Health Promotion Project Diabetes

Running head: DIABETES 1

Health Promotion Project: Diabetes

Name and Student Number

University;

Course Number:

Professor’s Name:

Due Date:

Date Handed In:

DIABETES 2

Table of Content

1. Introduction………………………………………………………………….3

2. Diabetes as a Learning Experience……………………………………….… 4

a. An Overview: The diabetic patient, a family circle, and a nurse……..4

b. Diabetes Self-Management Education and Support (DSMES)……….5

3. Lifestyle Management of Diabetes

a. Drug Therapy (Metformin)………………………………………………..6

b. James among South-Asians at Risk………………………………………..7

c. The Foot Ulcer and Its Dangers……………………………………………8

4. Conclusion: The Plan………………………………………………………….9

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1: Introduction

Type 2 diabetes mellitus is a chronic irreversible illness that requires patient self-

management and support to an unusual degree. For that to happen, the patient has to buy into and

actively participate in shaping and implementing a complex treatment plan characteristic of the

illness, one which has as its goal to establish specific practices over a lifetime that reduce the risk

of further development of the disease. For all those who suffer from diabetes are gravely at risk

of all manner of fearful outcomes in other health areas, like suffering a stroke, blindness, cancer,

coronary artery disease (CAD), amputation of limbs, kidney failure, and not surprisingly, a

feeling of depression and helplessness (American Diabetes Association, 2016). Worse, the

disease is reaching ever-younger population with untold consequences not only in the escalating

demand made on our health system, but as importantly on harm that may be cause by a lifetime

of treatment with powerful, and sometimes unproven, drug regime (Mayer-Davis,2017).

The following pages seek to establish and demonstrate a complex, patient-centered

treatment plan for diabetes specifically designed as an in intervention on behalf of a Chinese

grandfather, James, who does not speak English well and reacted with rage when, having at last

secured an interview, the specialist reacted with alarm and disgust when observing in a growing

a bleeding ulcer that lacerated his foot and left unhygienic tracks on the floor. James took great

offense at the specialist who seemed indifferent beyond prescribing the drug metformin, which

was poorly tolerated and was blamed for a severe depression that seemed to have lifted only by

his refusal to turn up for appointments the son made on his behalf.

As a visiting nurse who wraps his feet every two days, I was alarmed by James’ firm

refusal even to make medical appointments, still less to follow a diet he urgently needed among

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many other lifestyle changes. The family depended on me, and James, otherwise irritable, was

calm when I was working to save his foot, making it entirely possible to establish a working

relationship and design a working plan for the treatment of a disease that needs to be addressed

simultaneously on many levels,.

2: Diabetes as a Learning Experience

a. An Overview: The diabetic patient, a family circle, and a nurse

The plan directly addressing my clients as individuals, family or cultural grouping will be

framed in two inter-related categories. The first involves consciousness as in psychology and

sociology, and is focused on the learning process. The second involves the kind of attention

needed at the physical level to diet, activity, cessation of smoking and alcohol abuse, measuring

glucose levels and administering insulin, engaging in physical exercise—and keeping essential

medical appointments. In fact, in a medical system under great stress everywhere, the bad mood

and sometimes outright nastiness to be found too much in health care delivery may be variously

explained, but it is most likely that the endocrinologist who offended James and prescribed

metformin may soon send James to someone to look at his foot, and the wound specialist may

also lack bedside manners.

That James should immediately call the endocrinologist who offended him and establish

a place in the health network of his adapted country is underlined by the sheer danger he is in, as

my nursing research will firmly and insistently reinforce. Both the Canadian and American

Diabetes Associations issue practice guidelines which should be consulted for treatment goals

and principles every five years with the Canadian publication awaited in 2018. Thankfully, the

American Diabetes Associations (ADA) has already brought together already in volume the

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different practice-factors that would establish treatment goals and guidelines in the most varied

areas in Lifestyle Management: Standards of Medical Care in Diabetes—2018: “diabetes self-

management education and support (DSMES), medical nutrition therapy (MNT), physical

activity, smoking cessation counseling, and psychosocial care”. Each of these need be taken in

turn to establish, an appropriate plan which is, in the last analysis, patient-centred and deeply

empowering.

b. Diabetes Self-Management Education and Support (DSMES),

In 2015, the American Diabetes Association, the American Association of Diabetes

Educators, and the Academy of Nutrition and Dietetics together issued in 2015 strong support for

a network of health professionals to encourage, support and applaud coping mechanism whereby

diabetics perform complex-care health activities and make their way in the world as best they

can without being much of a burden to others in such areas as “healthy eating, being active,

monitoring, taking medication, problem solving, reducing risks, and healthy coping”. In effect, in

four different situations, we are called upon to look about us to render assistance to those facing

very hard times when they feel on their own, and in fact may be very isolated even within the

family unit, as James surely feels when diagnosed with diabetes for the first time just when

starting life in a poor land.

