A Look into Type 1 and Type 2 Diabetes Mellitus

A Look into Type 1 and Type 2 Diabetes Mellitus

Moberly Area Community College

Shayla L. Calvert

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Abstract

Diabetes affects many people all over the world.  In the United States alone nearly 26 million people are currently living with diabetes mellitus and there is another 79 million that have prediabetes (Ignatavicius, Workman 2016).  It is important that we as nurses know how to care for these clients in what may be some of the most demanding times of their lives.  Learning the differences between type 1 and type 2 diabetes is important in order to give appropriate care, knowing what that client may look like, and understanding the treatment options that may be done with both types.  With this proper care and teaching we can help each client to understand the importance of management, lifestyle changes that may need to be met, and the things they can do in order to live a healthy and normal lifestyle as they may have had before their diagnosis.

A Look into Type 1 and Type 2 Diabetes Mellitus

Diabetes mellitus is a complex metabolic disorder that is characterized by high blood glucose also known as hyperglycemia resulting from defects in insulin secretion, insulin action, or both (Craig et al., 2014).  Two classifications within diabetes mellitus includes type 1 and type 2 diabetes.  Type 1 diabetes can be defined as an autoimmune disorder in which beta cells are destroyed in a genetically susceptible person (Ignatavicius, Workman, 2016).  Type 2 diabetes can be defined as a progressive disorder in which the person has a combination of decreased beta-cell secretion of insulin and insulin resistance (Ignatavicius, Workman, 2016).

Diabetes affects many people in the United States alone.  Nearly 26 million people are currently living with diabetes mellitus and there is another 79 million that have prediabetes (Ignatavicius, Workman 2016).  With that being said, there is a great deal of patients that nurses will be taking care of, so it is of great importance that we know what these people will look like, what they may need, and what kind of treatment they will be given.  Throughout this paper I will be discussing the things that every nurse should know in order to give the best care to a client with diabetes.

To explain type 1 diabetes mellitus in more detail, type 1 diabetes is an autoimmune disorder in which the body starts attacking and destroying the insulin-producing beta cells within the pancreas (“Diabetes Basics: The Types of Diabetes… The Causes & Symptoms,” 2015).  This results in the body’s inability to produce insulin, which means that the glucose then stays in the blood where it damages the organ systems (“Diabetes Basics: The Types of Diabetes… The Causes & Symptoms,” 2015).  There are many factors that cause or may increase the risk of developing type 1 diabetes.  Diabetes has a genetic risk factor as well as other factors that may increase the risk such as your ethnicity, climate, childhood diet, autoantibodies, and respiratory infections (“Diabetes Basics: The Types of Diabetes… The Causes & Symptoms,” 2015).

In type 1 diabetes the symptoms one may experience can happen very quickly.  When assessing the client you may see things such as unusually thirsty, frequent urination, rapid weight loss, feeling very hungry, extreme weakness and fatigue, nausea, vomiting, and irritability (Nichols, 2015). The people usually experiencing these signs and symptoms are mostly of normal weight (Nichols, 2015).

Lifestyle changes may need to done in order to control type 1 diabetes.  These changes may include your diet such as eating breads, cereal, rice, whole grains, fruits, vegetables, dairy products, meat, meat substitutes, and healthy fats (Take Care of Your Diabetes Each Day, 2014).  Making sure to not skip meals, especially if you have taken your insulin is very important because your blood glucose levels can drop too low (Take Care of Your Diabetes Each Day, 2014).  Staying physically active can help to manage diabetes and there are a few physical activities that are especially good for someone with type 1 diabetes (Take Care of Your Diabetes Each Day, 2014).  These can include talking to your doctor before starting new exercise activities, doing aerobics activities such as a brisk walk, doing activities that help to strengthen muscle and bone such as sit-ups or weight lifting, and lastly stretching to lower stress and prevent muscle soreness (Take Care of Your Diabetes Each Day, 2014).

To break down type 2 diabetes in more detail, type 2 diabetes is a disorder in which the body either does not produce enough insulin or the cells ignore the insulin (“Diabetes Basics: The Types of Diabetes… The Causes & Symptoms,” 2015).  Similar to type 1 diabetes as talked about earlier, this causes a buildup of glucose in the blood which may damage the body’s organ system (“Diabetes Basics: The Types of Diabetes… The Causes & Symptoms,” 2015).  The genetic risk factor in type 2 diabetes is strong (“Diabetes Basics: The Types of Diabetes… The Causes & Symptoms,” 2015).  Other factors that increase the risk of diabetes is obesity, ethnicity, and geography (“Diabetes Basics: The Types of Diabetes… The Causes & Symptoms,” 2015).

Although the symptoms of type 2 diabetes come on slowly such as over years’ time, there are many of them (Nichols, 2015).  The things to assess in a client with type 2 diabetes include client being very thirsty, rapid weight loss, frequent urination, feeling hungry, feelings of extreme weakness and fatigue, nausea, vomiting, irritability, blurred vision, excessive itching, poor healing, dry and itchy skin, skin infections, and lastly numbness in feet (Nichols, 2015).  People with type 2 diabetes physical appearance usually includes being overweight or obese (Nichols, 2015).

