I.

INTRODUCTION
Diabetes Mellitus Type 2 is formerly non-insulin-dependent
diabetes mellitus (NIDDM) or adult-onset diabetes is a metabolic disorder
that is characterized by high blood glucose in the context of insulin resistance
and relative insulin deficiency. Diabetes is often initially managed by
increasing exercise and dietary modification. As the condition progresses,
medications may be needed.
Unlike type 1 diabetes, there is very little tendency toward
ketoacidosis though it is not unknown. One effect that can occur is nonketonic hyperglycemia. Long-term complications from high blood sugar
include an increased risk of heart attacks, strokes, amputation, and kidney
failure.
The most common symptom of a diabetes mellitus is excessive thirst
(polydipsia), excessive hunger (polyphagia), frequent urination (polyuria) and
severe weight loss.
Diabetes is a lifelong disease and nobody ever wises to
suffer from it. The reason is not being fetched. Nobody likes to fall sick (not to
talk of getting a lifelong disease like diabetes), with its lifelong effect. Those
who suffer from diabetes are constantly in a lifelong threat of dying. This is
because a diabetic is always in a threat of falling into coma. This coma
usually leads to death or permanent damage if not quickly treated.
What causes this coma is a phenomenon which medical
people call "hypoglycemia". This is a situation where the blood sugar level is
abnormally low. This leaves the body especially the nervous system with
inadequate sugar and energy. The nervous system, which cannot do without
this substance (sugar), reacts by leading the body into coma.
Diabetes mellitus can also affect the eyes. It can cause
partial or total blindness. In medical terms, it is called "retinopathy". It also has
neurological effects like the numbness of the feet. This numbness is caused
by the death and decay of these cells. It leads to amputation and can have
adverse psychological effect. It also affects the kidney. It can lead to kidney
malfunction or damage, which can consequently lead to death when not
quickly and properly treated.
It also weakens the body's immune system. This
consequently leads to the easy contamination of other disease. Top of these

diseases are cardiovascular diseases which are diseases of the heart and
circulatory system.
Apart from physical effects, diabetes mellitus also has
psychological and social effects. These effects are things that neither you nor
I desire. That is the more reason why you need to take charge of your life and
make your health a priority. go for test today and begin to manage your
health. Diabetes is bitter.
It can also affect the heart which can lead to myocardial
infarction and it can damage the kidney leading to nephropathy.
Risk factors include family history of the disease, obesity,
age 45 above, history of hypertension. Also, it is possible to have DM to a
person who has an HDL cholesterol level <35mg/Dl. African Americans,
Hispanic American, Native Americans, Asian and Pacific Islander are also at
risk to Diabetes Mellitus.

II.

DEFINITION
Insulin-insensitive diabetes, on the other hand, is generally categorized as
type 2 diabetes. Type 2 diabetes usually occurs in older adults, although it
can occur at any age. A distinguishing feature of type 2 diabetes is that, even
when there is a normal amount of circulating insulin, body tissues do not take

up glucose as readily as normal. This is called insulin resistance, a condition

in which normal concentrations of insulin in the blood produce less than the
normal effects in the body (ADA, 2014a).
More than 90% of people with diabetes have the type 2 form, previously
called insulin-insensitive diabetes, non-insulin-dependent diabetes, type II
diabetes, or adult-onset diabetes. In type 2 diabetes, the pancreas produces
enough insulin to prevent ketone (a chemical produced in the liver when fat is
used for energy) formation but, because of insulin resistance, not enough to
prevent hyperglycemia. Although there is a hereditary (i.e., genetic)
predisposition for the disease, type 2 diabetes does not appear to have a
single cause. Aging, a sedentary lifestyle, or excess intra-abdominal fat can
activate or enhance a persons predisposition to develop type 2 diabetes
(ADA, 2014a).
Type 2 diabetes worsens quickly if it is not treated. Both hyperglycemia and
higher-than-normal circulating insulin levels (hyperinsulinemia) increase the
existing insulin resistance. Hyperglycemia also injures the beta cells (the
insulin-manufacturing cells) in the pancreas, and this makes it increasingly
difficult for the pancreas to lower high levels of blood glucose. As these
processes continue and interact with each other, the patient has more
frequent and higher episodes of hyperglycemia, which over time damage the
eyes, kidneys, nerves, and blood vessels (ADA, 2014a).
III.

SIGNS AND SYMPTOMS

The classic symptoms of diabetes are polyuria (frequent urination), polydipsia
(increased thirst), polyphagia (increased hunger), and weight loss. Other
symptoms that are commonly present at diagnosis include a history of blurred
vision, itchiness, peripheral neuropathy, recurrent vaginal infections, and
fatigue. Many people, however, have no symptoms during the first few years
and are diagnosed on routine testing. People with type 2 diabetes mellitus
may rarely present with hyperosmolar hyperglycemic state (a condition of
very high blood sugar associated with a decreased level of consciousness
and low blood pressure).

