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Interventions for Type 2 Diabetes Mellitus






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Interventions for Type 2 Diabetes Mellitus

            Type 2 diabetes mellitus is a condition in which the body
does not use insulin properly. At first, the pancreas makes extra insulin to
compensate for this but, over time the body cannot keep up and doesn’t make
enough insulin to keep blood glucose at normal levels. High levels of insulin
in the body cause the body to store fat and prevent fat from being utilized by
the body. Diabetes Mellitus is a global problem affecting roughly 415 million
adults (Moloughney, 2017). Numbers are expected to increase significantly over
the next twenty years. Type 2 diabetes is the form that is most common. Not
only do patients have to worry about the disease itself but all the other
complications that go along with it if not controlled properly. Treatment is
life-long which can create fluctuations in compliance in many people. The
purpose of this paper is to explain nursing interventions that can be utilized
for patients affected with type 2 diabetes mellitus. The interventions will
include increased awareness of the role of uncontrolled diabetes, signs and
symptoms of hyperglycemia, strategies to improve nutrition, and the role of exercise
in controlling diabetes.

            The first intervention is to educate the patient on the
role of uncontrolled diabetes in the development of complications. By knowing
the risks associated with uncontrolled diabetes, it can help the patient to
stay motivated and on track with their care. Acute complications of type 2
diabetes mellitus can cause hypoglycemia, hyperglycemia, and a hyperosmolar
hyperglycemia state. Chronic complications can cause coronary artery disease,
peripheral vascular disease, retinopathy, neuropathy, and nephropathy. The
rationale behind this intervention is to stress the importance of personal
self-management and the responsibility of the individual to control their care.
These exacerbations of the condition can cause patients to lose their toes,
feet, or legs, it can cause blindness, and it can lead to serious heart
conditions such as congestive heart failure or a myocardial infarction.
Explaining these serious complications to the patient can hopefully lead to an
eye-opening experience for them and can help them to take control of their

            The second intervention includes teaching the patient the
signs and symptoms of hyperglycemia. Hyperglycemia can occur in a patient with
type 2 diabetes mellitus if they have increased food intake, if they omit their
oral medications, if they decrease their insulin dosing, decrease exercise, and
if they have infection, illness, or dehydration. The signs and symptoms of
hyperglycemia are a blood glucose level greater than 200 mg/dL, polyuria,
polydipsia, polyphagia, fatigue, blurred vision, and weight loss. Polyuria is
increased urination, polydipsia is excessive thirst, and polyphagia is
excessive hunger. The rationale behind this intervention is elevated blood
glucose causes dehydration from osmotic diuresis, potassium is elevated because
of hemoconcentration, and because carbohydrates are not metabolized, the client
loses weight. The patient should be aware of these symptoms so they know when
to increase their insulin or seek medical attention.

            The third intervention is to discuss strategies with the
patient to improve nutrition. Provide information regarding food groups such as
carbohydrates which include starches, starchy vegetables, milk, fruits, a
protein group, and a vegetable group. Instruct on the use of the “plate method”
as an easy way of meal planning and maintaining healthy nutrition. This
includes showing the client and family a paper plate that is divided into
quarter sections. Fill half of the plate with non-starchy vegetables (lettuce,
tomatoes, and broccoli), fill a quarter with protein (meat, beans, fish, and
eggs), and fill a quarter with starches (rice, potatoes, pasta, and bread). Add
one cup of skim milk, and one piece of fruit. Teach the client to lower fat
intake by trimming fat off meat, avoiding fried foods, limiting salad
dressings, and selecting low fat. Advise the client to drink water, limit diet
soda, coffee, and tea. Avoid all sugar drinks (juice, soda, and power drinks).
Eat breakfast every day (high-fiber cereal, low-fat milk), do not skip meals, make
an effort to eat the same amount at each meal, avoid seconds, and watch portion
sizes. The rationale behind this intervention is that balanced nutrition helps
to maintain normal blood glucose levels. The American Diabetes Association
recommends an individualized meal plan based on a client assessment. The “plate
method,” carbohydrate counting, and portion control are easy and acceptable
methods of meal planning. Low-fat foods, water as a beverage, and portion
controls of carbohydrates and protein can reduce weight and lower blood glucose.
Poor glucose control and insulin resistance are two of the most pervasive
bio-markers associated with chronic diseases affecting over 80% of Americans (Moloughney,
2017). Carbohydrate counting and controlling their diet can help the patient to
manage their type 2 diabetes mellitus and can keep exacerbations from

