is 51 years old, and father is 53 years old. The mother reports a history of Type 2 Diabetes and takes two oral medications to treat that. Mother had PCOS when she was 23 and then had a hysterectomy at age 46 due to abnormal uterine bleeding. The father has a history of HTN and Hyperlipemia.

The father is also morbidly obese. He is currently on medications for both medical problems. Maternal grandmother had HTN and passed away at age 86 from a CVA. Maternal grandfather had no chronic medical problems and passed away at age 88. Paternal grandmother has a history of Type 2 Diabetes, deceased. Paternal grandfather had a history of Type 2 DMD.M. complications and passed away at age 78. The mother had no complications during her pregnancy or delivery. The Patient was born full-term at 38 weeks gestation and weighed about 8 pounds.

OB/GYN History

Reports Oligomenorrhea for two consecutive years. Menses started at age 13 with irregular menstrual cycles. Admits to being sexually active and does not take oral contraceptives. Reports 1 sexual partner. Heterosexual. LMP was on January 5, 2019, and menstruated for nine days with a moderate flow. Uses tampons. The last PAP Smear was in 2016, with no abnormal findings reported. Has never been on oral contraceptives but uses condoms regularly. Has never been pregnant, nor does she plan on it. No family history of breast cancer, uterine cancer, or cervical cancer. Mother had normal PAP Smears. No dyspareunia was reported.

Social History (S.H.)

The Patient is currently residing in Odessa, Texas, and is originally from El Paso, Texas. Completed high school at age 19 and attended one year of a community college. The Patient does not exercise and does not participate in sports. The Patient does not smoke, drinks occasionally, and tried marijuana when she was 18 at a party. No other illicit drug use was reported. Mother and father do not smoke. There is no other exposure to second-hand smoke. Both parents drink on special occasions. The Patient drinks about 2-3 soft drinks per day. Averages about 7-8 hours of television. The Patient does own a cell phone. Currently employed as a bank teller. Works 8 hours per day, with 40 hours weekly. Averages about 6-7 hours of sleep. The Patient is in a monogamous relationship with a male.

Review of Systems

General – Denies any fever, chills, or weakness. Reports unexplained weight gain.

Skin – Denies lesions, petechiae, or rashes. No skin discoloration or bruises. Reports abnormal hair growth on upper lips and around her nipples. Reports acne on her back.

Eyes – Denies redness, swelling, and problems with vision. No contacts or glasses.

Head – Denies any headaches, dizziness, and light-headedness.

ENT/Mouth – Denies any hearing loss, ear pain, nasal congestion, cough, dry mouth, or sore throat.

Neck – Denies any swollen glands, lumps, pain, or stiffness.

Breast – Denies nipple discharge, lumps, or pain.

Respiratory – Denies cough, shortness of breath, sputum, asthma. No exposure to second-hand smoke.

Cardiovascular – Denies chest pain, palpitations, and heart problems. No varicose veins or edema.

Gastrointestinal – Denies nausea, vomiting, diarrhea, constipation, or abdominal pain. No changes in bowel habits. The Patient reports an unhealthy diet.

Genitourinary – Denies painful urination, elimination, or frequent urination.

Female genitals – Positive for Oligomenorrhea for two consecutive years. Reports bilateral pelvic pain. No discharge or abnormal vaginal bleeding. LMP was January 5, 2019. Sexually active with one partner. Monogamous relationship.

Musculoskeletal – Denies any joint pain, swelling, tenderness, stiffness, or limited ROM. Denies exercise or engaged activities.

Psychiatric – Denies any nervousness, nightmares, insomnia, depression, mood changes, or suicidal thoughts. No exposure to violence or excessive anger.

Neurological – Denies speech problems, gait problems, memory loss, vertigo, seizures, tremors, or numbness.

Hematologic – Denies any unusual bleeding or bruising, anemia, or recent blood transfusion. Denies fatigue.

Endocrine – Denies any heat or cold intolerance. Reports polydipsia, polyuria, polyphagia. No excessive sweating. No changes in hair or nail texture. Reports an increase in weight.

Physical Exam (P.E.) – Weight: 190 lbs. (86.1 kg) Height: 5’4″ (64 inches) BMI: 32.6

VS: (B.P.) 137/86 (H.R.) 76 (R.R.) 18 (SpO2) 98% on RA (Temp) 98.5 oral

General appearance: Well-appearing 25-year-old obese Hispanic female. Clean, well-groomed, and well-nourished. No distress.

