MBHT5001 Diabetes Management

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MBHT5001 Diabetes Management

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MBHT5001 Diabetes Management

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Course Code: MBHT5001
University: The University Of Sydney

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Country: Australia

Jaxson is a 5 year old boy who lives with both parents and his older sister in the suburbs of a large city. Jaxson was diagnosed with Type I diabetes 2 years ago which has been well managed by his parents. He is devolping normally and is about to start pre-school. As he will need to become more independent in the management of his diabetes he requires further education on how to test his blood glucose level(BGL). It is your role as the practice nurse of his local medical centre to teach him how to do this.

Self-management Blood Glucose Level for Diabetics
Diabetes mellitus is one of the most common kind of diabetes that has plagued the society in many occasions. The malady is characterized by various symptoms that point towards the positive identification of the same. The disease can be heritable or acquired depending on the diverse conditions that may be prevailing in a given environment. The condition is grave serious but it is treatable if discovered before its chronic stages (“Diabetes Prevention and Control”, 2018). The emergence of the disease may be exacerbated by some disorder with the metabolic system of an individual. Some of the symptoms of Diabetes mellitus are chronic hyperglycemia, and poor protein, fat, and carbohydrate metabolism. The phenomenon is induced by an anomaly in the secretion of insulin, action of insulin or both (“Kids & Diabetes – Diabetes Self-Management”, 2018). Effective control of the disease is attached to the reduction of the effects of mortality and morbidity. Inadequate or absence of consistent and close care results in confusion among patients. The situation leads to a decline in compliance among the patients. The emotional shock that arises in the family when a kin is positively identified as diabetic causes gross discomfiture. The discomfort is due to the negative effects associated with diabetes such as impotence, extreme unnecessary anxiety, and disruption in the normal family life, irritability, and increased fatigue (Sim, 2016). The paper will attempt to underscore the nature of diabetes mellitus and the possible ways of inculcating the self-management Blood Glucose Level in an individual especially the kids.
Diabetic patients, such as Jaxson, are required to be imparted with the knowledge and skills that are requisite to the management of their conditions in order to boost the treatment process even in the physicians’ absentia. Both the young and the aged are supposed to receive the training or rather teaching so as to avoid cases where the individuals find themselves on receiving end as a result of the lack of skills to help themselves whenever emergence incidents transpire. There are a plethora of mechanisms that are employed to ascertain that Jaxson gains the fundamental and requisite skills that will enable him to lead an ordinary life (“Diabetes – issues for children and teenagers”, 2018). Such mechanisms are non-pharmacological control, Glycemic control monitoring, pharmacological control, and prevention.
Non-pharmacological Management
Psychosocial Situations
Physicians deploy the professional communication skills that aid them in communicating them in relaying the unfriendly news to the patients especially when conveying the diagnosis information for the very first instance. That capacity will come in handy when identifying and treating diabetics’ psychological disorders. There are instances when the patient experiences heightened anxiety and the occurrence of the fear of complications. Besides, the patients may feel isolated from the rest of the community due to the embarrassment and stigma that stems from the medical situation. The prevailing conditions culminate in their low self-esteem. Social back from the network of family members and other diabetic social support parties and groups are crucial to the wellbeing of the diabetic community (“Diabetes in Children | Type 1 Diabetes | Type 2 Diabetes | MedlinePlus”, 2018). Such an atmosphere fosters an effective self-management of the diabetic patients since the individuals gather the confidence to lead normal lives. The ability to realize improvement with regard to glycemic control is linked to the kind of life the patients subjected to insulin treatment are leading. That case is mostly applicable to the diabetics who have been diagnosed recently. Research has it that there is no significant difference in the impact irrespective of the number of injections given to various patients (Nazmi, Hadithi & Khan, 2013). The quality of life of the diabetics was not adversely affected as a result.
Health Education
Education on diabetes is the pillar of the diabetic patient care as long as they aspire and strive to achieve exemplary health status and other related aspects. The physician or clinician serves a coordinator by ensuring that the patient receives the right and sufficient knowledge regarding the way of self-managing the diabetic condition in their daily life. The overall goal is attained via a well-crafted and tailored approach that allows the patients to integrate and understand the concepts such that s/he can apply the precepts in the real-life situation. The education is imparted systematically such that the patient and grasp every protocol so as to avoid any error of omission or commission in the self-management of blood glucose. The various contents of the type of education conferred to the patient are diabetes explanation, anti-diabetic drug explanation such as storage, technique, action, and equipment. There is the employment of various diabetes illustrations so as to create a firm and indelible impression of the various ways that are essential in the treatment process. The patient is informed of the various complications that arise from the disease, the way to observe the diet, the treatment of hypoglycemia, the effect of either using or omitting insulin use in case of disease symptoms such as puking and stomach upsets. The patient needs to undertake frequent urinalysis and hence there should be dipsticks at home for that function. The patient should be taught on the effect of avoiding smoking, caring for the feet, the essence of seeking counseling, and the benefits of exercise in a bid to mitigate the gross effect of the disease.  