IV.

MANAGEMENT AND DIET

Managing type 2 diabetes
In type 2 diabetes, your pancreas is still working but not as effectively as it
needs to. This means your body is building insulin resistance and is unable to

effectively convert glucose into energy leaving too much glucose in the blood.
Type 2 diabetes can sometimes initially be managed through lifestyle
modification including a healthy diet, regular exercise and monitoring your
blood glucose levels.
Eating well helps manage your blood glucose levels and your body weight
Exercising helps the insulin work more effectively, lowers your blood pressure
and reduces the risk of heart disease.
Regular blood glucose monitoring tests whether the treatment being followed
is adequately controlling blood glucose levels or whether you need to adjust
your treatment.
The aim of diabetes management is to keep blood glucose levels as close to
the target range between 4 to 6 mmol/L (fasting), this will help prevent both
short-term and long-term complications.
Your healthcare team including your doctor, specialist, dietician and
Credential Diabetes Educator, can help you with blood glucose monitoring,
healthy eating and physical activity.
However, sometimes healthy eating and exercise is not enough to keep the
blood glucose levels down. Type 2 diabetes is a progressive condition. As
time progresses, the insulin becomes more resistant and the pancreas is less
effective converting glucose into energy. To help the pancreas convert
glucose into energy, people with type 2 diabetes are often prescribed tablets
to control their blood glucose levels.
Eventually it may be necessary to start taking insulin to control blood glucose
levels. This is when your body is no longer producing enough insulin of its
own. Sometimes tablets may be continued in addition to insulin.
If you require medication as treatment, it is important to note that this is part
of the natural progression of the condition, and taking medication when
required can result in fewer complications in the long-term.
The tablets or injections are intended to be used together with healthy eating
and regular physical activity, not as a substitute.
Occasionally, side effects can occur with medications. Speak with your doctor
or pharmacist if you experience any problems. An alternative medication is
usually available.

V.

PATHOPHYSIOLOGY

Diet
Lifestyle
Obesity
Hypertension
Smoking

Dysfunction of the beta

cells in the pancreas

Age
Gender
Genetics
Race
Ethnicity

Decreased sensitivity of
the cells to insulin

Production of impaired
insulin

Glucose is unable to
enter the cells

Desensitization of the
liver and extremities to
the levels of blood
glucose

Glucose remains in the

blood stream

Continued release of
glucose by the liver

Hyperglycaemia

Diabetes Mellitus
Type 2

VI.

NURSING RESPONSIBILITIES
Nursing management of patients with diabetes can involve treatment of a
wide variety of physiologic disorders, depending on the patients health status
and whether the patient is newly diagnosed or seeking care for an unrelated
health problem. Glucose control in patients diagnosed with diabetes as well
as those who have not been diagnosed is an important consideration in the
hospital setting. Nursing management of patients with DKA and HHS and of
those with diabetes as a secondary diagnosis is discussed in subsequent
sections of this chapter.
Because all patients with diabetes must master the concepts and skills
necessary for long-term management and avoidance of potential
complications of diabetes, a solid educational foundation is necessary for
competent self-care and is an ongoing focus of nursing care

Managing Glucose Control in the Hospital Setting.

Hyperglycemia can prolong lengths of stay and increase infection rates
and mortality; thus, nurses need to address glucose management in all
hospital patients (Seggelke & Everhart 2012)
Providing Patient Education
Diabetes is a chronic illness that requires a lifetime of special selfmanagement behaviors, because MNT, physical activity, medication and
physical and emotional stress affect diabetic control and patients must learn
to balance a multitude factors.
Developing a Diabetes Education Plan
Changes in the health care system as a whole have had a major impact in
diabetes education and training. Patients with now-onset type 1 diabetes are
hospitalized for short period or may be managed completely on an outpatient
basis. Patients with new-onset type-2 diabetes are rarely hospitalized for
initial care. Outpatient diabetes education and training programs have
proliferated with increasing support of third party reimbursement. All
encounters with patients with diabetes are opportunities for reinforcement of
self-management skills, regardless of the setting.
Organizing Information.
There are various strategies for organizing and prioritizing the vast
amount of information that must be taught to patients with diabetes
Educating Patients About Survival Skills.
Survival skills must be learned by all patients with newly diagnosed
type 1 or type 2 diabetes and all patients receiving insulin for the first time.
Planning In-Depth and Continuing Education
This education involves more details related to survival skills. As
well as learning, preventive measures for avoiding long term diabetic
complications.
Assessing Readiness to Learn
Before initiating diabetes education, the nursing assesses the
patients readiness to learn. When patients are first diagnosed with diabetes,
they often go through stages of the grieving process.
Educating Experienced Patients
Nurses need to continue to assess the skills and self-care
behaviors of patients who have had diabetes for many years. Assessment of
these patients must include direct observation of skills, not just the patients