Skin: Warm and dry. No lesions, masses, or rashes were noted. No clubbing or cyanosis. Moderate Acanthosis Nigricans noted to the posterior neck. Hirsutism to the upper lip and bilateral nipples. Mild acne noted to back.

HEENT: Head- Normocephalic, symmetrical. Hair is evenly distributed, no hair loss. Eyes- Conjunctiva/sclera clear bilaterally, PERRL, red light reflex present bilaterally. Ears- external canal normal; clear, auditory canal; tympanic membrane intact; light reflex present. Nose- Nares patent, the septum is mid-line and intact, turbinates’ are clear, and no maxillary or frontal sinus pressure was noted upon palpation. Throat- no erythema, no exudate, tonsils normal, uvula midline, pharynx normal.

Neck/Lymphatic: Neck is supple, full ROM with no pain. No cervical lymphadenopathy. No thyroidmegaly.

Cardiovascular: No murmurs, regular rate, and rhythm, S1, S2 normal. No palpitations. Peripheral and central pulses were palpated.

Respiratory: Clear to auscultation bilaterally anterior and posterior, no wheezes, rales, rhonchi.

Breast: Symmetrical. No lumps or fixed masses were appreciated on the breast, and no nipple discharge or skin discoloration was noted. (Female chaperone present during breast exam).

Gastrointestinal: Obese, bowel sounds present, soft, non-tender, non-distended; no suprapubic tenderness. No masses, organomegaly, or tenderness was detected.

Genitourinary/GYN: External genitalia normal. Vagina and cervix without lesions or masses. No lesions on labia, bilaterally. Cervical Os closed with no bleeding or discharge. No odor. The uterus is normal. Bilateral adnexa tenderness on bimanual. Negative for masses. The urethral meatus is normal. Perineum and anus are normal. (Female chaperone present during pelvic exam).

Musculoskeletal: Steady gait. Equal strengths in all four extremities with full ROM noted. No crepitus was palpated.

Neurological: Alert and oriented x 3. Pleasant and cooperative. CN II-XII is intact. Motor and sensory function, reflexes, gait, and coordination are within normal limits.

Psychological: Interacts cooperatively during exams. Calm and pleasant affect.

Family Assessment

Looking back at the information provided in Module 1 in regard to Family Theory for Assessment, the Resiliency Model of Family Stress, Adjustment, and Adaptation definitely pertains to this Patient. This particular theory model explains different variations in how families respond to stressful situations and crises. I also learned that this theory model will help healthcare providers like Advanced Practice Registered Nurses (APRNs) handle situations and help the Patient’s family by guiding them through a crisis. According to McCubbin (1993), “the outcome of the family’s efforts over time fit at two levels: the individual to family and the family to the community.”

Reading through the research, I have learned that families, over the course of life, face hardships and changes as a natural and predictable family life. In my adult case study for this Patient, she comes from a large Hispanic family, along with a strong family history of Type 2 diabetes and obesity. She has three other siblings and is trying to adjust to living on her own in a new city. With the brand-new Diagnosis of Type 2 Diabetes, she is very resilient and has a hard time accepting her Diagnosis. Both of her parents are divorced. Her father stayed back in El Paso and is employed as a car dealer. Her mother is not employed and speaks no English.

Coming from a big family myself, I can understand how stress can play a huge role in how you’re raised as a child. My Patient is very motivated and seems like she is ready to make some lifestyle changes to improve her overall health. Her weight gain has played a huge in motivation and self-perseverance. Her father is morbidly obese himself, and she has very little interaction with him, staying back home in El Paso. Her mother has D.M. and manages her diabetes without issues. Her brothers both work and have had issues with weight gain.

The Resiliency Model of Family Stress, Adjustment, and Adaptation, according to McCubbin (1993), compares two distinct parts: The Adjustment Phase and the Adaptation Phase. Both of these describe the family’s ability to cope with illness or stressors, looking at each family’s strengths and helping through the coping phase. If my Patient had had the opportunity for diet modification, exercise encouragement, diet counseling, and primary care follow-up, the Patient’s BMI would not be so worrisome.

Cultural Assessment

In the Hispanic population and ethnicity, family planning is very important. According to an article published by Rodriguez & Fehring (2012), “Hispanic women (U.S. born and non-U.S. born) have higher pregnancy rates, desire more children, and have fewer lifetime sex partners and more unplanned pregnancies compared to non-Hispanic white women.” Many Hispanic women are interested in natural family planning (NFP) when presented and consider it in a positive manner (Rodriguez & Fehring, 2012, pp. 192-193). My Patient did not have a desire to become pregnant any time soon but did voice a desire before she turned 30.

