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Diabetes Mellitus, Type II: A Case Study

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Whitney McClure

on 21 October 2013

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Transcript of Diabetes Mellitus, Type II: A Case Study

Diabetes Mellitus, Type II: A Case Study
Meet Y.L.: In the not-so-distant past...
Jonelle (our lovely dietician) teaches Y.L. how to COUNT CARBS!
Insulin: What does it do, and how do I poke myself with that needle twice a day?!
By Brooklyn Bennett, Jessica Klopfenstein, Jonelle Lyken, Whitney McClure, Andy Noble, and Emily Walker
Community Resources for Diabetics in the Greater Jacksonville Area
http://www.diabetes.org/in-my-community/local-offices/jacksonville-florida/support-groups-clinics-and-resources.html (comprehensive list of local services)

http://www.firstcoastymca.org/explore/healthy_living/diabetes_support_group/resource_center (comprehensive list of support groups)


Audience Activity!
If you have a LOCK, Stand at the front of the room.
If you have a GLUCOSE molecule, find someone with a KEY. Once you have, stand in front of a LOCK at the front of the room, in lines of 1 lock-key-glucose group each.

What is diabetes, and why does it matter to us?
Pathophysiology of Diabetes
Epidemiology related to Diabetes
Economic Burden of Type II Diabetes
Genetics' role in development of Diabetes
Nurse Brooklyn teaches Y.L. how to check her blood glucose
Later that month...
Diabetes Mellitus Type II: A Case Study
Thank you!
"Eat it"
Find your partners!
To explain a bit better...
6 months later...
Counting Carbohydrates (CHO)
Effective medical nutrition therapy option for adults with Type 2 diabetes.
Can lead to improved diabetes control and weight loss in adults with type 2 diabetes
Involves matching your insulin dosage to the grams of carbohydrate in your food
Carbohydrates turn into glucose 2 hours after a meal, so diabetics need who take multiple insulin injections need to know how many grams of carbohydrates are in their meal so that they can calculate how much rapid acting insulin to take before they eat
Based on their own individual insulin-to-carbohydrate ratio
To calculate how much carbs are in your diet, you will need to know how many carbs are in each serving of food you eat; this information can be found on the nutrition label of most packaged foods
Calculating total carb intake of food that is not packaged:
You will need to know the standard portion of the carbohydrate-containing food
Each serving contains about 15 grams on carbohydrate
Ex. Take 1 unit of rapid-acting insulin for every 10-15 grams of carb you eat
You just ate a 50g of carbohydrate meal
You will need 5 units of insulin to keep your post meal blood sugar within your target level
A diabetic's insulin-to-carbohydrate ration can change over time!
• Very important in managing type 2 diabetes. Combining diet, exercise, and medicine can help control your weight and blood sugar level.
• Exercise helps control type 2 diabetes by:
 Improving your body’s use of insulin’
 Burning excess body fat, helping to decrease and control weight, which results in improved insulin sensitivity
 Improved muscle strength
 Increasing bone density and strength
 Lowering blood pressure
 Helping to protect against heart and blood vessel disease by lowering LDL cholesterol and increasing HDL cholesterol
 Improving blood circulation and reducing your risk if heart disease and stroke
 Increasing energy level and enhancing work capacity
 Reducing stress, promoting relaxation, and releasing tension and anxiety

• The genes that are associated with Type 2 diabetes are those that code for beta-cell mass, beta-cell function (ability to sense blood glucose levels, insulin synthesis, and insulin secretion), proinsulin and insulin molecular structures, insulin receptors, hepatic synthesis of glucose, glucagon synthesis, and cellular responsiveness to insulin stimulation. These genetic abnormalities combined with environmental influences result in the basic Pathophysiology mechanisms of type 2 diabetes.
• Insulin resistance is a suboptimal response of the liver, muscle and adipose tissue to insulin and is associated with obesity.
• Eventually, beta cell dysfunction leads to a deficiency of insulin activity. The progressive decrease of beta cells leads to exhaustion of the remaining cells and an increased demand for insulin biosynthesis.
• Glucagon concentration increases because the pancreas becomes less responsive to glucose inhibition which results in glucagon secretion.
• Hormones from the GI tract (Ghrelin) stimulate growth hormone release. Decreased level of Ghrelin have been associated with insulin resistance and increased fasting insulin levels. Incretins are peptides that are also released in the GI tract and are responsible for improving insulin responsiveness to meals.

