TYPE 2 DIABETES

AGES 65 YEARS AND OLDER

PAMELA COLLINS
MSN6007
FEBRAURY 27, 2017
 INTRODUCTION

The author is focusing on Home Health Patients. She has work for a number of years
since becoming an RN providing education to nurses on how to provide patient
education regarding signs and symptoms of type 2 diabetes, complications that occurs
from type 2 diabetes, What is the cause of type 2 diabetes? Her interest includes
diabetic education, and renal education. The author has been a nurse for over three
decades. She started out being a nursing assistant, medication aide, then an LVN
which lead her to be curious of how nursing. She completed her RN since 2003 and
have has numerous role, such as a quality manager, educator, provided skills
competency to LVNs and Nurse assistance. Because of her passion for older adults,
she wanted to stay in this age range 65 years and older. The main purpose of this
paper we be on Type 2 diabetes and the complications that arises from this disease.
 WHO DOES TYPE 2 DIABETES AFFECT

Type 2 diabetes is the most common form of diabetes. It affects more than 22
millions Americans and is projected to double by 2025. It typically occurs when
when your cells resist the insulin that comes knocking at their doors, leaving
glucose to circulate in your bloodstream instead of being used to fuel your cells.
In type 2 diabetes, your body does not use insulin properly. This is called insulin In
time your pancreas isnt able to keep up and cant make enough insulin to keep
your blood glucose levels normal.
Type 2 diabetes is treated with lifestyle changes, oral medications (pills), and
insulin. People with type 2 diabetes can control their blood glucose with healthy
eating and being active.
 WHO ARE AT RISK FOR TYPE 2 DIABETES

Type 2 diabetes is found to be more common in African Americans

Latinos
Native Americans
Asian Americans/Pacific Islanders
obesity
Family history of diabetes mellitus
Age and physical inactivity
 CAUSES OF TYPE 2 DIABETES MELLITUS

The pathophysiology of Type 2 diabetes develops when cells start ignoring insulin.
To understand why that matters, you need to understand that carbohydrates in food
break down into glucose (sugar) during digestion(Mayo, 2016). That glucose enters
the bloodstream. Meanwhile, the pancreas produces the hormone insulin in
response to the rise in blood glucose. Insulin is needed to "unlock," or open, the
cells so that glucose can enter and be used for energy. When cells become insulin
resistant, the pancreas struggles to make even more insulin. Eventually, the
pancreas may not be able to make as much insulin as before, and blood sugar levels
just get higher and higher (Mayo, 2016). The greatest feature of type 2 diabetes id
high blood sugar levels if your blood.
 WHAT ARE THE SIGNS AND SYMPTOMS OF TYPE 2 DIABETES?

Some of the symptoms of type 2 diabetes mellitus may include fatigue

or nausea, frequent urination, unusual thirst, weight loss, blurred
vision, excessive hungry, frequent infections, fatigue, and slow healing
of wounds or sores. However, some first symptoms of type 2 diabetes
may be blurred vision, erectile dysfunction or pain or numbness in the
feet or hands. Some people have no symptoms, until its to late.
However, you could have type 2 diabetes for years and be unaware of
it. If you become concern about these symptoms you need to see your
physician (ADA, 2017).
 COMPLICATION OF TYPE 2 DIABETES

The most common complications of type 2 diabetes mellitus in individual

65 years and older includes:
Heart disease and stroke
Kidney disease
Eye disease
Nerve damages
Diabetes damages the nerves. This can make individuals with type 2
diabetes less able to feel pain, pressure, heat or cold (Story, 2015).
 PATHOPHYSIOLOGY CHANGES AFFECTING HEMATOPOIETIC AND CARDIOVASCULAR FUNCTION

Hematopoiesis is the process of blood formation, an it occurs primarily in the bone marrow (Story, 2015). As we age, the function of the Bone
Marrow (BM) becomes comprise producing a stem cell niche, defect in hematopoietic stem cell mobilization (Kojima, Kim, & Chan, 2014).
Pathophysiology changes affecting type 2 diabetes in 65 years and older is related to the BM niche, often leading to multiple bone marrow
microenvironment defects, such as microangiopathy, neuropathy, and mobilization (Fadini, Ferro, Quaini, Asahara, & Madeddu, 2014). Overtime,
complications from defected BM cells can lead to vascular and cardiovascular complications such as heart disease, stroke, kidney disease, blindness,
and nerve damages with individuals with type 2 diabetes.
 CHANGES AFFECTING FLUID, ELECTROLYTE & URINARY FUNCTION