She is in a monogamous relationship with her significant other but uses condoms. She is aware that her having Type 2 D.M. and Polycystic Ovarian Syndrome, confirmed by ultrasound, will make it difficult for her to conceive someday. Teede, Misso, Costello, et al. (2018) also say “that information and education resources for women with PCOS should be culturally appropriate, tailored and high-quality, should use a respectful and empathetic approach, and promote self-care and highlight peer support groups” (Teede et al. & et al., 2018, p. 1605).

According to McCartney & Marshall (2016), the Diagnosis of “PCOS has life-long implications, with increased risk for infertility, metabolic syndrome, and type 2 diabetes mellitus, and possibly for cardiovascular disease and endometrial carcinoma. PCOS is diagnosed in adolescents with otherwise unexplained, persistent hyperandrogenic anovulatory symptoms that are inappropriate for age and stage of adolescence” (McCartney & Marshall, 2016, p. 58).

I learned that it should be considered in any adolescent girl with hirsutism, treatment-resistant acne, menstrual irregularity, or acanthosis nigricans, and evidence of these signs and symptoms should be especially sought in patients being evaluated for obesity. She wants to change her lifestyle and has a positive attitude about weight loss and the management of diabetes. Research shows that both physical health consequences and the emotional impact of PCOS have been ignored. PCOS and its influence on quality of life is an issue that needs to be taken seriously, as this syndrome affects many women across the world. As APRNs, it is our duty to help the Patient through any lifestyle change to ensure a great quality of life. Respecting the Patient’s culture is important and should be taken into account.

Differential Diagnosis

1. Type 1 Diabetes: Strong family history of diabetes on both sides of her family (maternal and paternal). Her excessive caloric intake and consumption make her a high risk. Initial labs will rule in and rule out this Diagnosis based on fasting glucose level and Hemoglobin A1C.
2. Hypothyroidism: Rule in and rule out this Diagnosis based on the TSH, Free T3/T4, and Cortisol level.
3. Depression: This can be ruled out by the excess amount of reported sleep, insomnia, anger outbursts, withdrawal from family, and low self-esteem. Poor hygiene.
4. Genetic Obesity: The Father is obese, and the Patient’s two brothers also have weight gain issues.
5. Polycystic Ovarian Syndrome: My Patient started her menstrual cycles at age 13 and has a high BMI for her age, height, and weight. Reported Oligomenorrhea and abnormal hair growth along with acne.
6. Pregnancy: This will be ruled out by performing an HCG (serum or urine).

Concluding Diagnosis:

1. Encounter for routine adult health examination with abnormal findings (Z00.01):

Increased BMI during the well-adult exam

2. Type 2 diabetes mellitus with other specified complications

This diagnosis was confirmed from previous labs. Fasting blood glucose of 186 and a Hemoglobin A1C of 8.1.

3. Acanthosis Nigricans (L83):

Dark discoloration on the back of the neck appears to be a case of Acanthosis Nigricans.

4. Body mass index (BMI) 32.0-32.9, adult (Z68.32):

Provided in the Patient’s objective data, according to the calculated BMI based on her weight of 190 lbs., height of 5’4″, her BMI is 32.6.

5. Family history of Diabetes Mellitus (Z83.3):

During my data collection for the Patient’s SOAP note, she has a strong family history of Type 2 Diabetes. Father and paternal grandmother are on medication regimens for their Type 2 Diabetes, putting my Patient at risk of inheriting this now.

6. Polycystic Ovarian Syndrome (E28.2):

Diagnosis obtained by ultrasound of the pelvis confirming polycystic ovaries, bilaterally. Confirmed by radiologist. The Patient also had a previous U.S. of the pelvis in another city.

7. Encounter for initial prescription of injectable contraceptive (Z30.013):

Will trial Patient on Depo-Provera 150 mg (using 150 mg/mL depot contraceptive injection suspension) I.M. every three months. 

