Diagnosis and Treatment of Diabetes Type 2 - Essay Example

Diabetes Level 6 Introduction Type 2 diabetes is a type of diabetes that is illustrated by the inability of the insulin to act within the body as well as its secretion within the body. This occurs when the pancreas does not produce adequate insulin or properly utilize it and this leads to failure to break down or control the level of glucose in the blood (American Medical Association and Metzger 2007, p. 10). When this occurs, glucose builds up within the body and is not utilized as required by the different body parts leading to symptoms such as excretion of large amount of urine, thirst, weight loss, fatigue and loss of vision amongst others (Eckmn 2011, p.475). When a person has the type 2 diabetes, the best therapy that is usually offered is the provision of oral therapy that consist of injection of insulin in order to make the blood attain the targeted glycemic levels. In addition, a person suffering from diabetes usually suffers from macrovascular and microvascular diseases. The most prominent microvascular disease amongst this group is the diabetic neuropathy that in most cases leads to the amputation of the lower limbs. It is also worth noting that a patient suffering from type 2 diabetes usually increases his chances of morbidity and therefore it is recommended that the person stops the smoking habit. This paper has four sections that includes a review of how to diagnose and manage a patient suffering from type 2 diabetes, the microvascular disease in type 2 diabetic patients, pharmacological management of such a patient and the effect of smoking and how to stop it. Thereafter a conclusion is made on the whole paper. a). Type 2 diabetes occurs when there is insufficient production of hormone insulin leading to high levels of glucose in the body. Therefore, the people with type 2 diabetes often require regular monitoring and reviewing of their treatment through changes in lifestyles, self-care measures and the use of the diabetes medicines. In the diabetes review, the first line of thought would be to find out the efficacy of the metformin as the first-line pharmacotherapy in the patient with the type 2 diabetes. Metformin is the first line oral antihyperglycemic drug that should always be used in patients with type 2 diabetes when it is difficult to attain glycemic control through changes in the lifestyle of the patient (McIntosh et al. 2011, p. 36). Therefore, the first question that the nurse must find out from the type 2 diabetes patient is the type of lifestyle that she lives and how often she smokes and evaluates whether this affects the effectiveness of the metformin. In the review, it would be important to diagnose the patient whether she meets the criteria for the management of the type 2 diabetes. In the case of Daisy who has been diagnosed with type 2 diabetes, it would be important to have a goal of reducing the chances of eye and kidney disease through the control of the glycemia while at the same time focusing on the reduction of macrovascular risks through the control of hypertension and stopping the smoking by the patient. It would therefore be important to confirm whether the patient is already on intensive insulin regimens or uses the insulin injections or non-insulin therapies to control the blood sugar level. As part of the review, I would check the level of eye dilation and conduct the microalbumin checks as well as the foot examination. Having carried out the blood examination, I would prescribe the metformin as the first line of drugs to control the type 2 diabetes and encourage a stop to the smoking (Khardori 2013, p. 68). b). The amputation of the foot of the type 2 diabetes patient may be attributed to microvascular disease that comes in when the disease progresses. This may lead to the exclusion of the lower limbs which may be attributed to the diabetic neuropathy that includes the presence of symptoms that point to the failure by the nervous system to function. The amputation of the foot may occur after the foot ulceration or injury attributed to the diabetic neuropathy (Boulton et al. 2005, p. 956). To this end, Chao and Cheing (2009, p. 604) argue that the diabetic foot disease and ulceration is a major cause of the amputation of the foot of most diabetic patients. The neuropathy in the patient comes in the form of pain especially at night or may come in the form of numbness. These may be attributed to the poor control of the glycemic levels as well as changes in the control of diabetes leading to different cases that necessitate the amputation of the lower limb. For example, the monoeuropathies may affect any nerve, mostly the median, ulnar and radial nerves as well as the cranial neuropathies hense affecting the diabetic sensory of the patient. The loss of this lower-extremity sensation as well as the negative effects on the peripheral vascular function leads to the ulceration of the foot. When the senses of the foot are destroyed through these microvascular processes, the only option that remains is for the foot to be amputated. Therefore, the microvascular disease that has likely led to the amputation of the foot of Daisy is the diabetic neuropathy that leads to loss of senses at the foot leading to pain and numbness, hence the cutting off of the lower limb. c). The treatment regimens of the type 2 diabetes and the pharmacological interventions for patients with type 2 diabetes are always tailored to the individual needs of the patient. Due to the fact that this type of diabetes is characterized by the resistance to insulin, the level of glucose within the body may get to worse levels and therefore the intervention offered must be one that meets the different symptoms presented by the disease over a period of time. This requires that the clinician makes a choice of his medication by considering the degree of hyperglycemia, the attendant risk of hypoglycemia and the efficacy of the intervention in addressing the risks brought about by the type 2 diabetes. An important intervention that forms part of the pharmacological interventions is to ensure that there is a change to the lifestyle of the patient, proper nutrition and exercise. Type 2 diabetes which is a progressive and chronic metabolic disorder is usually pharmacologically managed through oral agent monotherapy but may require the use of other oral agents such as the injection of insulin in