Lifestyle changes for type 2 diabetes as well may help with better management of this disorder.  Not skipping meals and eating small meals instead of large meals are both healthy ways to manage type 2 diabetes (Take Care of Your Diabetes Each Day, 2014).   Consuming a healthy diet with foods such as fruits and vegetables, breads, cereals, rice, whole grains, dairy products, healthy fats, and meat and meat substitutes can be beneficial (Take Care of Your Diabetes Each Day, 2014).  Before doing physical activity you should talk to your doctor and ask about if meals should be eaten before physical activity (Take Care of Your Diabetes Each Day, 2014).  Your activity may include the same as type 1 diabetes which includes aerobics such as brisk walking, sit-ups and weight lifting, and lastly stretching to help increase flexibility and prevent muscle soreness (Take Care of Your Diabetes Each Day, 2014).

Both type 1 and type 2 diabetes can be given the same priority nursing diagnoses.  A few priority nursing diagnoses that may be given to someone with diabetes may include a risk for unstable blood glucose levels, risk for injury, and acute pain.  These diagnoses will help you and your client to evaluate what needs to be done while they are in your care to reach a desired goal.

If you have a risk for unstable blood glucose level for a client with diabetes it may look something like this “Risk for unstable blood glucose level related to dietary intake as evidenced by client not watching food intake and not monitoring blood glucose levels” (Ackley Ladwig, 2014).  A goal may include that the client will identify self-care actions to take to maintain target glucose levels by day 2 (Ackley Ladwig, 2014).  Interventions will need to be done in order to reach this goal.  Interventions may include checking blood glucose three or more times daily, evaluating blood glucose levels in hospitalized clients before administering oral hypoglycemic agents or insulin, and referring the client to a dietician for carbohydrate counting instructions (Ackley, Ladwig, 2014).  To evaluate the effectiveness of these interventions in order to meet the goal you may see that the client is checking blood sugars frequently, see client watching intake and watching carbohydrates, and lastly make sure client is taking insulin or oral hypoglycemic agents at a times appropriate with their meals.

If you have a risk for injury for this client it may look something like this “Risk for injury related to diabetic neuropathy as evidenced by client not having feeling in her feet” (Ignatavicius, Workman 2016).  A goal for this client may be that client will identify precautions to take with the feet due to diabetic neuropathy by day 2. Interventions that may be done to meet this goal may include looking at feet often, watching when buying new shoes, and always wearing shoes when walking around due to not being able to feel if they step on something.  To evaluate if the goal was met you may ask them what precautions they may take when walking around and have them state things they may do in order to maintain good foot care.

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If you have acute pain for this client your nursing diagnosis may look like this “Acute pain related to diabetic neuropathy as evidenced by client’s pain being at a 5 on the pain scale and having trouble with being active due to pain.”  The goal for this client to achieve may be client will be able to perform activities of daily living easily by day 3 (Ignatavicius, Workman 2016).

One intervention that could be done in order to reach this goal may include asking the client to describe prior experiences with pain, effectiveness of pain management interventions, and concerns about pain and its treatment (Ackley Ladwig, 2014). Other interventions may include asking the client to identify a comfort-function goal that will allow the client to perform necessary activities easily and explain to the client that pain management approaches may include pharmacological and nonpharmacological interventions, and the importance of reporting the unrelieved pain (Ignatavicius, Workman 2016).   To evaluate the effectiveness of the interventions in order to reach our goal we may ask their current pain, ask what ADL’s they may still be struggling with if their pain isn’t managed, and ask them what is working for them for pain relief with both pharmacological and nonpharmacological management.

Knowing the signs and symptoms, the amount of time these symptoms may take to come on, what lifestyle changes the client may need to make, and lastly being able to teach and answer the concerns the client may have with diabetes is just a few of the things that will allow us to give quality care to each client.  Giving this quality care is done by not only knowing about diabetes but also knowing what interventions need to be implemented in order for each client to achieve a healthy lifestyle.  With all of the points talked about we can give each client with diabetes the proper healthcare they deserve and increase the client’s satisfaction, safety, and overall health.

References

Ackley, B., & Ladwig, G. (2014). Risk for unstable blood Glucose level. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (pp.386-388) Maryland Heights, MO: Mosby.

Ackley, B., & Ladwig, G. (2014). Acute Pain. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (pp.575-579) Maryland Heights, MO: Mosby.

Craig, M., Hattersley, A., & Donaghue, K. (2009). Definition, epidemiology and classification of diabetes in children and adolescents. Pediatric Diabetes, 103-12 10p. doi:10.1111/j.1399-5448.2009.00568.x

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Diabetes Basics: Types of Diabetes…The Causes & Symptoms. (2015). Retrieved March 04, 2016, from http://www.diabeticcareservices.com/diabetes-education/types-of-diabetes

Ignatavicius, D. D., & Workman, M. L. (2016). Medical-surgical nursing: Patient-centered collaborative care. St. Louis, MO: Elsevier.

Nichols, H. (2015, July 24). Diabetes Endocrinology Diabetes: The Difference Between Type 1 and Type 2 Diabetes. Retrieved March 04, 2016, from http://www.medicalnewstoday.com/articles/7504.php?page=2#signs_and_symptoms_of_diabetes_type_1_and_type_2

Take Care of Your Diabetes Each Day. (2014, February). Retrieved March 04, 2016, from http://www.niddk.nih.gov/health-information/health-topics/Diabetes/your-guide-diabetes/Pages/care.aspx