Managing Diabetes: A Collaborative Multidisciplinary Approach

Rising Diabetes: Insulin, Glucose, and Global Concerns

Diabetes is a severe illness where there is an insufficient amount of insulin. The body can find it difficult to utilize insulin adequately. The pancreas is the body structure that produces insulin. Islets of Langerhans are cells found in the pancreas, whereas beta cells are cells that are found in islets, which make insulin present. Food that is high in starch and carbohydrates, amongst other nutrients, is later broken down into glucose. This process happens in the stomach, which then glucose is transmitted into the bloodstream. In order for the cells to function well, they need energy. This is exhibited by glucose. The role of insulin is to prompt liver and muscle cells (among other cells) to absorb glucose to be transferred to energy. If the body has a considerable amount of energy, insulin prompts the liver to store glucose as glycogen.

Diabetes is a serious condition if not treated well. According to the World Health Organisation, in April 2016, diabetes was going to be the seventh most consequential cause of death around the world. Nowadays, diabetes is becoming more common. Worldwide, around 347 million of the population are known cases of diabetes. A rise in deaths in the coming future is not surprising. This is because 1.5 million cases were noted in 2012, and according to research, the probability of increasing by 50% is existing. (World Health Organisation, 2016).

There are three types of diabetes:

Type 1 (also known as insulin-dependent diabetes): This is often found in adolescents and youth. When food is absorbed and reached in the stomach, glucose is present and liberated in the bloodstream. Type 1 diabetes experiences a problem. They lack insulin production, and as a result of this, glucose can not get into the cells, and they experience an increment in blood glucose levels (Diabetes UK, 2017).

Type 2: This tends to be developed during the 40’s or older. Similarly, for type 1 diabetes mellitus, the same scenario is repeated where insulin somehow lacks and cannot penetrate the cells. Despite the fact that they are similar, there are cases which differentiate. Fatty deposits cling to the cells, forbidding the glucose from getting in. This is caused by the fact that fat disallows the process to exhibit in its normal manner and not because of a shortage of insulin in the body. Type 2 diabetes is experienced in 85% of the known cases worldwide. Some factors that make this condition more severe are smoking and being obese. This is because, as previously specified, the fat disallows insulin from functioning well.

Type 2 diabetes can be found in anyone who has a good Body Mass Index. If diabetes is mistreated, chronic health issues will be faced, such as blindness- retinopathy, and neuropathy, which can end up with amputations and kidney failure (Diabetes UK,2017). Folks who experience diabetes are more exposed to Cardiovascular diseases such as CVA. The nervous system may also be damaged due to diabetes, and neuropathy can arise. Numbness and lack of feeling in the extremities of our body are the result of diabetes, and ulceration may take place. One should give importance to any cuts that may appear during daily activities, such as nail cutting or walking on bare feet. Cuts and ulcers in diabetics may take longer to heel, which might result in wounds, and if not treated well, amputations may take place.

Gestational diabetes resembles that of type one and type 2, but it is often found during pregnancy. If diabetes is shown at the initial stage of the pregnancy, it might indicate that the mother suffered from diabetes before. This can be medicated with the use of insulin, amongst other treatments. In this type of diabetes, if treatment is given with immediate effect, the condition can be eliminated. Promoting a healthy lifestyle and a good Body Mass Index before, during, and after pregnancy is of utmost importance to eliminate as much as possible diabetes (Nice.org.uk,2016).

Nursing’s Vital Role in Diabetes Care and Education

Health care staff shows compassion and care towards the patients regardless of gender, ethnic race, and religion. The nursing role consists of looking after ill patients, dying patients, and patients with special needs and advocating health advice. (“WHO|Nursing”). The role of a nurse is essential when taking care of diabetes. When the nurse faces people who lack knowledge about healthy lifestyles, the nurse must emphasize the good practices. This has to be linked with the relatives, to work hand in hand with the nurse and cooperate by not giving sugar-based food or junk food, which may not help with his/her condition.