Hypernatremia, hyponatremia, and hyperkalemia are some pathophysiological changes

that occur in individuals and is the most common electrolyte abnormalities found in
patients 65 years and older. Patients with type 2 diabetes experience polyuria which is
defines as an increase in urination. This can leads to dehydration and other complications
Under normal conditions the elderly can maintain water and electrolyte balance but this
may be jeopardized by an illness, a decline in cognitive ability, and with certain
medications. Therefore, it is important to be aware of the potential electrolyte
abnormalities in the older adults that can arise under these various conditions to prevent
adverse outcomes (Schlanger, Bailey & Sands, 2010). The most common electrolyte
abnormalities in elderly patients are the dysnatremias, and age has been found to be an
independent risk factor for developing both hyponatremia and hypernatremia.
 CHANGES AFFECTING THE REPRODUCTIVE & ENDOCRINE SYSTEMS

Diabetes is a disease that affect the endocrine (Story, 2015). In type 2 diabetes, individuals body is resistant to the
effect of insulin and it compensate by producing and releasing more insulin, which can lead to beta cell damage.
Because of beta cell damage, type 2 diabetics may make very little insulin and require injection. In diabetic individuals, 65 years and older diabetes
have a major impact of multiple organs and leads to complications such as stroke, kidney damage, diabetic neuropathy, blindness, amputation, and
hypertension (Story, 2015). People with type 2 diabetes, 65 years and older, the productive system is also impaired when diabetes is present. The
biggest impact on the reproductive system for both men and women is sexual dysfunction. The prevalence of sexual dysfunction in diabetic men
approaches 50%, whereas in diabetic women it seems to be slightly slower.

Diabetes is the most common cause of erectile dysfunction in men. Among diabetic women neuropathy, vascular impairment and psychological
complaint have been implicated in the pathogenesis of decreased libido, low arousability, orgasmic dysfunction, and dyspareunia (Amaral, Oliveira, &
Ramalho, 2008).
 CHANGES AFFECTING THE GASTROINTESTINAL & MUSCULOSKELETAL SYSTEMS

Diabetes is a systemic disease that may affect many organ systems. Gastrointestinal (GI) tract is no
exception (Gunasekaran & Gannon, 2011). As with other complication of diabetes, the duration of the
disorder and poor glycemic control seem to be associated with severe GI problems. Pathophysiology
changes in diabetic patients 65 years and older are directly related to the pancreas. The pancreas
helps produce hormones especially insulin to help regulate blood glucose (Story, 2015). The
pathophysiology changes that affect the musculoskeletal system is peripheral vascular disease (PVD).
Peripheral vascular disease is a blood circulation disorder that causes the blood vessels out of your
heart and brain to narrow. hen there are changes affecting the pancreas insulin can not be produced
to help regulate blood glucose and to be related to dysfunction of the neurons supplying the enteric
nervous system. PVD can also cause pain and fatigue, often in you legs. Blood vessels becomes and
blood flow decreases this condition can be due to arteriosclerosis where plaques build up in the vessel
and limit the flow of blood and oxygen to organs and limbs. This can lead to organ damage and loss of
finger, toes or limbs.
 CHANGES AFFECTING THE NEURAL & SENSORY SYSTEMS

With type 2 diabetes, the high blood sugar from diabetes affect the nerves and overtime increases a persons risk for nerve damage. The most common
type nerve disease (neuropathy) affects both sensory nerves. Changes that can affect individual 65 years and older with type 2 diabetes are changes in
the patients vision and diabetic neuropathy (Story, 2015). Glaucoma and diabetic retinopathy, have show changes in sensory function by causing
cataracts and blindness in diabetic patients (Story, 2015). Annual eye examination can prevent many complications, along with well control blood
glucose levels.
 CHANGES AFFECTING INTEGUMENTARY AND BODY DISFENSE

Pathophysiological changes in patients with diabetes that can cause certain affect on the
integumentary system is bacterial and fungal infection. Diabetes can affect blood vessels
that cause the appearance of scaly patches to the skin. Atherosclerosis, a condition in
which blood vessels are narrowed, could cause the skin to turn hairless, thin, and shiny.
Insulin resistance in type 2 diabetes can cause a darkened areas of skin to appear in the
neck or armpits (American Diabetes Association, 2016). Most importantly, diabetes does
cause neuropathy, so if a diabetic patient suffer from diabetic nerve damage, they could
have an infected cut, skin puncture and not know it. It is important for diabetics to inspect
their feet every day and report and open areas to their physician immediately. The first line
of defense can help you avoid the cunts that can lead to infection. Keep skin dry, especially
between the toes. Get plenty of rest, eat a heart healthy diet and drink plenty of fluids to
keep well hydrated. (Story, 2015).
 HOW CHANGES CAN IMPACT DEVELOPMENTAL MILESTONES, GENDER & CULTURE

Developmental milestones are found to impact both type 1 diabetes and type 2 diabetes. However,
adults 65 years and older who are non-compliance with their treatment regime were found not able to
manage their diabetes which lead to more serious complications. There are many indications why
older adults are not able to manage their diabetes such as lack of financial, lack of education, lack of
transportation, and lack of supplies or medications.