            The fourth intervention is to explain the role of
exercise in controlling type 2 diabetes mellitus. Exercise intervention is
considered a cornerstone. It improves glycemic control significantly in
patients with type 2 diabetes.  Considering
the significant relationship between blood glucose content and the risk of
cardiovascular disease and premature death, such a decline in blood glucose
content would lead to a reduction in the risk of microvascular and macrovascular
disease and premature death. Besides lowering blood glucose content in these
patients, exercise interventions lead to improvements in exercise capacity,
decreases in adipose tissue mass, increases in lean tissue mass, improvements
in blood lipid profile and quality of life, and reductions in blood
inflammatory markers and blood pressure. Exercise interventions substantially
reduce cardiovascular disease risk. Explain to the patient that the goal is to
engage in a total of thirty minutes of moderate-intensity physical activity
every day. Wear a pedometer to monitor and motivate. Instruct the client to
seek the advice of a health care provider before beginning an exercise program.
Exercise may be contraindicated with certain complications (severe nephropathy
and proliferative retinopathy). Teach the client to avoid injecting insulin
into a body part that is about to be exercised. Encourage the client to
exercise with others or where other informed persons are nearby, always wear
diabetes identification, and always carry a fast-acting carbohydrate. Explain
how to reduce serious hypoglycemic episodes related to exercise, monitor blood
glucose before and after exercise, and exercise when blood glucose level tends
to be higher, such as shortly after a meal. Always carry a source of
fast-acting sugar for emergency. The rationale behind this intervention is insulin
absorption increases in a body part that is exercised, which alters the
insulin’s absorption. Exercising with others ensures that assistance is available
should hypoglycemia occur. Proper timing of exercise, monitoring blood glucose,
and adjusting food or insulin decreases the risk of exercise induced hypoglycemia.
In the event of a severe reaction, a semiconscious or unconscious client may
require glucagon. Exercise is one of the major factors in controlling type 2
diabetes mellitus so encouraging the patient to avoid a sedentary lifestyle is
very important.


            Diabetes is a worldwide epidemic
that can be easily controlled with diet and exercise. Consumers face many
challenges when it comes to managing this health condition, as it requires
life-long commitments that often lead to physical and mental struggles. There
are several interventions that can be used for patients with type 2 diabetes
mellitus. These include increased awareness of the role of uncontrolled
diabetes, signs and symptoms of hyperglycemia, strategies to improve nutrition,
and the role of exercise in controlling diabetes. All of these interventions
play a role in keeping the client on track and focused on their health. The
many complications that diabetes can cause are severe and can lead to a
shortened life. Explaining the importance of the improvement and maintenance of
health is imperative to the patient. Perhaps through these interventions, type
2 diabetes mellitus patients can avoid exacerbations and can control or even
improve their condition.



Carpenito, L. J. (2014).
Nursing Care Plans: Transitional Patient & Family Centered Care

417-419). Retrieved from

Hansen, D., Peeters, S.,
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Exercise Assessment and Prescription in Patients With Type 2 Diabetes in the
Private and Home Care Setting: Clinical Recommendations From AXXON (Belgian
Physical Therapy Association). Physical Therapy, 93(5), 597-610.

Moloughney, S. (2017,
October). Blood Sugar Under Threat: Developing Effective Management

Along with diet and lifestyle changes, nutraceuticals can help consumers
achieve better metabolic health. Nutraceuticals World, 20(8), 46+. Retrieved


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