Nursing Diagnoses
Desired Outcomes
Interventions for Y.L.
Class Objectives
Audience Activity!
If you have a LOCK, come stand at the front of the room, in a line next to one another, facing the class.

If you have a KEY, find someone with a GLUCOSE molecule and "bond" with them. Once you're part of a GLUCOSE-KEY BONDED PAIR, come to the front of the room and stand in front of a LOCK.

Any GLUCOSE molecules that can't find a KEY partner, stay standing in the aisle.

• To understand the pathophysiology of Diabetes
• To understand the use of Insulin as a pharmacologic intervention
• To understand the importance of lifestyle modifications in the management of Diabetes
• To understand the nursing care associated with Diabetes

I) Ineffective Self-Health Management r/t failure to reduce risk factors

II) Imbalanced nutrition: more than body requirements r/t dysfunctional eating patterns

III) Deficient knowledge r/t unfamiliarity with information resources

IV) Risk for unstable glucose level. Risk factors: deficient knowledge of diabetes management, physical activity level, weight gain
Y.L. will be able to:
Follow mutually agreed upon health care maintenance plan involving counting carbs and eating a well-balanced diet.
Demonstrate an understanding of her condition by naming 3 lifestyle changes she can implement in order to improve her health
State factors contributing to weight gain
Design dietary modifications to meet long-term goal of weight control
Incorporate increased exercise into daily life
Vocalize confidence in her ability to manage her health situation
Demonstrate how to perform diabetes management procedures correctly
Identify sources of community support and resources
Demonstrate how to accurately test blood glucose.
Identify self-care actions to take to maintain target glucose levels.
Demonstrate correct administration of prescribed medications.

1) Educate patient on the need to exercise 30 minutes daily at least 3 times/week.
2) Provide information regarding methods of smoking cessation.

1) Ask patient to keep a food diary
2) Help the patient understand and follow dietary guidelines
3) Make recommendation that the patient lose weight slowly and in a healthy manner
4) Demonstrate the use of food labels in healthy food choices

1) Use individualized approaches that focus on client priorities and preferences
2) Use motivational and problem-solving teaching strategies to support self-efficacy, self-regulation, and self-management
3) Provide visual aids to enhance learning
4) Use teaching methods that reinforce learning and allow adequate time for mastery of content.
5) Use outreach and community educational intervention as appropriate

1) Refer client to dietitian for carbohydrate counting instruction & weight loss counseling.
2) Evaluate client's medication regimen for medications that can alter blood glucose.
3) Teach patient to be aware of the signs and symptoms of hypoglycemia, such as shakiness, dizziness, sweating, hunger, headache, pallor, behavior changes, confusion, or seizures, especially after administering insulin lispro pre-meal.

Insulin is the "key" that allows the essential glucose to enter the cell in order to provide energy to power the cell's operations.
The cell is "locked" to glucose. Glucose cannot enter a cell on its own.
In diabetes, there are less insulin molecules than there are glucose, which leaves the unused glucose in the bloodstream unable to enter the cell to provide energy.
NCLEX Review!
*Pull out your phones and prepare to text responses to 22333 OR go to www.pollev.com/whitneyUNF (if you don't have free text messaging)
What IS Diabetes?
According to Huether and McCance, is a "group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both (p. 458)". Type II Diabetes specifically is caused by a combination of genetic, environmental, and other risk factors that together result in these defects.

Affects 25.8 million people, or 8.3% of the ENTIRE U.S. population
18.8 million diagnosed cases, 7 million undiagnosed
7th leading cause of death in the U.S. in 2007
71,382 diabetes was underlying cause of death; 160,022 it was a contributing factor-and these figures are likely underreported
1.9 million newly diagnosed cases in 2010
11.3% of all people aged 20 or greater have diabetes. Approximately 35% have prediabetes based on fasting hemoglobin A1c levels (equating to around 79 million prediabetic adults).
Incidence has doubled since 1980
Leading cause of kidney failure (44% of all new cases), nontraumatic lower-limb amputations (60%), and new cases of blindness.