Plan

1. Will provide sufficient education on the management and treatment of Type 2 Diabetes
2. Will start the Patient on Metformin 500 mg 1 tab PO BID. 30-day supply with two refills.
3. Set a baseline target for Hemoglobin A1C with the Patient.
4. Set a weight loss goal.
5. Will trial Patient on Phentermine 37.5 mg 1 tab P.O. daily.
6. The Patient will start an exercise plan and diet modification changes. This will include a healthy diet consisting of fruits, vegetables, and proteins. Will cut back on soft drinks and excessive caloric intake and eliminate sugars from her diet.
7. The Patient will check blood sugars at least 3 times per day and will keep a log and bring it to her next appointment.
8. Initial labs were ordered: CBC, CMP, U.A., HCG, TSH, Lipid profile, Follicle stimulating hormone, luteinizing hormone, androstenedione level, insulin levels, and add testosterone level.
9. The Patient will schedule her PAP smear for next month.
10. Will monitor the Patient’s weight and blood pressure.

Safety/Risk Assessment

Safety and risk assessment should include appropriate management and surveillance of diabetes. A well-controlled diet and exercise are crucial for the well-being of my Patient. According to McCartney & Marshall (2016), “anxiety and depressive symptoms should be routinely screened in all adolescents and women with PCOS at diagnosis.” If the screen for these symptoms and/or other aspects of emotional well-being is positive, further assessment and/or referral for assessment and treatment should be completed by suitably qualified health professionals, informed by regional guidelines (McCartney & Marshall, 2016, pp. 63-64).

Guidelines: Comparisons/Contrasts

There are many types of guidelines and comparisons shared by the American Diabetes Association (2013) for PCOS. The ADA 2013 states that “Doctors most commonly prescribe birth control pills for this purpose. Birth control pills regulate menstruation, reduce androgen levels, and help to clear acne. Providers will talk to the Patient about whether a birth control pill is right for them. There also are drugs available to control blood pressure and cholesterol. Progestins and insulin-sensitizing medications can be taken to induce a menstrual period and restore normal cycles. Eating a balanced diet low in carbohydrates and maintaining a healthy weight can help lessen the symptoms of PCOS. Regular exercise helps weight loss and also aids the body in reducing blood glucose levels and using insulin more efficiently” (ADA, 2013).

Conclusion

Another guideline researched was provided by The Androgen Excess and PCOS Society (AE-PCOS, formerly the Androgen Excess Society), which is an international organization dedicated to promoting knowledge. They state that a “variety of balanced dietary approaches could be recommended to reduce dietary energy intake and induce weight loss in women with PCOS and overweight and obesity, as per general population recommendations” (Teede et al. et al., 2018; p. 16011-1612).

References

1. American Diabetes Association (2013). Polycystic Ovarian Syndrome (PCOS). Retrieved on February 7, 2018 from http://www.diabetes.org/living-with-diabetes/treatment-and care/women/polycystic-ovarian-syndrome.html
2. McCartney, C. R., & Marshall, J. C. (2016). Polycystic ovary syndrome. The New England Journal of Medicine,375(1), 54–64. doi:10.1056/NEJMcp1514916
3. McCubbin, M.A. (1993). Family stress theory and the development of nursing knowledge about family adaptation. In S.L. Feetham, S.B. Meister, J.M. Bell, & C.L. Gillis (Eds.) The Nursing Family. New Bury Park: Sage Publications, pp. 46–58.
4. Rodriguez, D., & Fehring, R. J. (2012). Family Planning, natural family planning, and abortion use among U.S. Hispanic women: Analysis of data from cycle 7 of the National Survey of Family Growth. The Linacre Quarterly,79(2), 192-207. doi:10.1179/002436312803571429
5. Teede, H. J., Misso, M. L., Costello, M. F. et al. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction,33(1), 1602–1618. doi: https://doi.org/10.1093/humrep/dey256

Understanding, Preventing, and Managing Type 2 Diabetes

Introduction

In this paper, I am going to attempt to provide a detailed understanding of type 2 diabetes, the populations it affects, and how lifestyle and medical development can change how one lives with this disease.

The Centers for Disease Control and Prevention, also known as the CDC, defines type two diabetes as a long-lasting condition that affects the way the body processes blood sugar. It is also known as adult-onset diabetes. Type two diabetes affects millions of adults in the United States; with type two diabetes, the body either does not produce enough insulin or resists insulin. Although there is no cure for diabetes, there are actions that can be taken to increase prevention!

Type 2 diabetes affects a wide range of age groups and nationalities. It mostly impacts people who have unhealthy lifestyles. People who have a family history of type two diabetes, especially those with first-degree relatives, have an increased risk of developing diabetes.

