Diabetes, Case Study Example

Introduction and Background

Diabetes mellitus is a serious and debilitating medical condition that if left untreated, leads to numerous complications and bodily system decline and permanent physical damage in patients. It is important to identify the challenges that patients face with this condition and to determine methods of managing the illness to minimize its symptoms and long-term complications. Diabetes emerges when the body is unable to effectively produce insulin at the pancreatic level, thereby interfering with blood sugar levels. When these levels cannot be controlled, a proper diagnosis and treatment must be identified to reduce possible organ and system damage. If treatment is not successful, progressive damage is likely to occur. Therefore, actions to prevent diabetes are essential, including maintaining a healthy weight, proper nutrition, and a routine exercise plan. The following discussion will present an example case study of a 46 year-old female named TP exhibiting many of the advanced symptoms of uncontrolled diabetes mellitus. Her condition will be explored in greater detail and will emphasize the importance of early diagnosis and proper treatment in the continuous management of this condition.

Literature Review

Uncontrolled diabetes represents a unique challenge to physicians and caregivers in the modern era. This condition leads to a significant burden for hospitals and other healthcare facilities as they treat this patient population (Kim, 2007). In 2004, statistics demonstrated that “609,000 admissions were primarily a result of diabetes. Among these 609,000 admissions, 191,181 (or 32%) were due to uncontrolled diabetes conditions” (Kim, 2007, p. 1281). Therefore, the condition of uncontrolled diabetes must be evaluated more closely in patients who face this concern to improve treatment options and to reduce the necessity for hospitalizations (Kim, 2007). It is necessary to consider the alternatives that are available to prevent hospitalizations for diabetes, particularly when there are no debilitating symptoms (Kim, 2007).

In patients with uncontrolled diabetes, the continued elevation of blood sugar leads to a variety of complications which may cause extensive organ and system damage over time (World Health Organization). Conditions such as diabetic retinopathy, diabetic neuropathy, kidney failure, heart disease, and stroke are common long-term complications of uncontrolled diabetes and must be prevented through a comprehensive treatment plan as best as possible (World Health Organization).It is expected that the economic burden of diabetes will continue to grow; as a result, it is necessary for those at high risk to manage their weight, partake in healthy nutrition, and exercise regularly to minimize these risks (World Health Organization).

It is recommended that patients at risk of diabetes or who have already been diagnosed to be provided with education and training in self-management and prevention strategies (American Association of Diabetes Educators, 2010). In this capacity, diabetes experts must address some of the most common types of self-care behaviors for diabetics, including nutrition, physical activity, medication administration, risk assessment (American Association of Diabetes Educators, 2010). From this perspective, patients face critical challenges in managing the diabetic condition, so education is a helpful tool in providing much-needed knowledge and guidance regarding this condition and its long-term impact on organs and systems (American Association of Diabetes Educators, 2010). These efforts also demonstrate the importance of establishing relationships with patients to increase their comfort level and discussion of diabetes and its impact on their lives (American Association of Diabetes Educators, 2010). This is an important and meaningful tool for patients, and in particular, those who experience uncontrollable diabetes and its complications over a period of time (American Association of Diabetes Educators, 2010).

When diabetes remains in an uncontrollable state, it is often very difficult to overcome the symptoms and to lead a life of normalcy without complications. There are methods of managing diabetes that are likely to provide some relief, including the development of a strategy to manage the condition that is adopted on a daily basis to prevent further complications from taking place. For example, blood sugar levels should be monitored daily and patients should recognize the importance of regular meals with a balance of proper nutrition (Mayo Clinic, 2013). In addition, portion control is one of the key necessities of a healthy diet and requires an effective understanding of recommended portion sizes and other characteristics (Mayo Clinic, 2013). In addition, if a patient is insulin dependent, he or she must coordinate the medication schedule along with food intake in order to accomplish the desired treatment and management objectives (Mayo Clinic, 2013). When administering insulin or other medications, it is necessary to be cautious and observant to ensure that there are no accidental errors in use that could further harm blood sugar levels (Mayo Clinic, 2013). This is an important step towards the creation of a more effective treatment plan for the diabetic condition (Mayo Clinic, 2013). Most importantly, patients should be aware of their blood sugar levels on a regular basis so that if any complications arise, they are treated rapidly and effectively (Mayo Clinic, 2013).

