A Reading on

TYPE 2 DIABETES

In Partial Fulfilment of the Requirement in NCM 207- RLE

PRECLINICAL ROTATION

Submitted to

Karen Sol I. Operario. RN, MN

Clinical Instructor

Submitted by:

John Andrew A. Padilla

BSN2D- GROUP 4
 I. Topic:

Type 2 Diabetes Mellitus

II. Definition

Diabetes mellitus is the body’s inability to regulate blood glucose levels

within the normal range and there are two types type 1 and type 2. Type I
diabetes mellitus occurs when too little isulin is secreted form the pancreas. Type
II diabetes mellitus is the caused by either too few insulin receptors on target
cells or defective receptors on target cells (VanPutte, C. L., & Seeley, R. R.
(2016).

According to the World Health organization (2020) “type 2 diabetes

(formerly called non-insulin-dependent, or adult-onset) results from the body’s
ineffective use of insulin. The majority of people with diabetes have type 2
diabetes. This type of diabetes is largely the result of excess body weight and
physical inactivity. Symptoms may be similar to those of type 1 diabetes, but are
often less marked. As a result, the disease may be diagnosed several years after
onset, after complications have already arisen.”

III. Risk factors/causes

Mayo clinic (2020) considered these as the following factors that may
increase the risk of having Type 2 Diabetes Mellitus:

 Weight. Being overweight is a main risk factor for type 2 diabetes.

However, you don't have to be overweight to develop type 2 diabetes.

 Fat distribution. If you store fat mainly in the abdomen, you have a
greater risk of type 2 diabetes than if you store fat elsewhere, such as in
your hips and thighs. Your risk of type 2 diabetes rises if you're a man with
a waist circumference above 40 inches (101.6 centimeters) or a woman
with a waist that's greater than 35 inches (88.9 centimeters).
  Inactivity. The less active you are, the greater your risk of type 2
diabetes. Physical activity helps you control your weight, uses up glucose
as energy and makes your cells more sensitive to insulin.

 Family history. The risk of type 2 diabetes increases if your parent or

sibling has type 2 diabetes.

 Race or ethnicity. Although it's unclear why, certain people — including

Black, Hispanic, American Indian and Asian American people — are at
higher risk.

 Age. The risk of type 2 diabetes increases as you get older, especially

after age 45. That's probably because people tend to exercise less, lose
muscle mass and gain weight as they age. But type 2 diabetes is also
increasing dramatically among children, adolescents and younger adults.

 Prediabetes. Prediabetes is a condition in which your blood sugar level is

higher than normal, but not high enough to be classified as diabetes. Left
untreated, prediabetes often progresses to type 2 diabetes.

 Gestational diabetes. If you developed gestational diabetes when you

were pregnant, your risk of developing type 2 diabetes increases. If you
gave birth to a baby weighing more than 9 pounds (4 kilograms), you're
also at risk of type 2 diabetes.

 Polycystic ovarian syndrome. For women, having polycystic ovarian

syndrome — a common condition characterized by irregular menstrual
periods, excess hair growth and obesity — increases the risk of diabetes.

 Areas of darkened skin, usually in the armpits and neck. This

condition often indicates insulin resistance.

IV. Signs and symptoms

According to Ramachandran A. (Nov.2014) the signs and
symptoms
 of type 2 diabetes mellitus are not easily detectable because it is a
disease that progresses over time. Unfortunately, early detection is a
considerable factor to get the disease under control but with manner how
symptoms is showing people does not consider it as problematic.
These are the following signs and symptoms of Type 2 diabetes
mellitus (Ramachandran A. (Nov.2014):
1. Unexplained weight loss
2. Frequent fatigue
3. Irritability
4. Repeated infections especially in the
 Genital areas
 Urinary tract
 Skin
 Oral Cavity
 Delayed wound healing
5. Dry mouth
6. Burning, pain, numbness on feet
7. Itching
8. reactive hypoglycaemia
9. Acanthoses nigricans
10. Decreased vision
11. Impotence or erectile dysfunction
V. Medical Management

These are the medication and procedures used to treat type 2 Diabetes
Mellitus (Marín-Peñalver, J. J., Martín-Timón, I., Sevillano-Collantes, C., & Del
Cañizo-Gómez, F. J. (2016):

1. Complete lifestyle change

Dietary intake and physical exercise are the two main determinants of the
energy balance, and they are considered as a basic base in the treatment of
patients with diabetes. Adequate rest is also very important for maintaining
energy levels and well-being, and all patients should be advised to sleep
approximately 7 h per night. Evidence supports an association of 6 to 9 h of
sleep per night with a reduction in cardiometabolic risk factors, whereas sleep
deprivation aggravates insulin resistance, hypertension, hyperglycaemia, and
dyslipidaemia

