Nutrition. Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT

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1 1 Nutrition Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT

2 2 Type 2 Diabetes: A Growing Challenge in the Healthcare Setting Introduction and background of type 2 diabetes: Diabetes is the seventh leading cause of death in the United States. It continues to be a growing problem in our country. Almost 3,000,000 people in the U.S. are affected by this disease. Many more people are yet undiagnosed. 1 Diabetes is a disorder of carbohydrate metabolism--the way our bodies use digested carbohydrates for growth and energy. 2 When functioning properly, the pancreas produces sufficient insulin to regulate the body and to keep blood glucose stable. However, in individuals with diabetes, the pancreas produces either very little insulin or none at all, which causes the blood glucose to to rise higher than normal. High blood sugar levels are known as hyperglycemia. 2 Causes and types of disease or condition: There are three major types of diabetes. They are as follows: type 1 diabetes; type 2 diabetes; and gestational diabetes. Type 1 diabetes is usually diagnosed early in childhood or young adulthood. It was formerly known as juvenile diabetes or insulin-dependent diabetes. The pancreas does not make any insulin in type 1 diabetes. In type 2 diabetes, the body doesn't produce enough insulin or cells do not recognize the insulin. 2(p632) The incidence of type 2 diabetes is not only increasing among adults but also in children and adolescents. It has greatly increased in the past 20 years. It has been estimated that approximately 3,700 children aged 10 to 19 years of age are being newly diagnosed each year with type 2 diabetes. Obesity in children is the biggest cause of type 2 diabetes in this age category. 3 There are risk factors that increase the risk for type 2 diabetes. Obesity is one of the major risk factors for type 2 diabetes. As fat increases in the body, the cells become more resistant to insulin. Lack of exercise is also a risk factor. Physical exercise helps to control weight, uses

3 3 glucose, and increases insulin sensitivity in the cells. Race is also a factor. American Indians, Asian Americans, Hispanics, and African-Americans have a higher risk of developing type 2 diabetes. As a person becomes older, there is an increased risk due to less activity, weight gain, and muscle loss. Due to the obesity trend in our country, children and younger people are now developing type 2 diabetes. If a person has a family history of type 2 diabetes, the risk is also greater. Gestational diabetes is the third type of diabetes, which develops during pregnancy. If gestational diabetes occurs, it is also considered a risk factor for developing type 2 diabetes later in life. 4 Treatment and pharmaceutical recommendations: People who have type 2 diabetes may or may not have early symptoms before being diagnosed with type 2 diabetes. Early symptoms may include: increased thirst; increased urination; hunger; and fatigue. Infections of the bladder, kidney, and skin or other types of infections may also occur frequently and heal slowly. Other early symptoms can also present as blurred vision, erectile dysfunction, or pain or numbness in the hands or feet, which is called neuropathy. During a doctor visit or health screening, a person's blood glucose might be elevated. If the blood sugar level is higher than 200 mg/dl, the physician will do further testing to confirm type 2 diabetes. A fasting blood glucose level is obtained. If the blood glucose is higher than 126 mg/dl after two tests, type 2 diabetes is diagnosed. A lab called hemoglobin A 1 C is drawn as well. If the result is 6.5% or higher, diabetes is indicated. An oral glucose tolerance test may also be given. If the blood glucose level is higher than 200 mg/dl after two hours, diabetes is diagnosed. Once diabetes has been diagnosed, close monitoring of blood glucose and the overall health of the newly diagnosed patient is necessary. Blood-pressure monitoring on a regular basis is important. The blood pressure should be 130/80 mmhg or lower. The hemoglobin A 1 C should

4 4 be checked every six months to ensure that diabetes is well-controlled. If it is poorly controlled, a three-month follow-up is recommended. Cholesterol and triglyceride levels should be monitored as well. LDL levels below mg/dl are recommended. 5 Labs that evaluate kidney function are vital to ensure that the kidneys are functioning well, since diabetes can cause kidney failure. The longer a person lives with diabetes, the greater the risk of developing kidney damage or kidney failure. Vision exams are very important as well to determine if diabetes is affecting the eyes. Retinopathy or other eye problems may develop over time. Ongoing assessments regarding blood circulation and possible nerve damage are needed due to the increased risk of stroke, heart attack, and peripheral artery disease. If hardening of the arteries or damage to the nerves occurs, poor circulation and decreased sensation will result, which can cause an increased risk for infections and skin ulcers. Nerve damage can also lead to digestive symptoms such as nausea, vomiting, and diarrhea. 6 The first step in managing diabetes is close glucose control. The patient must be taught how to test his or her blood glucose and to keep a daily record to determine if the glucose level is being managed well. Type 2 diabetes can sometimes be controlled by diet and exercise. Increasing physical activity and losing weight are lifestyle changes that are usually recommended by a physician when the diagnosis of type 2 diabetes is first determined. Many people with type 2 diabetes require oral medications or insulin therapy. Metformin is an oral drug that is commonly prescribed. It is designed to improve the body's sensitivity to insulin and to help lower the production of glucose in the liver. Different oral medications work in various ways to treat type 2 diabetes. Glucotrol is an example of a drug that can stimulate the pancreas to provide more insulin. Precose is an example of a drug that blocks enzymes from breaking down carbohydrates in the intestines. If metformin or other oral medications are not