$174 billion in total costs of diabetes in the United States, both direct and indirect, in 2007
$116 billion direct
$58 billion indirect (due to loss of ability to work, disability, or premature mortality)
Average medical expenses around 2.3 times higher for people diagnosed with diabetes than for people without diabetes.
Genetic variants alter either insulin secretion or sensitivity in such a way that when combined with environmental factors result in increased susceptibility to Type II diabetes.
TCF7L2: Blood glucose homeostasis, pancreatic islet cell function. Genetic variants may be responsible for increased risk of Type II DM
FTO: Obesity and fat-mass gene
SLC30A8: Intracellular zinc accumulation. Highly expressed only in the pancreas.
MTNR1B: melatonin, link between metabolism and circadian rhythm
IRS1: Action of insulin (versus secretion)
PPARG & KCNJ11: Encode proteins targeted by antidiabetic drugs

Ackley, B., & Ladwig, G. (2013). Nursing diagnosis handbook: A guide to planning care. (10 ed.). St. Louis, MO: Elsevier.
Adeghate, E., Schattner, P., & Dunn, E. (n.d.). An update on the etiology and epidemiology of
diabetes mellitus. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17151290
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. (2011). National surveillance data. Retrieved from http://www.cdc.gov/diabetes/statistics/age/fig4.htm
Dah58dah58. (2009, April 27). Diabetes – made simple [Video file]. Retrieved from
Dedoussis, G., Kaliora, A., & Panagiotakos, D. (n.d.). Genes, diet and Type 2 diabetes mellitus: a review.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892523/
Harris, M. (2013). Classification, diagnostic criteria, and screening for diabetes. Retrieved October 7, 2013, from http://diabetes.niddk.nih.gov/dm/pubs/america/pdf/chapter2.pdf
Huether, S.E., & McCance, K.L. (2012). The Endocrine System. Understanding pathophysiology (pp. 426-474). St. Louis, MO: Mosby, Inc. an imprint of Elsevier Inc.
Ignatavicius, D., & Workman, L. (2012). Medical-surgical nursing: Patient-centered collaborative care. (7 ed.). St. Louis, MO: Mosby. (*NCLEX Questions)
Ingelheim, B. (2009, September 7). Diabetes & assoicated complications [Video file]. Retrieved from
Lilley, L.L., Collin, S.R., & Snyder, J.S. (2014). Antidiabetic Drugs. Pharmacology and the nursing process (pp. 510-531). St. Louis, MO: Mosby, Inc. an imprint of Elsevier Inc.
McCarthy, M. (2010, Dec 9). Genomics, Type 2 Diabetes, and Obesity. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMra0906948
McCulley, D. (2013). Death to diabetes. Retrieved October 3, 2013, from http://www.deathtodiabetes.com/Diabetes_-_Epidemiology.html#.UmKhwXPD-00
Medicom Digital. (2009, August 17). Diabetes animation [Video file]. Retrieved from
Mosby. (2008). Mosby’s dictionary of medicine, nursing and health professions (9th ed). Maryland Heights, MO. Elsevier Health Sciences.
National Diabetes Fact Sheet, 2011. (n.d.). Centers for Disease Control and Prevention. Retrieved
October 20, 2013 from http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf
SLC30A8 solute carrier family 30 (zinc transporter), member 8 [Homo sapiens (human)] - Gene - NCBI.
(n.d.). National Center for Biotechnology Information. Retrieved October 20, 2013, from http://www.ncbi.nlm.nih.gov/gene/169026
TCF7L2 transcription factor 7-like 2 (T-cell specific, HMG-box) [Homo sapiens (human)] - Gene - NCBI. ( 2013, Oct 12). National Center for Biotechnology nformation. Retrieved October 21, 2013, from
If you have a LOCK, come stand at the front of the room, in a line next to one another, facing the class.

If you have a KEY, find someone with a GLUCOSE molecule and "bond" with them. Once you're part of a GLUCOSE-KEY BONDED PAIR, come to the front of the room and stand in front of a LOCK.

Any GLUCOSE molecules that can't find a KEY partner, stay standing in the aisle.
Full transcript