According to Powers et al.(2015) there are “4 critical times to assess, provide, and adjust

DSME” and that is “(1) with a new diagnosis of type 2 diabetes, (2) annually for health

maintenance and prevention of complications, (3) when new complicating factors influence self-

management, and (4) when transitions in care”. It is good that there are those in the nursing

profession who are aware and helpful when a client first becomes aware that a whole new world

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opens in which they will suffer a protracted kind of illness that cannot be easily thought of in

positive terms as a learning experience and a chance to prove one’s resilience. Yet the patient

may be advised that how he interprets the experience of illness is really in his own hands ,

allowing for a new openness to be established and good advice received to overcome the

emotional climate for a more accepting one as type 2 diabetes progresses and treatment takes

ever new forms, leading the patient in unexpected directions with new contexts coming into play

when jut being able to carry out conventional activities under pain and psychological pressure

like buying food, taking a walk or checking blood pressure, all become a sign of inner grace and

courage, at least when it is done when the successive stages of illness from which there is no

escape strikes. How actions are interpreted by the mind is now set side to study our mateial

existence,

3: Lifestyle Management of Diabetes

a. Drug Therapy (Metformin)

It will be remembered that James had a negative reaction both to his first doctot and the

prescribed medication.The American Diabetes Association (ADA) and the European Association

for the Study of Diabetes (EASD) formed in 2012 a joint taskforce that repeatedly urged caution

regarding a class of drugs that are widely distributed as the first line of defense at an early, pre-

insulin stage of diabetes. After a rigorous study setting claims against real achievements, the tone

of the commission sounded grim concerning the scientific credibility of product lacking “primary

source evidence” and employing “clinical trial results in highly selected patients, using limited

strategies” that assert an imagined average, rather than the vital question of who responded to

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one or another drug regime and why they had done so. That said, of all the possible choice of

drugs, the one James rejected most strongly, “metformin’s low cost, proven safety record, weight

neutrality, and possible benefits on cardiovascular outcomes have secured its place as the favored

initial drug choice” (Inzucchi et al., 2015). To be sure, “possible benefits” suggests that however

cheap and easy to tolerate the drug may be, it had not really proven itself which should raise

questions when “85.2% of patients on medication having a prescription for this drug. A recent

population-based study in Ontario reported that 79% of initial prescriptions for elderly patients

were for metformin in 2006” (Greiver, 2014).

b. James among South-Asians at Risk

That James belongs ethnically to the South Asian population in the kind of studies which

take ethnomethodology as their foundation is especially important in Toronto which has a very

large population, and an exceptional data-base from which we may learn a great deal in making a

workable plan, or at least consider what such a plan should contain (Rowan et al., 2014). For one

thing, it is highly recommended that culture be a factor in advising a diabetic concerning dieting,

however important that factor may be in the course of the illness. Specifically, in a patient-

centered therapy, we are advised to pay attention to “individualized assessment of current eating

patterns, preferences, and metabolic goals…. tradition, culture, religion, health beliefs and goals,

economics… as well as metabolic goals when working with individuals to determine the best

eating pattern for them.” That said, and however it is achieved, calorie interventions, the

strategies for maintaining weight loss are in the order of 5% to 7% to produce beneficial

outcomes in glycemic control, lipids, and blood pressure. Moreover, the call to eat “nutrient

dense” food including “vegetables, fruits, legumes, low-fat dairy, lean meats, nuts, seeds, and

whole grains” in strictly restricted quantities was not at all the meal plan James had in mind, or

DIABETES 8

one that he is likely to follow. But the choice is drug therapy, including insulin use, without the

need for a radical diet, or a diet that may have made diabetes less likely, but not one ready to

accommodate James and his deep roots in Chinese culture that he left only recently. Powers et

al., 2015)

Repeated studies have shown enormously heavy smoking of over 50% males in East

Asian countries. White rice and other refined grains, which are linked to increased risk of

diabetes, make up a large proportion of daily energy intake in Asian diets. The wealthy suburb

where James’ family lives is given to fast foods and little incentive for walking. All these have

been identified as reasons for the high rates of diabetes in the community, and therefore

important factors to consider in making a plan specific to James, and one he is more likely to

follow.

c. The Foot Ulcer and Its Dangers

It is clear that having delayed going to see the doctor, James’ diabetes was greatly

advanced with a possibly dangerous condition developing in the leg requiring the immediate

intervention of a foot doctor. That leakage caused so much embarrassment that James thought

never to his doctor again may be a comorbidity of the most severe, immediate nature, given that

an ordinary first visit brought me before inflammation with a foul smelling discharge which

made me extremely uneasy, to say the least. Foot ulcer gradually wears away flesh and works its

way toward the bone. All along the way, an osteomyelitis attack is possible, which can end in

amputation or even death (American Diabetes Association, 2018). It is noteworthy that most

diseases can come under the umbrella of a single agency exclusively dedicated to its

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investigation and treatment. Uniquely, diabetes is linked, seemingly, to the detriment of every

possible organ from the mind, through the foot.