The professionals must not use as many as possible so that the patient can absorb all the said information. If this is not abided by, goals set by the multidisciplinary team will not be achieved (Nursingworld.org.org,2017). The nurse has to undertake BGM. Following this, the nurse has to observe any differences noticed in the patient and document them in order to administer the adequate dose of medication. Prevention of sores is prudent; therefore, information is provided to the patient and relatives. Cushions and adequate padding under the legs is a good prevention.

A particular nursing role is the Tissue Viability Nurse, who has a crucial role in monitoring wounds for fast-paced healing. Foot ulcers are very trivial in patients who are experiencing diabetes. 6% out of the 15% who developed a foot ulcer ended up in the hospital to treat infection and other complications (Apma, 2016). Patients who have stage I ulcers should be treated immediately to eliminate escalating tissue damage and promote healing. Stage I foot ulcer is classified as a superficial ulcer, where wadding and cushioning are used to ease pressure and off-load the leg (Doupis & Veves, 2008).

Poor circulation, irritation, diabetic neuropathy, trauma, and pressure on the foot for long hours cause diabetic foot ulcers to form. A podiatrist’s advice is vital to recommend footwear. Footsteps are monitored by the podiatrist during follow-ups to see the patient’s process and not developing new ulcers (Nice.org.uk, 2015).

Collaborative Care: Diet, Exercise, and Physiotherapy in Diabetes Management

Promoting a healthy and accustomed diet for the patient is the role of the dietitian. The reason behind this is to keep blood glucose levels in the blood under control, together with cholesterol levels and blood pressure. A dietician is a paramount source because he aids patients with customized diet plans to minimize the risk of stroke and heart disease. The recommended food has reduced fats, salts, and sugars (Diabetes: Healthy Eating with Diabetes, 2009).

As much as possible, the nurse collaborates with the dietician to support the patient to keep his intake of biscuits and sweets as low as possible. These can be altered with fat-free and sugar-free biscuits. This way, the patient is balanced; he is pleased with biscuits, but at least fats and sugar are minimized. Sugary drinks such as soft drinks should be eliminated as blood glucose levels would increase. Two liters of water are recommended to eliminate dehydration (Bda.uk.com, 2013).

PhysiotherapyPhysiotherapy is part and parcel of the multidisciplinary team as they have to work hand in hand to achieve the goals set. Physios aid patients in enhancing their conditions by suggesting and recommending different exercises according to the condition of the patient. They analyze the improvements and appraise every little advancement to encourage independence and give hope. Physiotherapists and Pedologists are to work hand in hand for recommendations of best care, especially when mentioning foot care. A case in point is when analyzing the mobility of an individual to prevent any bed sores from forming and assessing the patient for the right posture of walking (Nhs. uk, 2017).

Nurturing Patient Awareness: Education and Challenges in Diabetes Care

Having a look at the journey of care, one can see a variety of cases. People who are not residing in long-term facility care and are diagnosed with diabetes may not be aware that they are not eating the right food with adequate amounts, which may include fat, sugar, and salt intake. They may also miss the treatment as they forget or see it as a cost, and they don’t even dare to buy it or take it when they feel up to it. Part of the role of the multidisciplinary team is to educate the patient and enhance his knowledge for better self-care. The main focus in all these scenarios is always the patient; therefore, promoting a healthy lifestyle is necessary for the good of the patient.

Education is the key to patient awareness; therefore, without it, the patient lacks self-care, healthy nutrition intake, and treatment and may mislead the planned goal. With knowledge, the patient can also be more independent, excluding that Dementia or similar conditions are not present in this case. With all of this, the nurse can promote a better way of living, and the patient looks at life in a more interesting manner. An obstacle that a nurse may face is when patients are not willing to cooperate and neglect instructions that are made clear.