Description of Case History

Patient Profile

The patient in question is a 46 year-old Caucasian female who is married with two high school-aged children. She is 5 feet, 3 inches tall and weighs 225 pounds. Over the past five years, TP has gradually gained weight and is now well above her ideal weight of 130 pounds. She does not partake in a healthy diet and eats many of her meals on the go. She also does not exercise on a regular basis and often experiences fatigue. Both of TP’s pregnancies were difficult and had minor complications during birth. TP also experienced post-partum depression with both of her children and has periods of mood swings. She works outside of the home and volunteers at her children’s high school on the PTA. She is often on the go and finds it difficult to maintain a healthy diet. As a result, her weight has increased dramatically over the past several years.

Patient History and Clinical Course

Laboratory Data

The patient first presented at the emergency room with lethargy, fatigue, excessive thirst, and frequent urination. She had become severely dizzy at home and was unable to regain her balance and stand on her own. Her husband suggested that she should be taken to the emergency department for further evaluation. Upon initial examination, her initial blood sugar level upon testing was 205 mg/dL, which was cause for immediate concern. Upon additional testing at fasting, her blood sugar level was 175, which remained high, with diabetes as the primary suspected cause. During her stay in the emergency department, TP’s dizziness subsided and she began to regain full balance and awareness of her surroundings.

Investigations

Upon physical examination and vital signs, the physician noted that TP was severely overweight. Her blood pressure was 165/100 upon measurement. The physician was concerned that a combination of elevated blood pressure and diabetes-related symptoms was highly problematic for TP and likely contributed to her recent dizzy spell. Therefore, she was diagnosed with diabetes and hypertension at the time of the visit. The physician was required to make decisions regarding the course of her care and treatment plan so that she would be able to better manage her symptoms and related complications. However, the physician was concerned regarding her dizziness and as a precaution, ordered additional testing to ensure that there were no underlying neurological complications. Therefore, she was admitted to the hospital overnight for observation and for further testing.

Medication

The physician in charge of TP’s case was required to make a number of decisions regarding the administration of medications to treat the diabetic condition. TP had been notified of her diagnoses and the risks associated with these conditions. Therefore, the physician prescribed an oral medication to determine if TP would respond to this first line of defense and if it would be effective in regulating her blood sugar levels. TP was prescribed Metformin (Glucophage) 500mg BID and Lisinopril (Zestril) 10 mg BID to determine whether or not the patient would respond favorably to this treatment regimen.

Treatment from Admission to Transfer of Care

Upon the decision to admit TP overnight, it was important to administer the recommended medications to ensure that her diabetes and hypertension began to regulate as quickly as possible. This was an important step towards the discovery of new insights regarding the patient and her ability to tolerate the medication and to determine if it would be effective over the long term. It was important for the patient to begin pharmacological treatment as quickly as possible to prevent further complications from her excessive blood pressure and blood sugar levels. Therefore, she was administered the first dose of each medication in the emergency department while waiting to be transferred to the medsurg unit for overnight observation and long-term management of these conditions. TP recognized the severity of her condition and accepted the physician’s recommendations because she sought to improve her own health and to feel better on a daily basis, which she had not experienced for quite some time.

Care Plan During Admission: Patient Goals and Outcomes

Upon review of TP’s current symptoms and presentation, it was important to identify both a short and long-term treatment strategy so that her symptoms would not only improve, but she would also experience significant benefits from medication administration as well as lifestyle changes. It was important to identify the challenges associated with her condition but to also recognize that they were treatable and manageable. Upon review of TP’s case and the decision to admit her overnight for testing and observation, it was determined that her level of comfort and level of knowledge regarding her health status were of critical importance.