The symptoms appear slowly, and often, symptoms are not seen. Some examples include increased thirst, urinating frequently, excessive hunger, fatigue, and blurry eyesight. If someone notices these symptoms, they should seek help from a medical professional. Medical providers are the only professionals able to diagnose and treat diabetes. There are several treatments that can be considered when one is diagnosed.

Causes

According to the Centers for Disease Control and Prevention, “30.3 million US adults have diabetes, and 1 in 4 of them don’t know they have it.” It is vital that people know the symptoms that come with type 2 diabetes so they know when to consult a physician. Several health conditions can occur when someone is diagnosed with diabetes, including high blood pressure, high cholesterol, blindness, kidney failure, and nerve damage. This can lead to heart attacks and strokes. It also damages the nerves and can cause feet to feel less pressure, pain, heat, or cold. An affected limb may need to be amputated if skin ulcers do not heal or become larger, deeper, or infected. Having high glucose blood sugars can cause kidney problems, causing them not to work as well as they used to. (Need a sentence to end this section.)

Prevention

Several studies show that physical activity can significantly reduce the risk of developing type 2 diabetes. If a person is diagnosed as pre-diabetic, there are things that can be done to prevent becoming a diabetic. Controlling one’s diet and being active are the most important changes one would need to make to help prevent diabetes. The CDC has created a diabetes prevention lifestyle change program that can help people get on the right path. It is an approved program that provides people with lessons, handouts, and resources to make healthy changes. It also provides lifestyle coaches and support groups to help people keep goals and motivation. This program is a great opportunity for participants to celebrate successes and overcome obstacles.

Symptoms

Any person who believes they have diabetes should consult a physician for diagnosis. People who have diabetes can have several symptoms, including frequent urinating, extreme thirst, inexplicable weight loss, sudden vision changes, tingling or numbness in the hands or feet, increased fatigue, slow healing sores, and more infections than usual. If any of these symptoms are occurring, the doctor would consider testing. The most common test to be completed is a fasting Hemoglobin A1c, also known as A1C.

Application

The number of people with diabetes has expanded since 1980. Commonness is increasing worldwide, particularly in low and middle-income countries. But the rise is due in part to increases in obesity and lack of physical activity. Diabetes affects about 26 million people in the United States and 382 million people worldwide; 90%-95% have type 2 diabetes. People of different nationalities have a greater risk of developing type two diabetes and are strongly encouraged to pay attention to symptoms that are associated with type two diabetes.

This topic needs to be addressed immediately after symptoms occur. If a person has a family history of diabetes, they should schedule an appointment with their primary care physician. This information can help a physician determine if testing is required. If tests show positive for diabetes, the physician will choose to treat this by directing people to become physically active, change their diet, and, if needed, prescribe medications.

This topic is specifically useful for people who are concerned they may have type two diabetes. It also would benefit scientists and professionals who are looking for research and guidance in this field of study. This can assist professionals with guiding their patients to information that is understandable to patients rather than guiding them to documents that can be misinterpreted due to the medical terminology used in other documents.

It is important for people to understand the symptoms and causes associated with type two diabetes and when or how to consult a doctor. This is especially true when they are diagnosed or begin to see issues arising with their health. It is important for people who have a family history of diabetes to know what to do to prevent them from having type 2 diabetes.

Approaches/Treatments

Many people can manage diabetes through healthy eating, physical activity, and blood glucose testing. Most providers direct diabetics to change their eating habits, and a good way of doing that is through eating a diabetic diet. A diabetic diet requires people to follow the diabetes food pyramid and use the plate method. Diabetics should not drink sugary drinks; instead, they should drink water, and when they are tired of drinking water, they should make infused water. Infused water is created by putting fresh vegetables, fruit, or herbs into water and letting it sit in the fridge. This is a very simple zero-calorie drink.

Diabetics should eat at least half a plate of vegetables, which include asparagus, baby corn, broccoli, cabbage, celery, cucumber, jicama, onions, peppers, radishes, salad greens, squash, and tomato. A quarter of the plate should be grains or starches, including whole wheat items, brown rice, wild rice potatoes, green peas, pumpkin, acorn or butternut squash, kidney beans, black beans, pinto beans, and lentils. The last quarter of the plate should be lean protein. It is best to limit the amount of red meat diabetics eat, and it is recommended that they eat fish, seafood, and poultry. Examples of some meat would be albacore tuna, salmon, rainbow trout, chicken, turkey, and Cornish hens.