self-report of self-care behaviors. In addition, these patients must be fully

aware of preventive measures related to foot care, eye care and risk factor
management.
Determining Education Methods
Maintaining flexibility with regard to education approaches is
important. Providing education on skills and information in a logical sequence
is not always the most helpful method for patients. For example, many
patients fear self-injection. Before they learn how to prepare, purchase, store
and mix insulins, they should be taught to insert the needle and inject insulin.
Educating Patients to Self-Administer Insulin
Insulin injections are self-administered into the subcutaneous tissue
with the use of special insulin syringes. Basic information includes
explanations of the equipment, insulins and syringes and how to mix insulin, if
necessary.
- Storing Insulin
- Selecting Insulin
- Mixing Insulin
- Withdrawing Insulin
- Selecting and Rotating the Injection Site.
- Preparing the Skin
- Inserting the Needle
- Disposing of Syringes and Needles
VII.

CURRENT TRENDS AND ISSUES

Standing, walking may help type 2 diabetes patients control blood sugar
WEDNESDAY, Nov. 30, 2016 -- For people with type 2 diabetes, better blood
sugar control may be as easy as getting up off the couch and standing every
so often, or taking a leisurely walk, a new study shows.
Dutch researchers noted that "moderate to vigorous" exercise is often
recommended for people with diabetes -- but most patients don't comply with
that advice.
This small new study suggests that even sitting a bit less might be of real
benefit.
One diabetes expert in the United States agreed with that advice.
"For years, I would suggest an exercise regimen to my patients that I knew
was doomed to failure," said Dr. Robert Courgi, an endocrinologist at
Northwell Health's Southside Hospital in Bay Shore, N.Y.

However, "by tweaking the message a bit, the odds of success increase
significantly," he said. "Ultimately, any activity helps lower glucose [blood
sugar]. The message of 'sitting less' will have a higher success rate than
exercise regimens of the past."
Current physical activity guidelines call for a minimum of 150 minutes of
moderate to vigorous exercise a week to help prevent type 2 diabetes. But
the study authors pointed out that nine out of 10 people fail to meet this
guideline.
The new study was led by Bernard Duvivier of the department of human
biology and movement science at Maastricht University Medical Center in the
Netherlands. His team wanted to see if a program to reduce sitting time -- by
encouraging patients to simply stand and do light-intensity walking -- could
offer an alternative to a standard exercise regimen.
The study included 19 adults, average age 63, with type 2 diabetes who did
three programs, each lasting four days. In the first program, the participants
sat for 14 hours a day and did only one hour a day of walking and one hour a
day of standing.
In the second program (the "sit less" program), the participants did a total of
two hours a day of walking and three hours a day of standing by breaking up
their sitting time every 30 minutes.
In the third program (exercise), the participants replaced an hour a day of
sitting time with indoor cycling.
The sit less and exercise programs were designed to burn similar amounts of
energy, the researchers said.
Significant improvements in blood sugar control occurred when the patients
did the sit less program or the exercise program, but the improvements were
generally stronger during the sit less phase, according to the study.
Courgi said the new trial has helped him "rethink the way I treat diabetes with
exercise."
He said that, although it would be nice to see the results replicated in a larger
trial, the study findings remain "very interesting."
The study was published Nov. 30 in the journal Diabetologia.

Platypus venom could treat type 2 diabetes, Adelaide researchers find

A longer-lasting form of a hormone found in platypus venom could pave the
way for new treatments for type 2 diabetes in humans, according to
researchers at the University of Adelaide.
The team found both the platypus and echidna produce a long-lasting form of
the hormone glucagon-like peptide-1 (GLP-1).
GLP-1 is normally secreted in the gut of both humans and animals,
stimulating the release of insulin to lower blood glucose levels.
But GLP-1 typically degrades within minutes.
Lead researcher Frank Grutzner said his team was surprised to find the
hormone was produced not only in the platypus' gut, but also in its venom.
"We've found that GLP-1 is degraded in monotremes [platypus, echidna] by a
completely different mechanism," Professor Grutzner said.
"Further analysis of the genetics of monotremes reveals that there seems to
be a kind of molecular warfare going on between the function of GLP-1, which
is produced in the gut, but also surprisingly in their venom."
The platypus has spurs on its hind limbs for delivering venom to its
competitors during mating season.
Associate Professor Briony Forbes said the two different functions of GLP-1
in the platypus in the gut as a regulator of blood glucose, and in the venom
to fend off other males have seen the hormone evolve.
"The function in venom has most likely triggered the evolution of a stable form
of GLP-1 in monotremes," she said.
VIII.

REFERENCES
Brunner & Suddarths Textbook of Medical-Surgical Nursing 13 th Edition
www. Diabetes.Org
www. Healthline.com
www. webmd.com
www. Mims.com