As an individual gets older the risk for type 2 diabetes goes up. Type 2 can affect any gender or
culture but it has been found to affect the African Americans, Native Americans and Mexican
Americans the most and this is partly due to this populations are overweight and have high blood
pressure, also this disease is more related to family history. Making a few small changes to eat
healthier and become more physical active can have a big effect on ones health.
 MODIFIABLE RISK FACTORS

While some things that contribute to the development of diabetes are beyond a
person control, there are also a number of modifiable risk factors. By making
healthy changes in these areas, people can reduce or delay the development of
diabetes and improve their overall quality of life (American Diabetes Association,
2016). Modifiable risk factors are things that individuals can change such as eating a
healthier diet, getting physical active 75 minutes per week of vigorous-intensity
aerobic physical activity and strengthening is important for ones overall
cardiovascular health, stop smoking can decrease nerve damage to small vessels,
controlling high blood pressure, and controlling high blood cholesterol along with
losing weight can help reduce development of diabetes. These modifiable risk
factors can help reduced it you make lifestyle changes.
 NON-MODIFIABLE RISK FACTORS

There are a number of risk factors that increase a persons risk for developing type
2 diabetes. Some of these characteristics are beyond a: persons control such as:
Family History- If you have a blood relative with diabetes, your risk for developing it
is significant.
Race or ethnic background- If you are African-American, Asian-American,
Latino/Hispanic-American, Native-American, or Pacifier Islanders descent, you have
a greater likelihood of developing diabetes.
Age- The older you are, the higher your risk. There also is a factor that if you get
gestational diabetes during pregnancy, you are at increased risk (American
 PRIMARY, SECONDARY & TERTIARY PREVENTION

Primary prevention of type 2 diabetes could be achieved at a population level by lifestyle interventions which leads to healthy eating and increased
physical exercise. Primary Prevention aims to prevent a condition which does not yet exist, moving for normoglycemia to abnormal glucose levels.

Secondary prevention targets individuals with borderline elevations of blood glucose or other markers of risk. It is based on the earliest identification
of the disease and uses a process that is assessed by glucose tolerance test. Such intervention have shown that obesity-related diabetes is potential
reversible.

Tertiary Prevention is offered to those who already have the condition, and aims at soften the impact of an ongoing illness that has lasting effects.
This is done by helping people manage long-term, often complex health problems in order to improve as much as possible their ability to function,
their quality of life and their life expectancy.
 Primary Rehabilitation Service- could be achieves at the population
level by lifestyle interventions which leads to healthier eating and
increased physical exercise.
Secondary Rehabilitation Service- Annual follow up appointments for
eyes and foot examinations, and monitor your blood sugar levels on a
routine base and reporting high levels to your physician goes a long
way in preventing complications.
Tertiary Rehabilitation Service- Chronic disease, support groups, and
rehabilitation if one need it to re-gain function to become independent
again.
 RISK FACTOR: RISK FOR UNSTABLE BLOOD GLUCOSE AND KNOWLEDGE DEFICIT

Inadequate monitoring
Lack of adherence to diabetes management
Medication Management
Knowledge deficit
Sedentary activity level
Diet Modification
Stress
Sedentary activity level
 NURSING INTERVENTION: RISK FOR UNSTABLE BLOOD GLUCOSE AND KNOWLEDGE DEFICIT

Teach patient how t

Assess for signs of hyperglycemia
Assess blood glucose level before meals and at bedtime
Assess foot for open areas and redness
Teach signs and symptoms of hyperglycemia and hypoglycemia
Assess feet for temperature, pulse, color, and sensation
Assess the pattern of physical activities
Assess the patients current knowledge and understanding about prescribed diet
 RATIONALE: RISK FOR UNSTABLE BLOOD GLUCOSE AND KNOWLEDGE DEFICIT

Knowledge deficit
Unstable blood glucose
Knowing if your blood glucose levels are in control
Illness and diet can affect blood glucose levels
To much carbohydrate, sugar and fat can affect blood glucose levels
Hyperglycemia is left untreated can cause serious complications
 TREATMENT PLAN

Monitoring and managing blood glucose levels

If on insulin take correct dosage and compliant with oral agents

Stay on a good nutritional regime, avoid sugar, fats and carbohydrates

Keep control on weight

See physician as schedule

Eyes and foot examination annually

When education is provided and understanding is prohibit, ask question is theres concerns