order to attain the required glycemic levels (Luna and Feinglos 2001, p. 1748). The improvement of the glycemic levels leads to the reduction of the cases of microvascular diseases. It is important to note that in the pharmacological management of type 2 diabetes, if the glycemic targets are not met within 2-3 months of managing the lifestyle of the patient, then the antihyperglycemic pharmacotherapy should be commnenced. Similarly, there should be timely alteration of the antihyperglycemic agents in order to reach the glycated hemoglobin (A1C) within a period of 3-6 months. As already stated, unless indicated, the metformin should form part of the first agent of controlling the glycemic level but other agents may be added as more clinical issues arise. In the case of the pharmacological management of type 2 diabetes with more than glycated hemoglobin [A1C] ≥8.5%), then several agents may be used to manage the glycemic levels. Initially, it is important to use doses of antihyperglycemic agents that can help in controlling the glycemic levels. In the present case, metformin will be preferred as the initial agent as it is effective in lowering the level of blood glucose and the fact that it has a negligible chance of causing hypoglycemia (Nathan et al. 2009, p.194). In addition, the metformin is also chosen as it leads to less chances of leading to overweight. In addition, there should be a combination of the oral antihyperglycemic agents with insulin in order to regulate the glucose levels of the patient. The insulin should also be tailored to ensure that there is a good metabolic control as well as avoid hypoglycemia, and the timing of the injection must be according to an individual. However, with the progression of type 2 diabetes as is the case with Daisy, it would be important to increase the insulin doses such as the basal and bolus insulin. Further, concomitant metformin therapy may be used together with the other insulin regimens so as to enhance the glycemic control by the patient and reduce the risk of increasing weight and incidences of hypoglycemia. d). As a person suffering from type 2 diabetes, it would be important for Daisy to quit smoking so as not to aggravate her health situation. The bad situation that smoking causes on a diabetic patient is that it can lead to problems associated with the determination of the right dose of insulin to be administered as well as the level of control that can be exercised against the effects of the disease (Sherman 2005, p. 202). This therefore means that the more a person smokes the higher the chances of making the diabetes hard to control, which may result into more serious health complications. These complications include; heart and kidney disease, poor flow of blood to the lower limbs which may increase the chances of amputation, retinopathy or diseases of the eye and the peripheral neuropathy that leads to poor coordination of the nervous system. It is therefore prudent to advocate for the quitting of smoking by Daisy in order to encourage proper absorption of insulin and better health. The decision to quit smoking must be made at the earliest opportunity by first starting to discard the cigarettes or smoking apparatus. When there is a craving for cigarette, it is important to breathe deeply or hang out in areas that there are no smokers. Daisy should also make attempts to use only low calorie foods as well as fruits and vegetables to encourage appetite. It is also prudent to exercise a lot so as to reduce the exposure to smoking of cigarettes as well as the probability of craving to smoke. The smoking cessation programs for the diabetics must possess certain characteristics that must guarantee a smooth quitting of the habit. The program must therefore incorporate techniques for changing the behavior of the person, which may be achieved through stratification of the individuals according to their state of behavioral change. According to Ruggiero et al. (1999, p. 573), the grouping of the smokers according to their stages of behavior helps the healthcare providers to provide advice for the changing of behavior amongst diabetic patients. From the above assertion, it can be shown that the targeted technique for patients suffering from type 2 diabetes can be effective means of stopping smoking. In order to control the craving for the smoking, it is also advisable to apply the cognitive strategies that can help in quitting the habit. Therefore, Daisy can be grouped according to the stage that she has reached in terms of smoking and encouraged as well as supported in quitting the habit in order to stay healthy and control the glucose level within the body. Conclusion From the above discussion, it has been shown that type 2 diabetes is one of the most common forms of diabetes but also difficult to manage. It has been shown that this type of diabetes is caused by the inability of the body to regulate the production of insulin, which leads to higher levels of glucose in the blood of those that are suffering from it. When a person has been diagnosed with the type 2 diabetes, it is important that the patient is placed under a pharmacological intervention that focuses on a therapy aimed at regulating the glucose levels in the blood. Metformin still remains the most recommended form of therapy for such a patient, but may be varied with a combination of other therapies as the disease progresses and becomes severe. Further, it has been discussed that the diabetes may also become severe leading to an amputation of the lower limbs especially due to the effects on the nervous system at this particular part of the body. It has also been indicated that lifestyle change remains an important intervention in the control of type 2 diabetes and this includes a cessation of smoking as a habit which impedes the absorption of insulin. References American Medical Association/ Metzger, B. E., M.D., & Metzger, B. E. (2007). American Medical Association guide to living with diabetes: preventing and treating type 2 diabetes--essential information you and your family need to know. Hoboken, N.J., Wiley. Boulton, A. J., Vinik, A. I., Arezzo, J. C., Bril, V., Feldman, E. L., Freeman, R., Malik, R. A., ... American Diabetes Association. (January 01, 2005). Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care, 28, 4, 956-62. Chao, C. Y., & Cheing, G. L. (January 01, 2009). 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