Assessment and Management of Patients with Diabetes Mellitus and Other Endocrine Disorders - Essay Example

Assessment and Management of patients with endocrine disorders; Diabetes Mellitus Introduction Type II diabetes has become a global problem, affecting mostly the adults. It is occurs because of disorder in the endocrine system causing fluctuation of blood sugar levels. This arises due to a defect in the insulin production and glucose metabolism (Wu et.al 2010). The prevalence of the disease is estimated to increase by 7.7% or 439 million people by 2030 (Shaw et.al 2010). One of the health promotion initiatives has been health education and provision of free clinics for diabetic checkup and follow-ups. The strategy of the education programmes has been to give knowledge as well as transfer attitudes of the population and patients as regards management of diabetes. Some of the factors that have contributed to poor compliance of the diabetic instructions and management have been low levels of psychosocial support and self-efficacy. To be able to achieve the self-efficacy (confidence) of managing the self-care regimen indicates a milestone or good outcome for health education (Wu et.al 2008). Therefore, with the increased risk of many people getting the disease and those with the sickness failing to manage the disease it is imperative to come up with interventions that works to enable diabetic patients take control of their lives and be able to manage the disease. Therefore, this literature will review what current studies have concluded concerning medication as an initial intervention in type II diabetes. In addition, it will examine diet and lifestyle as a discharge instruction. Medication as the intervention Although type II diabetes is a widespread disease, chronic elevation in blood glucose level can result in a number of complications such as retinopathy, renal failure, neuropathy, coronary artery disease, stroke, and reduced circulation. These complications can be preventable with proper medical management by the health care providers and self-management by the diabetic patients. Administering oral medications and insulin for the newly diagnosed type 2 diabetes patients is one of the most important intervention that help in achieving blood glucose level close to the normal level. As it is evidenced based, oral hypoglycemic drugs reduce significantly the morbidity rate that is associated with long-term microvascular and neuropathic complications. On the other hand, apart from maintaining blood glucose level within normal range, medication administration is the nurses responsibility hence it is imperative for them to be aware that some oral hypoglycemic agents may cause hypoglycemia as well as significant weight gain. Research indicates that there is significant relationship between hypoglycemic and hospitalization in the general wards. Hence, it is important for nurses to closely monitor the combination of the antihyperglycemic medicine and the nutrition intake or it could be an indication for the necessity of increased monitoring, more aggressive treatment of infections, transitioning to a more intensive care setting and case management (Turchin et.al 2009). The choice for which types of medicine to use depends on the duration since onset of diabetes and the glycaemic levels. The patients with high glycaemic levels and those who have had the disease for long, are prescribed the drugs from classes with rapid lowering effect of glucose levels or use of combination therapy. Those with recent onset of the disease tend to be given less intensive treatment (Nathan b et.al 2009). It is important to individualize the glycaemic goals and medication used to achieve the goals; this is to balance the benefits as well as the safety issues like adverse or side effects, tolerability, ease of use, long-term adherence, the financial commitments and the non glycaemic effects of the medication. There are major classes of drugs used in control of the glycaemic levels; these include Metformim, which works by decreasing the hepatic glucose output and lowering the fasting glycaemic. It is mostly preferred, as it has no hypoglycemic side effects. Sulfonylureas, which lower the glycaemic, level by enhancing insulin secretion. It has an adverse effect of hypoglycemia. Other medications include thiazolidinediones and the alpha glucosidase inhibitors Discharge instruction: Diet and Lifestyle Discharging of a patient needs careful organization to avoid or prevent recurrent hospitalization for the same condition. This comes with an improved intervention strategy that enables diabetic patients to manage the condition through self-management and hence reduce hospitalization. One of the major environmental factors that increase the risk of diabetes are the over nutrition and a sedentary lifestyle which consequently leads to overweight and obesity. An improvement in these factors has led to an improvement in the control of glycaemic levels in the type