type 2 diabetes question

luvmy2angels · Nov 7, 2005

Not all people with type 2 diabetes need insulin. Sometimes people can control their sugar level with diet and exercise alone. Someitmes they may need an oral anti diabetic like glipizide or glyburide. It really all depends on the circumstances. So I would tell her "No, you may not have to be on insulin." Most people with type 2 diabetes tend to be overweight and will be encouraged to lose weight to help better control their diabetes. Hope this helps some.

Daytonite, BSN, RN · Nov 7, 2005

MM is a newly diagnosed Type II diabetic and needs teaching about the disease. You will want to assess just how much MM does know about diabetes. A general discussion about what diabetes is is in order here. Your teaching will need to address the treatment for diabetes. Some people will be maintained by diet only, others by taking an oral medication, and others by taking insulin. It's not mentioned what treatment has been ordered for this lady. MM needs to be taught how diet contributes to Type II, the treatments for it, blood sugar and HbAc1 testing, and perhaps go into complication prevention.

One issue, I think, is that the patient is concerned that a serious illness may cause her to need to take insulin. That can be handled by explaining that while an illness in a diabetic can cause elevated blood sugars, it is only when the pancreas begins to fail to produce hardly any to no insulin at all the people are put on insulin. So, you would need to assure the patient that every diabetic is different and you have no way to know the specifics about the kind of diabetes that her neighbor has. MM's diabetic condition may be totally different from her neighbor.

This patient's second concern is with weight loss. In this case I think it would be appropriate to discuss with M.M. that once diabetes is controlled that the only way she is going to lose weight is if she diets in order to do so. If she wants to lose weight or has been encouraged to lose weight she will need to be monitored by her doctor.

All of this teaching and exchange of information needs to be done "in plain English" as you mention, but I will leave that part up to you!

In general, for you about diabetes: Most Type II diabetics are overweight and because of insulin resistance come to develop Type II diabetes. There is also a feeling that there is a genetic link. Type II is a very gradual condition that develops over some years. The pancreas has to overcompensate and produce higher amounts of insulin as these patient's blood sugars start to remain high (up to 100 and slightly over). The insulin these individuals produce just isn't working up to snuff. What happens is the pancreatic cells that produce the insulin will begin to peter out and left untreated will progress to the patient having to take insulin. If Type II diabetes is caught early the treatment is dietary control (low carb diet). If this doesn't work or the patient does not follow the dietary restrictions the next course of treatment is the oral medications. If the patient still does not follow the dietary restrictions and lose weight, they will eventually need to take insulin. However, the progression of all this generally takes many, many years. FYI, there has been a lot of research and study into Type II. Obese children are now getting it. It is very prevalent in the American Indian population of this country. There is research to suggest that refined sugars and refined grains are the culprits which is why low carb diets and natural foods are being promoted. Don't know if you want to get that deep into the subject of diabetes, but Diabetes for Dummies gives a pretty good picture of this disease along with the required tests and all the complications that come with it. It would be a very good idea for you to develop a good understanding of the pathophysiology and current treatments for it as you are going to see many, many patients with it along with their other disease problems. My diabetes was detected not so much because my blood sugars were consistently in the 90's, but because a very astute doctor had an insulin level done on me and found it was three times normal. This is the newer type of testing being done to find this disease, but this lab test is much more expensive than a simple blood sugar.

NurseyBaby'05, BSN, RN · Nov 7, 2005

Another thing to consider: the pt may only need insulin coverage while she is ill. Illness, stress and infection can all put blood sugar out of whack in a patient that usually has pretty good control. Also, with regard to the pt with pneumonia, it's often treated with steroids. These can raise a even a non-diabetic patient's blood sugar enough to warrant sliding scale coverage. These are things that need to be explained to this patient as well as what the other posters have said. Good luck!

unc005 · Nov 7, 2005

WELL said y'all :yeah: ! I'm also a Type 2 diabetic and have been since 8/3/04 when I was diagnosed with it. My Dad was too. He was diagnosed in '96, but ONLY put on medication in '98, although he'd lost 106#. He went on Gluctrol XL---I went on metformin HCl, 500mg, initially 4 pills, but I'm at 2-AM, 3-PM AND glyburide 5mg, QID (2-AM, 2-PM), although overall I judge accordingly (with the glyburide). I just thought I'd let y'all know that your information is EXCELLENT! BRAVO! :)

rogramjet · Nov 7, 2005

There are many reaons a Type 2 may be on insulin, and nearly 40% are (that's why we don't call it non-insulin dependant diabetes anymore). Uncontrolled type 2 will lead to insulin, injury, illness....anyway, lots of reasons.

Putting her on insulin will not make her lose weight like her neighbor. In fact if she has very elevated BG, initially the insulin can make her gain weight. All that sugar gets sucked into the cells, and stored. After the BG is controlled then the weight starts coming off again.