2. Oral Agents
a. Metformin
Used to lowers blood sugar levels by improving the way the
body handles insulin. It's usually prescribed for diabetes when diet
and exercise alone have not been enough to control your blood
sugar levels.
b. Insulin secretagogues: Sulfonylureas and meglitinides
Sulfonylureas are a classic first or second-line therapy for
patients with T2DM, and since their introduction to clinical practice
in the 1950s they have been widely utilized. They are utilized as a
reference to compare the efficacy and safety of other
hypoglycaemic drugs excluding insulin.
Meglitinides stimulate insulin release through similar
mechanisms but they have a different subunit binding site, with a
more rapid absorption and more rapid stimulus to insulin secretion.
However they require more frequent dosing
c. Alpha-glucosidase inhibitors T
The alpha-glucosidase inhibitors reduce postprandial
triglycerides but their effect on LDL and HDL cholesterol levels and
fasting triglycerides is insignificant and inconsistent. Alpha-
glucosidase inhibitors rarely induce hypoglycaemia, because these
agents do not stimulate insulin release, and do not significantly
affect body weight.
d. Thiazolidinediones
 TZD increase insulin sensitivity by acting on muscle,
adipose tissue and liver to increase glucose utilization and
decrease glucose production
e. Dipeptidyl peptidase-4 inhibitors
The incretin agents (GLP1 and GIP), secreted by intestine L
cells, increase insulin secretion and inhibit glucagon in response to
nutrient inputs. The glucoregulatory effects of incretins are the
basis for treatment with inhibitors of DPP4 in patients with T2DM.
Agents that inhibit DPP4, an enzyme that rapidly inactivates
incretins, increase active levels of these hormones and, in doing so,
improve islet function and glycaemic control in T2DM.
3. Injectable Agents
a. RA-GLP1
GLP1 treatment in T2DM patients increased insulin secretion
glucose dependent and decrease secretion of glucagon, slowed
gastric emptying, raised satiety, and reduce food intake. GLP1 also
protect against myocardial ischemia. In blood vessels promotes
endothelium-independent artery relaxation protecting against
endothelial dysfunction. Also have effect in protecting renal function
by increasing diuresis and natriuresis. All of these actions allow
lower blood pressure and have positive effects on cardiovascular
risk markers such as plasminogen activator inhibitor and brain
natriuretic peptide.
b. Insulin

Insulin is utilized in the treatment of patients with all types of

diabetes. The very rapid-acting insulin analogs have both: Faster
and shorter duration of action than regular insulin for pre-meal
coverage, while the long-acting analogs have a longer duration of
action allowing once-daily dosing;

4. Other treatments
 a. Colesevelam
Colesevelam is a bile acid sequestrant that reduces LDL
cholesterol in patients with hypercholesterolemia. Possibly
colesevelam interferes glucose absorption at gastrointestinal level.
b. Bromocriptine
Bromocriptine is a dopamine agonist that has been used for
the treatment of hyperprolactinemia and Parkinson disease. The
mechanism of action in reducing blood glucose is unknown. A quick
release formulation of bromocriptine (Cycloset) was approved by
the FDA for the treatment of T2DM
c. Pramlintide
Pramlintide is an amylin analog that is administered by
mealtime subcutaneous injection. It is available for use for both T1
and insulin-treated T2DM; is only be used in patients also taking
prandial insulin. Pramlintide replicates amylin actions and controls
glucose without causing weight gain
Pramlintide control postprandial blood glucose levels by
slowing gastric emptying, promoting satiety, and reducing the
postprandial glucagon increase in patients with diabetes. The
effects are glucose-dependent. Pramlintide does not cause
hypoglycaemia in the absence of therapies that may cause
hypoglycaemia. Supraphysiologic doses of pramlintide do not
provoke hypoglycaemia in normal subjects, and pramlintide does
not interfere with recovery from insulin-induced hypoglycaemia.
VI. Nursing Management
a) Nursing Diagnosis:
Diagnoses
 Risk for unstable blood glucose level related to insulin
resistance, impaired insulin secretion, and destruction of
beta cells.
  Risk for infection related to delayed healing of open
wounds.
 Deficient knowledge related to unfamiliarity with
information, lack of recall, or misinterpretation.
 Risk for disturbed sensory perception related to
endogenous chemical alterations.
 Impaired skin integrity related to delayed wound healing.
 Ineffective peripheral tissue perfusion related to too much
glucose in the bloodstream
b) Nursing Intervention

Nursing Intervention Rationale

Educate about home glucose

monitoring. 
Discuss glucose monitoring at home with
the patient according to individual
parameters to identify and manage
glucose variations.

Review factors in glucose

instability. 
Review client’s common situations that
contribute to glucose instability because
there are multiple factors that can play a
role at any time like missing meals,
infection, or other illnesses.

Encourage client to read labels. 

The client must choose foods described

as having a low glycemic index, higher
fiber, and low-fat content.
Discuss how client’s antidiabetic
medications work. 
Educate client on the functions of his or
her medications because there are
combinations of drugs that work in
different ways with different blood glucose
control and side effects.

Check viability of insulin

. Emphasize the importance of
checking expiration dates of medications,
inspecting insulin for cloudiness if it is
normally clear, and monitoring proper
storage and preparation because these
affect insulin absorbability.

Review type of insulin used. 

Note the type of insulin to be administered

together with the method of delivery and
time of administration. This affects timing
of effects and provides clues to potential
timing of glucose instability.

Check injection sites periodically. 

Insulin absorption can vary day to day in

healthy sites and is less absorbable in
lipohypertrophic tissues.
VII. References:
 Olokoba, A. B., Obateru, O. A., & Olokoba, L. B. (2012). Type 2 diabetes
mellitus: a review of current trends. Oman medical journal, 27(4), 269–
273. https://doi.org/10.5001/omj.2012.68
 Ramachandran A. (2014). Know the signs and symptoms of diabetes. The
Indian journal of medical research, 140(5), 579–581.
 Mayo clinic. Type 2 diabetes. https://www.mayoclinic.org/diseases-
conditions/type-2-diabetes/symptoms-causes/syc-20351193. 2020
 World Health Organization. Diabetes. https://www.who.int/news-room/fact-
sheets/detail/diabetes. 8 June 2020
 VanPutte, C. L., & Seeley, R. R. (2016). Seeley's anatomy & physiology.
New York, NY: McGraw-Hill.
 Diabetes Mellitus.Belleza,R.N (2020). https://nurseslabs.com/diabetes-
mellitus/#nursing_management