Prior to her visit to the emergency department, TP had recognized that her health was suspect; however, she had chosen to ignore some of the warning signs and did not take any precautions or other steps to improve her health and wellbeing through lifestyle changes. Therefore, in addition to establishing a medication-based treatment plan, the patient would be required to obtain additional education regarding her condition and how to best manage it through a combination of medication administration and lifestyle changes. The latter would serve as the primary focus of the educational component of her treatment plan to lose weight, consume a healthier diet, and exercise regularly.

Assessment of Body Systems Influencing Diabetes

Diabetes has a number of significant impacts on organs and systems if left uncontrolled or undiagnosed for long periods of time. In addition, for those patients who are able to manage their diabetes effectively, organ and system damage may also occur. From a cardiac perspective, diabetes is perhaps one of the most important contributors to the diagnosis of hypertension (Diabetes.co.uk) and is likely the reason behind TP’s own diagnosis. Furthermore, patients with diabetes are more likely to experience a greater risk of cardiovascular disease in different forms (diabetes.co.uk). In this context, patients must be observed regularly to identify any possible cardiovascular complications as a result of the diabetic condition (diabetes.co.uk). In addition, diabetes is a precursor in increasing the risk of stroke (diabetes.co.uk). Over time, diabetes has a significant impact on eye function, including a greater risk of diabetic retinopathy, particularly when diabetes is uncontrolled (diabetes.co.uk). Kidney function may also decline with diabetes and may lead to diabetic nephropathy (diabetes.co.uk). Diabetes has a significant impact on nerve function throughout the body, particularly in the hands and feet, and may lead to numbness and tingling, as well as the development of diabetic neuropathy (diabetes.co.uk). Under these conditions, it is important to identify the challenges associated with managing diabetes effectively as early as possible so that long-term damage is minimized for this patient population to prevent serious complications (diabetes.co.uk).

Discussion

It is important to diagnose diabetes as early as possible so that treatment may begin and long-term complications and organ/system damage may be reduced (Spollett, 2003). In supporting the educational strategy for TP, it was important to utilize the services of an advanced practice nurse (APN) to support the treatment plan and long-term management program (Spollett, 2003). In this capacity, “At the completion of assessments, advanced practice nurses, in conjunction with patients, identify management goals and determine appropriate plans of care. A review of patients’ self-care management skills and application/adaptation to lifestyle is incorporated in initial histories, physical exams, and plans of care” (Spollett, 2003). Therefore, it is important for patients to be provided with a strategy or plan of care that will be most effective in meeting their specific needs associated with diabetes management to promote the desired outcomes (Spollett, 2003). It is important for APNs and other clinical knowledge experts to provide guidance and insight as necessary to ensure that patient outcomes are accomplished and met on a continuous basis (Spollett, 2003). It is not sufficient to provide initial education and then fail to continue to provide guidance on a routine basis; rather, patients such as TP must be evaluated and monitored consistently to determine how to best move forward in the chosen treatment plan (Spollett, 2003).

Key Outcomes

In the example case study involving TP, it was important to identify the challenges associated with her diagnosis and plan of care over the long term. TP’s diabetes had progressed for a period of years and had gone undiagnosed. However, the physician and clinical team believed that she could maintain her health and minimize damage by taking her medication as required and conducting several important lifestyle changes in her personal life. The physician recommended that TP establish a healthy nutrition plan and exercise regimen to reduce her weight on a gradual basis. TP took these recommendations seriously and joined a local Weight Watchers group to assist her with her weight loss goals. She began with small yet gradual changes to her diet, replacing some carbohydrates with vegetables and reducing her meat intake. She quit drinking soda altogether and also reduced her intake of sweets. She also began walking three times per week and gradually increased it to six days per week, four miles per day.