These patients need watching constantly and also need a lot of support from their relatives (Nice.org.uk, 2015). When meeting the patient, it is of utmost importance that the nurse conduct eye contact with the patient. If this is not abided by, the patient may lack concentration, and the nurse will show a lack of interest. Speaking rapidly may also make the patient feel lost. When reaching a certain old age, the senses may start to deteriorate, such as poor eyesight and poor hearing; therefore, speaking adequately, calmly, and repeating when necessary is prudent to ensure that the message is conveyed.

Fostering Trust and Education: Effective Communication in Diabetes Care

Empathizing with the patient and treating him/her with dignity may make the patient acquire trust in the nurse, rather than unnecessary shouting and being hard. Explaining to the patient without using a lot of jargon makes the patient comfortable to understand his case. For example, Notifying the patient that he/she is suffering from hyperglycemia is useless if the patient does not know what the term hyperglycemia means. Rather than that, the nurse could say the patient is suffering from high blood sugar in the blood. In this way, the nurse is speaking in a way that she is assuring herself/himself that the patient is getting the message. Keeping distractions to the minimum is another advantage to help the patient get the message (Fischbach, 2010).

Informative leaflets can be given to the patients and their family members to help them gain more knowledge about the condition. When patients are in long-term care or residential homes, the nurses and healthcare team are responsible for taking blood glucose frequently. Also, giving out treatment and delivering good care will show up by stabilizing the blood glucose, for instance, by administering treatment regularly at the proper time and proper dosage and eating food to enhance the situation. This stability will show progress and minimize the risk of developing other health conditions.

Groups and organizations associated with diabetes are available. These contribute to awareness and conduct programs to help people overcome diabetes. These entities also provide a good source of education, where anyone concerned may utilize this knowledge to handle his/her condition better. The World Health Organization organizes an agenda for the scope of increasing information about minimizing the risk of diabetes and supplying people with information on how to adhere to healthy habits. Who also publish statistics about anyone experiencing diabetes. WHO also remarks a lot on healthy eating to make people more aware of how to live healthily and achieve a good Body Mass Index. This also includes exercising daily because being in a healthy state may be key to keeping chronic illnesses away, such as diabetes and being overweight (Who. int, 2009).

Collaborative groups like the Malta Diabetes Association give their helping hand by visiting patients, educating them and their family members, and clearing any uncertainties that they might have. The Pursuit helps by giving out concrete and practical advice. During educational sessions, leaflets are distributed to make it easy for the patient to remember and understand what it is all about. Newsletters and magazines are issued often in order to keep patients informed regarding diabetes. (Maltese Diabetes Association,2017) A good informative program about diabetes is X-PERT. These include changes in food intake, healthy snacks, and daily fitness sessions. The meetings are two and a half hours over a period of six weeks. (X-PERT Diabetes 2016).

Conclusion

When treating patients with diabetes, the multidisciplinary team is essential for the care of the patients to enhance their way of living. The multidisciplinary team does not focus on oneself or independently, but on the contrary, they work as a team to achieve the desired goal for the good sake of the patient. The focus of the multidisciplinary team is always on the patient; therefore, they must work hand in hand because if not, the patient is the one who will have a bad experience. The multidisciplinary team must make use of continual professional development in order to keep updated with new procedures, techniques, and new evolutions because medical health evolves rapidly, and with the education acquired, one can help the patient fruitfully.

In this assignment, the significance of including patient education as part of the care was emphasized. This can be achieved with the help of groups, which we specified earlier, and with the involvement of the multidisciplinary team. It is imperative that the education provided should be well elucidated and implicated by the family members. As data is showing, which is quoted earlier on, diabetes is getting more common nowadays, but longevity is getting longer, too. To be able to reduce the number of diabetes sufferers, one must understand and get educated, and that’s where the role of health promotion kicks in.