5 5 effective in controlling blood glucose, insulin, which is given by subcutaneous injection, might be required to manage glucose. 4 Dietary recommendations: "Although people with diabetes have the same nutritional needs as anyone else, good diabetes control requires that they monitor their food intake carefully." 2(p637) A well-balanced diet that is low in fat helps to keep weight in control. Carbohydrates should be obtained from whole grains, fruits, and vegetables. 2(p637) Whole grains and fiber are known to improve sensitivity to insulin. Fiber also improves insulin secretion. The amount of carbohydrate intake is the primary determinant of how high the blood sugar will rise. It is important to recognize that each person has unique nutritional needs and cultural preferences. A person's willingness to change is essential in the management of diabetes and in the prevention of future complications as much as possible. 7 Interview questions: I interviewed my mother regarding type 2 diabetes. She is 78 years old and has type 2 diabetes and hypertension. She has had diabetes for 25 years now. She is taking an oral medication called glipizide every day. She also takes Lantus subcutaneously at night. Her diabetes was controlled by diet when she was first diagnosed. She was probably 40 pounds overweight when she was diagnosed. She is also of American Indian heritage, one of the risk factors for diabetes. She states that controlling her diet does help with glucose control but also says she is not always consistent with her diet. She has never formally talked with a dietician about diabetes but did attend classes on diabetes control and was given diabetic education booklets. She stated that the information she received was helpful in understanding the disease process and the need for a diabetic diet.

6 6 Conclusion: Type 2 diabetes continues to be a growing concern in the healthcare setting. It is now also affecting children and young adults due to the increased rate of obesity. Patients with type 2 diabetes have a two to fourfold higher risk of developing stroke and heart disease. "Effective management of diabetes is crucial in preventing the long-term complications of the disease, which have a high risk of morbidity and mortality." 8 The treatment of diabetes is complex, and adjustments must be made often in order to control blood glucose levels as well as to try to manage other co-morbidities such as hypertension and dyslipidemia. Frequent, scheduled visits are needed to reduce the risk of the numerous complications that can occur with type 2 diabetes. Lifestyle changes are recognized as a vital part of managing type 2 diabetes effectively. Patients and their families should be educated thoroughly regarding lifestyle changes needed and encouraged to make those changes. Diabetes education should not end after educating a newly diagnosed patient, but rather it should be ongoing and include a patient-centered approach. Active engagement on the part of the patient is crucial in the management of diabetes and for the well-being of the patient. There are many resources available in the community and online to assist in the management of type 2 diabetes. Prevention of type 2 diabetes will no doubt become a major focus in the healthcare screenings of all ages. A collaborative approach is vital in the prevention of this disease. 8 All healthcare professionals--doctors, nurse practitioners, nurses, and dietitians--are needed to intervene with early education and ongoing support to greatly reduce the incidence of type 2 diabetes in the future.

7 7 References 1. CDC. National Diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, Accessed October 12, Insel P, Ross D, McMahon K, Berstein M. Nutrition. Burlington, MA: Jones & Barlett Learning; Zeitler P. Type 2 Diabetes Mellitus. Contemporary Pediatrics. July 2012; Mayo Clinic. Type 2 Diabetes. Mayo Clinic. 2-diabetes/DS00585/DSECTION. January 25, Accessed 10/12/ Medline Plus. Diabetes diet type 2. Medline Plus. Updated June 28, Accessed October 12, WebMD. Type 2 Diabetes Overview. WebMD. diabetes Accessed October 12, American Diabetes Association. Nutrition recommendations and interventions for diabetes; A position statement of the American Diabetes Association. Diabetes Care. 2007;30:1, 4-5. doi: /dc07-s Robertson C. The role of the nurse practitioner in the diagnosis and early management of type 2 diabetes. Journal of the American Academy of Nurse Practitioners. 2012;24; doi: /j x.

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