Over a period of nine months, TP lost 65 pounds and was on her way to achieving her weight loss goal of 95 pounds. She had achieved her goals and now had a new lifestyle to show for it. As a result, TP’s diabetes was under control and her blood sugar levels were almost consistently in the proper range. In addition, her blood pressure was under control and her medication levels were reduced. She continued to see her physician every few months to determine if there were any other required changes to her medication schedule. TP was on the right track to successful outcomes and sought to be as successful as possible in her lifestyle regimen to eventually be permitted to manage her diabetes without medication and solely with proper diet and exercise.

What Was Learned

With this example case study, it became evident that diabetes is a very serious and debilitating condition that causes widespread damage to organs and systems if left untreated. Therefore, this condition requires immediate diagnosis, care, and treatment to ensure that it is managed properly and effectively. This is an important step towards the development of new strategies to reduce diabetes-related complications and symptoms and to focus on prevention as best as possible. In this example, TP recognized that her health was in a decline, but was perhaps fearful of the outcomes. Therefore, she did not obtain treatment until she had no other choice. This is not the most ideal means of managing this type of condition, as it should be diagnosed and treated as quickly as possible to prevent further complications and other long-term damage to body organs and systems. It is imperative that individuals recognize that when symptoms arise that are typical of diabetes, immediate guidance and treatment are essential to the long-term care plan for these patients.

What Should Readers Learn

Based upon the results of this case study, it is important for readers to recognize the necessity of being proactive rather than reactive in diagnosing, treating, and managing diabetes over the long term. These efforts require a greater understanding of diabetes and its impact on organs and systems, as well as the importance of diabetes-related education and a proper treatment plan. This case study example provides further evidence of the dangers of excess weight and obesity on the body and how poor diet and limited exercise play a role in increasing the risk of diabetes and related complications. Therefore, nurses and other clinical staff members must be prepared to work with diabetes patients and possess the knowledge that is necessary to improve outcomes and to reduce these risks over time. These efforts will demonstrate that diabetes should be taken seriously at all times under all conditions and that there are significant benefits to establishing a treatment plan and lifestyle changes to reduce the long-term impacts of this condition.

Conclusion

Diabetes is a highly challenging and complex condition that requires significant attention and focus in order to reduce its symptoms and long-term complications. In this context, it is necessary for patients to recognize when they might have some of the symptoms of diabetes and to seek guidance and treatment from their physician. These efforts require a greater understanding of diabetes and its impact on organs and systems because these impacts may ultimately reduce the quality of life for these patients. Therefore, it is important to identify methods of reducing the risks of diabetes at the prevention stage so that there are fewer diagnoses of this condition in the general population. With this framework in mind, diabetes-related education is critical to prevention and in enabling population groups to recognize their own risks and how to prevent these risks from leading to a diagnosis of diabetes. It is imperative that clinical professionals work with patients such at TP to recognize these risks and to begin treatment as necessary when a diagnosis is made. This will enable clinicians to be effective in addressing the severity of diabetes and its potential impact on patient care and wellbeing for many patients.

References

American Association of Diabetes Educators (2010). Diabetes education services:

reimbursement tips for primary care practice. Retrieved from http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/research/Diabetes_Education_Services6-10.pdf

Kim, S. (2007). Burden of hospitalizations primarily due to uncontrolled diabetes. Diabetes Care, 30(5), 1281-1282.

Mayo Clinic (2013). Diabetes management: how lifestyle, daily routine affect blood sugar. Retrieved from http://www.mayoclinic.com/health/diabetes-management/DA00005

Spollett, G. (2003). Case study: a patient with uncontrolled Type 2 diabetes and complex comorbidities whose diabetes care is managed by an advanced practice nurse. Diabetes Spectrum, 16(1), 32-36.

World Health Organization. Diabetes. Retrieved from http://www.who.int/nmh/publications/fact_sheet_diabetes_en.pdf