No wonder that there were repeated rumors of a miracle cure that will bring about

diabetic foot healing, bringing to end a long period of ugly, smelly , running wound that ended

in amputation, a fate suffered by so many diabetic sufferers. It was hyperbaric oxygen therapy

(HBOT) in patients with diabetic foot ulcers which had some early positive result, Now subject

to high-quality double-blind study of patients with chronic diabetic foot ulcers, hyperbaric

oxygen as an adjunctive therapy bailed to prove the benefit of HBOT or have been relatively

small with potential flaws in study design A well-designed randomized controlled study

performed in 103 patients found that HBOT failed to reduce the indication for amputation or

facilitate wound healing compared to comprehensive wound care in patients with chronic

diabetic foot ulcers (American Diabetes Association, 2018 ).

The ever-rising cost of leg-wounds due to the progress of diabetes reaching ever larger

numbers of the population puts incredible stress upon Canada’s health system with its competing

demands and finite resources (Hopkins et al.,2017). It is evident that something need be done at

all levels. Fortunately, for me, that means only that within the above framework I need to

provide care to one person, James, as if he were multitudes, which in a sense he is within the

demographics this study thought to place him.

4. Conclusion: The Plan

Obviously, the above is not at all a plan such as the one that may be prescribed advising

exercise, cessation of smoking, diet, in fact every one of the many factors that need be taken into

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account when making a workable plan when so many areas of health practices are involved.

Indeed, this is the foundation for a person-centered plan that has as its basis the kind of factors

that are at play and need to be appropriately lined up and effectively deployed for my client

whose illness after a recent arrival in Canada surely puts enormous strains on care-givers, the

patient, the system—and the visiting nurse. That the advice which is sought is full of uncertainty

may not in the end may be less of an obstacle, if what is known is mapped out and what is

uncertain frankly acknowledged. That was the goal of this exercise, which had a wonderful side-

effects in clarifying what I do to myself as observed through peer-reviewed publications of my

field. It is a surprising, but oddly gratifying experience.

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References

American Diabetes Association. (2018). Standards of medical care in diabetes—2018: summary

of revisions. Diabetes Care, 40(Supplement 1), S4-S5.

American Diabetes Association. (2016). 2. Classification and diagnosis of diabetes. Diabetes

Care, 39(Supplement 1), S13-S22.

Greiver, M., Williamson, T., Barber, D., Birtwhistle, R., Aliarzadeh, B., Khan, S., ... & Katz, A.

(2014). Prevalence and epidemiology of diabetes in Canadian primary care practices: a

report from the Canadian Primary Care Sentinel Surveillance Network. Canadian

Journal of Diabetes, 38(3), 179-185.

Hopkins, R. B., Burke, N., Harlock, J., Jegathisawaran, J., & Goeree, R. (2015). Economic

burden of illness associated with diabetic foot ulcers in Canada. BMC Health Services

Research, 15(1), 13.

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M. &

Matthews, D. R. (2012). Management of Hyperglycaemia in type 2 diabetes: a patient-

entered approach. Position statement of the American Diabetes Association (ADA) and

the European Association for the Study of Diabetes (EASD). Diabetologia, 55(6), 1577-

1596.

Mayer-Davis, E. J., Lawrence, J. M., Dabelea, D., Divers, J., Isom, S., Dolan, L. & Pihoker, C.

(2017). Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012. New

England Journal of Medicine, 376(15), 1419-1429.

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., ... & Vivian,

E. (2015). Diabetes self-management education and support in type 2 diabetes: a joint

position statement of the American Diabetes Association, the American Association of

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Diabetes Educators, and the Academy of Nutrition and Dietetics. Journal of the Academy

of Nutrition and Dietetics, 115(8), 1323-1334.

Rowan, C. P., Miadovnik, L. A., Riddell, M. C., Rotondi, M. A., Gledhill, N., & Jamnik, V. K.

(2014). Identifying persons at risk for developing type 2 diabetes in a concentrated

population of high risk ethnicities in Canada using a risk assessment questionnaire and

point-of-care capillary blood HbA 1c measurement. BMC Public Health, 14(1), 929.

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