Sample Undergraduate 1st Nursing Report
The Nursing Management of Type 2 Diabetes Mellitus
This essay will refer to type 2 diabetes mellitus as “Type 2 diabetes,” which is a chronic illness marked by insufficient insulin production (Robbins, Shaw and Lewis, 2007). It takes place as a result of the pancreas’s exhausted -cells, which produce insulin (Robbins, Shaw and Lewis, 2007). About between 3.9 and 6.7 mmol/L is the blood glucose range that is maintained by the hormone insulin (Robbins, Shaw and Lewis, 2007). Hyperglycemia, or high blood sugar, is a complication of type 2 diabetes (Robbins, Shaw and Lewis, 2007; National Institute for Heath and Care Excellence [NICE], 2015a). When hyperglycemia is not well managed, it can lead to a number of problems, including micro- and macrovascular disease (Goldstein and Muller-Wieland, 2007; World Health Organisation [WHO], 2018).
The United Kingdom (UK) has a high prevalence of type 2 diabetes; in fact, there were around 3.7 million new cases reported there in 2017. (Diabetes UK, 2017). The primary national organisation for diabetes in the UK, Diabetes UK, believes that there are an additional 1 million cases of Type 2 diabetes in the country. With the prevalence of Type 2 diabetes, nurses are likely to care for patients who have this condition in every clinical environment; it is crucial that nurses are aware of the proper nursing management of Type 2 diabetes. This essay offers a critical evaluation of Type 2 diabetic nurse care.
Achieving sufficient glycaemic control, as determined by the blood concentration of glycosylated haemoglobin, is the primary objective of Type 2 diabetes care (HbA1c). Glycosylated haemoglobin is an objective measure of long-term glycaemic management and, consequently, of the likelihood that someone’s Type 2 diabetes will worsen and that they will develop complications from the disease (Zhang et al., 2012). According to research, nurses have a crucial role in managing Type 2 diabetes, especially when it comes to helping a patient maintain long-term glycemic control. This is true even though the holistic, multidisciplinary management of a person with Type 2 diabetes is necessary (Richardson et al., 2014).
Strategy #1 – Patient education
According to the NICE (2015a) guideline, all patients with Type 2 diabetes should be given organised, evidence-based, and resource-efficient education to help them manage their condition on their own. This instruction must emphasise food recommendations (see Approach #2 below), as well as related lifestyle adjustments like exercising to reduce weight (Lawrence, Conrad and Moore, 2012). According to a recent systematic review and meta-analysis, nurse-led education for persons with diabetes can significantly improve glycaemic control, and this improvement is frequently sustained over time (Tshiananga et al., 2011). Unfortunately, there is still a dearth of clear information regarding the best layout for Type 2 diabetes patient education, especially in terms of frequency and time, delivery methods, and content (Tshiananga et al., 2011)
Strategy #2 – Dietary advice
Dietary recommendations must be the main emphasis of patient education, as described in Strategy #1 above, as food intake is the primary factor in the development and control of Type 2 diabetes (Ley et al., 2014). The NICE (2015a) recommendation emphasises the value of continuing to offer tailored dietary guidance to patients with Type 2 diabetes, particularly in regard to their consumption of high-fibre, low-glycaemic-index (GI) carbohydrates. Nurses should advise patients with Type 2 diabetes on the best eating habits to maintain glycaemic control, including the need of eating three balanced meals and the right kinds of snacks in between each meal (Lawrence, Conrad and Moore, 2012). Notwithstanding the fact that nurses have “expertise and duty” with regard to diet (Xu et al., 2017).
Strategy #3 – Blood pressure management
As previously mentioned, those who have Type 2 diabetes are more likely to develop vascular disease (Goldstein and Muller-Wieland, 2007; WHO, 2018); this could lead to new hypertension or exacerbate preexisting cases. As a result, the NICE (2015a) recommendation suggests that individuals with Type 2 diabetes monitor their blood pressure at least every two months and, as needed, treat it with anti-hypertensive medicine or medications. Specific blood pressure goals are established by the NICE (2015a) guideline for patients with Type 2 diabetes: 140/80 mmHg for them and 130/80 mmHg for those with vascular disease. Individualized targets might be more suitable, according to a growing body of literature that questions the use of universal blood pressure targets in the management of Type 2 diabetes due to the paucity of supporting data and, consequently, their inconsistent use (Grossman and Grossman).
Strategy #4 – Drug treatment
If a person with Type 2 diabetes is unable to maintain appropriate glycaemic control using the aforementioned techniques, the NICE (2015a) guideline advises starting pharmacological therapy. Metformin, which stops gluconeogenesis, or the liver’s generation of excess glucose, is the first-line anti-hyperglycaemic drug that is advised for treatment in Type 2 diabetes in the UK (Downis, 2015). Sulphonylureas or thiazolidinediones are only two examples of the many second-line drugs that can be coupled with metformin. If the disease worsens, insulin may also be used (Downis, 2015). Unless they are independent prescribing professionals skilled in Type 2 diabetes medication management (RCN, 2018b).
References
Journal of Family and Community Medicine, vol. 13, no. 1, pp. 13–18, Alfadda, A. and Abdulrahman, K. A. B. (2006). Evaluation of care for Type 2 diabetic patients at the primary care clinics of a referral hospital.
November 2017, Diabetes UK (2017), Diabetes Prevalence 2017, acquired on June 30, 2018, from
Type 2 diabetes: Prevention, diagnosis, and management, Downis, S. (2015) Nursing Times, vol. 111, no. 10, pp. 14–15.
Type 2 Diabetes: Fundamentals and Practice (2nd edn), by BJ Goldstein and D. Muller-Wieland, Boca Raton, FL: Taylor & Francis Group, 2007.
Blood pressure regulation in Type 2 diabetic patients, Grossman, A. and Grossman, E. (2017), Cardiovascular Diabetology (online), retrieved 30 June 2018, from
G. Jermendy (2005), Is it possible to avoid type 2 diabetes mellitus?, Diabetes Research and Clinical Practice,
Hypertension Research, vol. 40, no. 8, pp. 721–729; Kai, H. (2017). Blood pressure treatment in individuals with Type 2 diabetes mellitus.
Type 2 diabetes: Rising to epic proportions, Nursing Management, vol. 43, no. 1, pp. 20–25, Lawrence, W., Conrad, S., and Moore, A.
Prevention and control of Type 2 diabetes: Dietary components and nutritional methods, Lancet, vol. 383, no. 9933, pp. 1999-2007, by Ley, SH, Hamdy, O, Mohan, V, and Hu, FB (2014)
British Journal of Nursing, vol. 16, no. 4, pp. 232–235, M. Nair (2007), “Nursing management of the person with diabetes mellitus: Part 2.”
Type 2 Diabetes in Adults: Management (NG28), National Institute for Health and Care Excellence (NICE) (2015a), accessed 30 June 2018 from
