Running head: DIABETES TYPE 2

EBP Project Paper

Liza McGill SN, SMH
University of South Florida

DIABETES TYPE 2
Diabetes Type 2
Diabetes Mellitus is a metabolic disease distinguished by hyperglycemia resulting from
deficiency in insulin secretion, insulin action or both. The American Diabetes Association
(ADA) has four classification categories for diabetes mellitus. They are Type 1, Type 2, other
specific types and Gestational diabetes (Huether et al., 2012). Base on the ADA to be diagnose
with diabetes mellitus is based on glycosylated hemoglobin (HbA1C ) which will be 6.5%, a
fasting plasma glucose (FPG)which will be 126 mg/dL, a 2-hour plasma glucose which will
200 mg/dL during an oral glucose tolerance testing (OGTT) using a 75mg oral glucose load or
a random plasma glucose 200 mg/dL( ADA standard of medical care, 2014). With that been
said the purpose of this paper is to take an in depth look at the life of one type of diabetes
mellitus. The research paper will turn its focus on Type 2 diabetes. T2D or non-insulin
dependent diabetes as it is also called is more common than the others. This disease has been
around since the 1940s and has been rising. In the United States alone, T2d affect 10.5% of
people between the age of 45 to 65 years and 18.4% between the ages of 65 to 74 years. The
most well recognized risk factors are age, obesity, hypertension, physical inactivity and family
history (Huether et al., 2012). The paper will provide information about the pathophysiology,
the symptoms and its prevalence in society will be explored. Additionally, this research paper
will discuss medical interventions and care guidelines, discuss clinical application and conduct

analysis to determine if any shortcomings existed between the recommended care guidelines and
those that were actually practiced during the clinical application.
Type 2 diabetes mellitus is a multifactorial metabolic disorder. It is characterized by
chronic hyperglycemia, insulin resistance, and a relative insulin secretion defect. Although the
genetic contribution to T2D is well recognized, the current set of 56 established susceptibility

DIABETES TYPE 2

sequences, identified primarily through large-scale genome-wide association studies (GWAS)

captures at best 10% of familial aggregation of the disease. The traits of the variant contributing
to the unexplained genetic variance remains far from clear (Morris et al., 2012). These genetic
abnormalities combined with environmental influences such as obesity, result in the basic
pathophysiologic mechanism of this disease which is insulin resistance and decreased insulin
secretion by beta cells (Huether et al., 2012). Insulin resistance is defined as a suboptimal
response of insulin sensitive tissues to insulin and is associated with obesity. Cellular insulin
resistance and obesity are present in 60 to 80% of those with type 2 diabetes. Obesity
contributes to the development of insulin resistance and diabetes through several mechanisms.
Obesity is linked with hyperinsulinemia and decreases with insulin receptor density. Also,
obesity causes the hormone leptin that is produced in the adipose tissue to be elevated and these
changes decreases insulin sensitivity. In T2D glucagon concentration is increased because
pancreatic alpha cells become less responsive to glucose inhibition, resulting in an increase in
glucagon secretion. These abnormally high levels of glucagon increase blood glucose level by
stimulating glycogenolysis and gluconeogenesis. Hormones releases from the gastrointestinal
(GI) tract play a role in insulin resistance, beta cell function and diabetes (Huether et al., 2012).
The prevalence of type 2 diabetes mellitus has risen worldwide in large part because of
an increase in obesity and sedentary lifestyles (Surampudi et al., 2009). The prevalence for T2D
varies by ethnic group and gender. Type 2 diabetes is highest in black women with an overall
prevalence of 34% within the age of 65 to 74. There is also an increase prevalence of T2D
among children especially Native American and obese children. Type 2 diabetes affects
approximately 55 million Americans. Type 2 diabetes is rank as the seventh cause of death. For
people with type 2 diabetes the clinical manifestation are nonspecific ( Huether et al., 2012).