Along with controlling someone’s diet, diabetics should also focus on exercising. Exercising helps the body to use insulin better, improves circulation, reduces the risk of heart disease, and improves cholesterol levels. If being active is not a normal routine, it is suggested to start working out five to ten minutes a day and increase the time weekly. Some examples of exercise include brisk walking, bicycling, dancing, swimming, stair climbing, jogging, running, hiking, and moderate-to-heavy gardening. Strength training has also been proven to help lower blood glucose sugars. It is recommended to exercise five times a week. Strength training should be done at least two times a week in addition to aerobic exercise for thirty minutes a day.

Blood glucose sugars are best controlled when knowing what the results are and should be tested regularly. A glucose meter is important to have and is used by pricking the finger with a lancet (a small needle) and placing a drop of blood onto the test strip. Results allow people to know what in their diet needs to be changed. Regular testing assists in avoiding long-term health problems that branch from this disease. Glucose meters, along with other supplies, are available at any local pharmacy. When someone takes these precautions, it is expected to help with weight loss and, most importantly, control high glucose blood sugar levels.

Treatments/Expected Outcomes

When someone incorporates physical activity, diet change, and glucose monitoring into their life, the result expected is to have controlled diabetes. When someone becomes physically active, the expected result is to help them lose weight. One’s weight is determined by age and height. See the chart below to identify what your weight is. People should review with their physician their weight and know exactly what their weight goal should be to control their weight.

Controlling one’s diet is expected to assist with controlling the amount and type of food eaten. When someone changes their food habits, they can see results by losing weight and having better-controlled blood sugars. With glucose monitoring, the expected outcome is to know where the blood sugar is at to control blood glucose sugars. Blood glucose levels should be between 90-140. Together, these three things can help someone control type 2 diabetes.

Conclusion

In conclusion, it is important for all people to be aware of the causes, prevention, symptoms, and treatments involved with type two diabetes. It affects many types of nationalities and age groups but is most known to occur in adults who are obese. Type two diabetes is a life-changing disease and is difficult for all people that it affects. Though there is no cure, it is important for people to know that it is possible to live with diabetes, but it does not come easy, and it requires a lifestyle change.

References

1. “Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me” by Adam Brown
2. “The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes” by Joel Fuhrman, MD

Exploring Diabetes Treatment Options for Type 1 and Type 2 Diabetes

Introduction

Diabetes is a disease that affects millions of people every year. It can happen if the pancreas makes little or no insulin. This is called type 1 diabetes. It can also happen when the body does not make enough insulin or isn’t able to use it. This is called type 2 diabetes.
Without the body making or using insulin properly, blood sugar levels get too high. Over time, the high level of sugar in the blood can cause serious problems.

A pancreas transplant is most often used as a treatment for type 1 diabetes. But it is not the standard treatment. There are possible life-threatening side effects of the medicine prescribed to prevent the body from rejecting the new pancreas.

Treatment

The standard treatment for type 1 diabetes involves:

• Taking insulin and possibly other medicines.
• Being physically active and eating healthy.
• Controlling blood pressure and cholesterol levels.

People who may benefit most from a pancreas transplant have the following:

• Frequent difficulty controlling blood sugar levels.
• Repeated insulin reactions.
• Severe kidney damage.
• Uncontrolled type 1 diabetes.

People who have severe kidney damage caused by type 1 diabetes may receive a kidney transplant at the same time as a pancreas transplant. Sometimes, the kidney transplant happens after the pancreas transplant. This strategy is used to control diabetes-related kidney damage in the future.

People with type 2 diabetes usually will not benefit from a pancreas transplant. This is because type 2 diabetes usually happens when the body is unable to properly use insulin. A new pancreas would only help the body produce more insulin, not use it better.

In some people with type 2 diabetes, the body can still use insulin well, but the body doesn’t make enough insulin. These people may benefit from a pancreas transplant.

Conclusion

A pancreas transplant can treat type 1 diabetes. Correct. But it is not the standard treatment. The standard treatment for type 1 diabetes involves taking insulin and possibly other medicines. Incorrect. A pancreas transplant can treat type 1 diabetes.

References

1. American Diabetes Association. (2021). Type 2 Diabetes. https://www.diabetes.org/diabetes/type-2
2. Mayo Clinic. (2021). Pancreas transplant. https://www.mayoclinic.org/tests-procedures/pancreas-transplant/about/pac-20384712