Leaflets, magazines, billboards, and health promotion advertisements on television are crucial. This will contribute to making society more intelligent and reduce the number of new cases of diabetes. We, as a society, have to contribute in order to reduce the risk of ill suffering and obviously cure. Diabetic patients may be more susceptible to experiencing depression. When this happens, the multidisciplinary team must target to tackle it as well, with care and empathy, and above all, with lots of support. If the mentioned measures are adhered to, people with diabetes will face an easier life, which involves support, a healthy lifestyle, exercising, reading of BGM on a regular basis, and treatment as required.

Appendix:

Mr. X’s condition was identified six years ago and resulted in type 2 diabetes. He is a 70-year-old gentleman who has been residing in the elderly residence for four years. He used to live with his child, who was unable to handle his bad tendencies of food, and despite healthy food being provided, he still entertains himself with food that is rich in fats and sugars. An episode of dehydration occurred, and his daughter brought him to casualty while she was alerted that her father was urinating often and haematuria was present. Mr.X was disoriented. A urinalysis and CBC, amongst other tests, were taken on admission, and it resulted that he was suffering from diabetes.

While he was in hospital, BGM was recorded regularly and resulted in type 2 diabetes. Gliclazide was administered at the dose of 80mg daily, Metformin was administered at 500 mg twice daily, and fixed doses of Insulatard. These were the treatments required to treat his condition, that is, diabetes type 2. Both patient and relative agreed that Mr.X should be sent to a long-term care facility for more professional care. On discharge, the patient was sent to St. Vincent De Paul because his daughter could not take care of him, where he could be provided with the necessary treatment and care daily. This was to safeguard Mr. X because he also had traces of Dementia and could risk an overdose leading to hypoglycemia or miss his treatment if left independently.

Mr.X is now living in Saint Vincent De Paul and is a semi-dependent patient. BGM tests are still being monitored daily. He is still being treated with metformin gliclazide and insulin, according to his BGM. Lately, he was diagnosed with a pressure sore stage 1 in his left heel. As advised by TVN, he is to be ambulated regularly, avoid long stays in bed, and observe the sore to heal to prevent further complications.

References:

World Health Organisation. (2016). Global Report on Diabetes. Retrieved from https://www.who.int/diabetes/global-report/en/
Diabetes UK. (2017). Diabetes – The Basics. Retrieved from https://www.diabetes.org.uk/resources-s3/2017-11/diabetes_the_basics_2017.pdf
Nice.org.uk. (2016). Diabetes in Pregnancy: Management from Preconception to the Postnatal Period. Retrieved from https://www.nice.org.uk/guidance/ng3
WHO. (n.d.). Nursing and Midwifery. Retrieved from https://www.who.int/news-room/q-a-detail/nursing-and-midwifery
Nursingworld.org.org. (2017). The Role of Nurses in Diabetes Care. Retrieved from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-role-of-nurses-in-diabetes-care/
Apma. (2016). Foot Complications. Retrieved from https://www.apma.org/Patients/FootHealth.cfm?ItemNumber=981
Doupis, J., & Veves, A. (2008). Classification, Diagnosis, and Treatment of Diabetic Foot Ulcers. Wounds, 20(5), 117-126.
X-PERT Diabetes. (2016). About X-PERT. Retrieved from http://www.xpertdiabetes.com/about-x-pert
Diabetes: Healthy Eating with Diabetes. (2009). British Dietetic Association. Retrieved from https://www.bda.uk.com/resource/diabetes-healthy-eating.html
Bda.uk.com. (2013). Diabetes. Retrieved from https://www.bda.uk.com/resource/diabetes.html
Nhs. uk. (2017). Physiotherapy. Retrieved from https://www.nhs.uk/conditions/physiotherapy/
Fischbach, F. T. (2010). A Manual of Laboratory and Diagnostic Tests (8th ed.). Lippincott Williams & Wilkins.
Who.int. (2009). Promoting a Healthy Diet for the WHO European Region. Retrieved from https://www.euro.who.int/__data/assets/pdf_file/0017/146721/E93736.pdf
Maltese Diabetes Association. (2017). About Us. Retrieved from http://www.diabetesmalta.org/about-us/