II diabetes. High stress and chaotic lifestyles can lead to poor self-care and resultant inability to control the glycaemic levels (Weinger et.al 2013). Though the lifestyle intervention has been effective, it is not used for long-term intervention due to high rate of weight regain. (Nathan 2009b). Attained weight loss and exercise in diabetic patients leads to improved coincident cardiovascular risk factors such as blood pressure and atherogenic lipid profiles. There are adverse effects on the use of this intervention, which include musculoskeletal injuries, potential problems associated with neuropathy such as foot traumas and ulcers, which might occur due to increased activity, it may also be difficult to integrate the new lifestyle and diet. However, such adverse effects do not outweigh the benefits of the intervention. (Nathan 2009b). According to Nathan (2009b), weight loss in diabetic patients may not be easy as there are hyperglycemic drugs that increase the weight for example insulin, sulfonylureas and thiazolidinediones. According to Nathan et.al (2009a), weight reduction results not only on glycaemic control but also on causes a reduction on the use of oral hypoglycemic drugs. This has also been advocated by NICE (2008) which suggests that dietary strategies have been known to have a significant effect on glycaemic control. Studies have related the low levels of glycaemic index in diets with reduced resistance levels of insulin resistance and hence reduced risk of getting metabolic syndrome. Hence it is advisable to use diets with low Glycaemic index like whole grain cereals, fruits, vegetables and unsaturated fats. According to research done, division of calories intake a day into small portions of food spread out throughout the day leads to reduced pressure on the metabolic functions of the cells and improves their efficiency thus resulting in a reduced and controlled blood sugar level (COHN;Joseph 1960 cited in Saheli,Yousefinejad and Pishdad 2012). According to Jenkins, et.al decreasing the amount of food and increasing the number of meals per day is important in reducing the insulin level for injection and leads to better control of the blood sugar. (1992 cited in Saheli et al 2012). To assist in achieving this lifestyle change, studies have shown that physicians can encourage the patients by using the motivational interview technique where the patient is asked to choose a self-management goal that he/she can handle. This gives the patients the motivation to change and a participatory and active role in change process (Christian et.al 2008). This technique enables the physician to bypass the patient’s resistance and its gives satisfactory results for both the physician and the patient. A low GI diet leads to normalization of the risk factors like hepatosteatosis , microalbuminuria and atherogenesis, this was indicated in normalized metabolite profiles in plasma and liver (Radonjic et.al 2013). Other techniques to assist in behavior and lifestyle change include scaffolding techniques and brief cognitive behavioral strategies. Weinger et.al (2011), in their study, they indicated that nurses and physicians could incorporate behavioral strategies to assist the diabetic patients in their self-care and in controlling the glycaemic levels. Social grouping of diabetic people has been seen to improve patients meeting their self-management goals and hence most physicians advice on this when discharging the patients from hospital. Recommendations and conclusion Diabetes Mellitus is a manageable condition and with good nurse management and social support system, it can be managed. Holdich (2009) indicate that individual patient care planning is important as it involves the patient in the decision-making through active partnership and goal setting with the service provider. For the intervention of medication to be successful, it is good to put into consideration many factors like the cultural, social, economically impact of the intervention on the patient (Asche, LaFleur and Conner 2011). It is important for the nurses to ensure compliance from the patients and continued adherence of medication for a successful management of the diabetic condition. There is also the need to encourage the patients apart from joining groups of other diabetic patients to also visit the diabetic clinics for blood sugar, high blood pressure and weight loss monitoring and more information on lifestyle changes and diets (Hughes 2012). It is then recommended to come up with plans and policies that cater for the needs of the diabetics by making their medicine affordable and there to be support systems in the community to enable the diabetics after discharge to become socially integrated into the society. Word Count: 1525. References Asche C., LaFleur J., & Conner C (2011). A review of diabetes treatment adherence and the association with clinical and economic outcomes. Clin Ther. 2011;33: 74–109. 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