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Diabetes Mellitus is a metabolic disorder in which the pancreas’ ability to produce or respond to insulin is diminished. A long-lasting multisystem disease related to irregular insulin production, impaired insulin utilization, or both resulting in an abnormal metabolism of carbohydrates and raised levels of glucose in the blood and urine. There are two categories of diabetes mellitus, Type 1 and Type 2. Type 2 is the most common form of diabetes which has no age limit onset, which can occur to do certain lifestyle choices. Such as, bad eating habits, lack of exercise and obesity. While Type 1 is also called juvenile-onset or insulin dependent diabetes, which is the inability of the pancreas to make insulin; typically beginning at an early age. This chronic illness affects more than 29.1 million people in the world. Diabetes is considered one of the top leading causes of death, it is also one of the contributing causes of adult blindness, neuropathy, end-stage kidney disease, peripheral vascular disease and non-traumatic lower limb amputations (Lewis, Bucher, Heitkemper & Harding, 2017, p.1120). Diabetes mellitus is significantly more prevalent in African American, American Indian and Hispanic populations, and is more common in men (Holman, Williams, Johnson, Ball, Wheless, Leehy, & Lemon, 2018, p. 527). Diabetes is a chronic illness which can be maintained with a balanced proper diet, exercise and the daily use of medication. With an appropriate diet, a person’s blood glucose level can be controlled and well managed.
The patient is a 52-year-old African American male, with a history of hypertension, and migraines. He came into the emergency department with a blood glucose reading of 439, a temp of 98.6, respiration 19, pulse oximetry 97 and a B/P of 159/86. His daughter noticed that he was drinking more water than usual and needed to stop and use the restroom four times while shopping at Target. She grew concerned when he was driving home, and he screamed that he couldn’t see the lines on the road clearly. He is a widower of two years and lives alone with his dog. He works as a Septa bus driver and can work upwards to 16 hours a day. His wife used to cook, so he usually eats frozen meals from the market now. His two daughters and one son are all in college or living on their own. They visit him quite often, usually bringing home cooked meals with them. One daughter is a newly licensed nurse and noticed the signs of diabetes mellitus and brought him into the hospital. The patient was admitted and placed on an insulin drip. The diabetes team has informed him that he is a type 2 diabetic.
The patient completed high school, as well as finished trade school. He stated that he learns best by reading and being hands on with the materials. Utilization of the brochure handout for healthy eating as well as step by step instructions for the blood glucose testing would be appropriate. He has been sticking his finger, checking his blood glucose levels for the past two days without missing a step and recording the values in his notebook. The patient states he can cook meals, he just doesn’t know what to cook; subsequently, it is easier to heat up a frozen meal in the microwave and eat. As studied by Sumlin and Brown (2017), traditional diabetes education which includes information on the recommended dietary changes, has been attempted in African American communities however there is little success (p.566). The patient will need a thorough break down on the types of dietary changes he will have to make. After reviewing the documented assessments in his chart, the patient is willing and ready to learn how and what to eat for a balanced meal and appropriate snacks to maintain acceptable blood glucose levels. A dietician has been contacted regarding the explanation of meal preparation and healthy eating.
By the end of the teaching, the patient will be able to teach back the proper diabetic food choices and appropriate portion of meals. As well as the patient will be able to explain how to read the nutritional values of food and beverage packages and to be cautious on the amount of sugar and carbohydrate in each intake. Lastly, the patient will be able to find simple and healthy food selections to prepare prior to discharge.
Knowledge deficit as related to lack of awareness about the diabetes disease process and ineffective health teaching as evidence by unhealthy food choices and sedentary lifestyle.
Short term – To reduce his sugar intake by planning his meals for the day and keeping a journal to track the amount of carbohydrates and sugar consumed.
Long term – To be able to maintain a normal blood sugar level by eating healthier food choices.
To utilize the diabetes brochure to demonstrate the proper food choices and adequate food portioning. To give examples of food groups that will control blood sugar level. The brochure will guide him to be able to select the appropriate food choices. To explain to the patient the importance of daily food journal in order to effectively monitor sugar consumption. However, counting the grams of sugar in a food item is good, the best way to take control of the blood glucose level is to count the carbohydrates. “Although, the amounts of other nutrients in the diet can affect blood sugar levels to some degree, the amount of carbohydrates consumed has the most significant effect”, (Bussel, 2016, p.26). By documenting the meals and snacks eaten throughout the day; the journal will be a good tool for him to keep track of his food choices and intake.
By the end of the conversation the patient was able to do a complete teach back. Explaining the benefits of a healthy diet change incorporating portion sizes and carbohydrate counting. Discussed, were topics such as how to continue eating the meals he loved within moderation, rather than a complete overhaul dietary restriction. Capehorn (2017) stated that it’s best to modify a person’s diet slightly to get the best overall results, rather than attempting to change the foods they consume completely; this gives the best adherence to monitoring a person’s blood glucose (p. 94). He was able to make a list of all the snacks and meals he loves and discovered there were plenty of items he would be able to continue eating, within moderation.
Overall the teaching was beneficial, and the patient seemed to understand that this new diagnosis will be based upon self-discipline when it comes to dietary modifications. Vanstone, Rewegan, Brundisini, Giacomini, Kandasamy, & DeJean, (2017), states that having self-discipline can be facilitated by portion control, allowing favorite or socially significant foods to be consumed in small quantities (p. 223). The patient seemed open to the new dietary changes, only time will tell whether he will adhere to the new diet plan.
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