DIABETES TYPE 2

The affected individual is often overweight, hypertensive and high levels of fat and insulin in
their blood. A type 2 diabetic person may show some classic symptoms such as polyuria
(excessive voiding) and polydipsia (excessive thirst). Often times they may nonspecific
symptoms such as fatigue, pruritus, recurrent infection, visual changes or weakness.
Prior to determine required care for a patient with T2D there are several things that are
recommended as standard of care by the American Diabetes Association (ADA). A complete
initial medical evaluation should be performed to confirm the type of diabetes, to detect the
presence of complications by the diabetes, to review previous treatment and risk factor control in
patients with the established diabetes, to assist in formulating a management plan of care, and to
provide a basis for continuing care (ADA standards of medical care, 2014). Also, laboratory
tests should be done that is appropriate to the evaluation of the patient condition. Too provide
proper and appropriate care, ADA recommend looking at the person age, eating habits, physical
activity habits, nutritional status, weight, previous treatment and diabetic teaching. The
American Diabetes Association also recommends that referrals for eye care professional, a
registered dietician, self management education and family planning for woman of reproductive
age (ADA standard of medical care, 2014).
To understand the clinical application of type 2 diabetes a patient case scenario will be
used. A.B. is a retired 69-year-old man with a 5-year history of type 2 diabetes. However, prior
to been diagnose, 2 years ago when he was in the hospital he had shown symptoms that
suggested that he was borderline diabetes. However, the nurse suggested was that he should lose
weight and no further action was taken. Although A.B was taking his medication for his high
cholesterol he had stop taking the medication for his diabetes stating that it makes him dizzy. He
does not test his blood glucose levels at home and expresses doubt that this procedure would help

DIABETES TYPE 2

him improve his diabetes control. What would knowing the numbers do for me? he asks. The
doctor already knows the sugars are high. A.B. has limited knowledge regarding diabetes selfcare management and states that he does not understand why he has diabetes since he never eats
sugar. Since the last year A.B. has gained 22lbs. A.B.s diet history reveals excessive
carbohydrate intake in the form of bread and pasta. His normal dinners consist of 2 cups of
cooked pasta with homemade sauce and three to four slices of Italian bread. During the day, he
often has a slice or two of bread with butter or olive oil. Upon a physical examination it was
reveal that A.B. was overweight for his height, his blood pressure was high and his glucose level
was also over. A.B. neurological assessment showed diminished vibratory senses and
diminished ankle reflexes (Diabetes Spectrum, 2003). After the assessment A.Bs nurse
practioner was more concern with addressing the most important issue at hand and making a care
plan for him. A.B was happy with the recommendations and promises to adhere to them.
Base on the interventions made for A.B by the nurse practioner, it was apparent that she
had followed most of the recommendations from the ADA. The nurse did the initial evaluation
of gathering all the necessary information needed to provide the proper care and teaching for
A.B. The care provider recommended the dietician, she changes his medication to a first line
drug, and she recommended that he up his activity. She also, thought the patient about personal
foot care. There were still some gaps between the findings and the actual practice and
interventions. Even though A.B eyesight was good it is recommended that patient with diabetes
is referred to an eye specialist whom the care provider did not do. However, this outcome could
have been a little different if initially someone intervene and explained to A.B the seriousness of
T2D when it was first noticed. The treatment for type 2 diabetes is the restoration of a normal
blood glucose level and the correction of related metabolic disorders. As mentioned above

DIABETES TYPE 2

dietary measures and activity are primary importance in both preventing and treatment.
Although the priors are the most important, medications are usually needed for optimal
management (Huether et al., 2012).
In summary, genetics and environmental factors such as obesity plays a major role in
insulin resistance and insulin secretion deficiency of people with type 2 diabetes. T2D or noninsulin dependent diabetes as it is also called is more common than the other types of diabetes. .
As healthcare workers, we should intervene more for our patient to educate them about issues
that may develop as time goes by with an unhealthy lifestyle as was proven in the scenario
above. The application of the patient case scenario, the discussion of findings and the actual
practice, the pathophysiology, symptoms and prevalence, and the interventions and care
guidelines all tie together to bring across the purpose of this paper.

DIABETES TYPE 2
References

DiabetesPro American Diabetes Association. Retrieved July 16, 2014, from

http://professional.diabetes.org/ImageBank
Diabetes Spectrum. (n.d.). Case Study: A Patient With Uncontrolled Type 2 Diabetes and Complex
Comorbidities Whose Diabetes Care Is Managed by an Advanced Practice Nurse. Retrieved July
16, 2014, from http://spectrum.diabetesjournals.org/content

Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (4th ed.). St. Louis,
Mo.: Mosby/Elsevier
Morris, A., Voight, B., Teslovich, T., Ferreira, T., Segr, A., Steinthorsdottir, V., & ... Luan, J.
(2012). Large-scale association analysis provides insights into the genetic architecture
and pathophysiology of type 2 diabetes. Nature Genetics, 44(9), 981-990.
doi:10.1038/ng.2383
Surampudi, P. N., John-Kalarickal, J., & Fonseca, V. A. (2009). Emerging Concepts in The
Pathophysiology of Type 2 Diabetes Mellitus. Mount Sinai Journal Of Medicine, 76(3),
216-226. doi:10.1002/msj.20113