Physical Activity
The practice of undertaking physical exercise perpetuates the beneficial impact of enhancing the metabolism of carbohydrate and then makes the insulin sensitive. The benefit of insulin is then sustained for more than five years. Studies conducted show that regimens of physical activity undertaken trice to five times in every week for half to one hour edify the body system. There were significantly improved results of the Hb1c as the reading registered 10 to 20 percent of baseline. The higher percentage of the population composed of diabetes type 2 patients and specifically those who demonstrated insulin resistance. A combination of insulin and physical activity help one achieve the target weight and then maintain the status. The patient is encouraged to engage in any sort of exercise since it has significant health benefits to the diabetics.
Diet Observation
Majority of the diabetic patients depict insulin resistance and overweight conditions. Such patients are subjected to medical nutrition therapy which will center focus on dynamic changes in the lifestyle of the patient so that there will be a considerable reduction in the amount of energy intake coupled with physical exercise. Effective health lifestyle is geared towards the regulation of blood glucose level, blood pressure, and dyslipidemia (Information et al., 2018). The above strategies should be deployed in the initial stages after diabetes diagnosis. The patients are supposed to ingest carbohydrate-rich foods such as whole grains, vegetables, fruits, and low-fat milk. The consumption of large quantities of fibre confers vital metabolic benefits necessary for the control of hyperinsulinemia, glycemia, and plasma lipids. Carbohydrate is the major food component that has a significant impact on the blood glucose content in an individual. The micronutrients such as fat and protein have the influence the ability on the postprandial level of glucose. The quantity of carbohydrate intake serves as a key predictor of glycemic response (Sakurai, Kawai, Yamazaki & Komatsu, 2018). Monitoring the cumulative quantity of the grams of carbohydrate is essential in the quest to control the blood glucose levels. Low glycemic index contributes considerably towards mitigating the levels of glucose in the blood. Protein consumption is supposed to consist of fifteen to twenty percent of the mean energy intake. Patients manifesting microalbuminuria should reduce protein intake from 0.8g to 1 g in each 1kg body weight every day. Patients experiencing overt nephropathy requires to lose 0.8 g in every one kilogram of body weight each day which will reduce the progress of nephropathy (“Type 1 diabetes in children – Diagnosis and treatment – Mayo Clinic”, 2018).
Pharmacological Management
Pharmacological management involves the use of drugs to help lower or maintain the HbA1c close to the levels of the normal physiological status. The lower threshold for initiating insulin in the patient manifesting type 2 diabetes is linked to the reduction of complications on a long-term basis. Insulin should be added early when the therapy of Maximum Sulfonylurea is inactive so as to boost glycemic control. However, one should ensure that the move does not raise hypoglycemia or overweight. All the lifestyle intervention strategies would be integrated into therapies in the process of arresting the situation. The kind of diet diabetics should embrace would be discussed and offered by the physician (“What Is a Normal Blood Sugar Level? – Diabetes Self-Management”, 2018). Problematics incidents emerging during the entire is closely monitored by medical professions in order to avoid a healing crisis. Insulin therapy should be observed strictly as it has been discovered in patients who have survived the malady for a range of five to fifteen years.  Diabetes 2 patients should be psychologically prepared such that they are aware of the need for the insulin at some stage in order to avoid future inconveniences. Patients suffering from frequent hypoglycemia are recommended to utilize insulin glargine (Bond & Hewitt-Taylor, 2014). Insulin glargine exacerbates reduced nocturnal hypoglycemia than NPH. By so doing, there is the removal of the barrier associated with the initiation of insulin therapy. Metformin is included during the insulin therapy since the combination boosts glycemic control and at the same time reducing the amount of required insulin.
Monitoring of Glycemic Control
The HbA1c levels in the body are supposed to as close to the normal physiological quantities as possible that is, close to 7% or less (Walker, 2018). Any slight deviation results in disease symptoms. Checking the glycemic levels frequently allows for the control of metabolism and reduce the incidents of hospitalizations that result from poor glucose level control. Young diabetic patients should maintain sustained lower HbA1c levels sometime after the diagnosis. The patients should then use sensitizers such as Metformin and Glitazone in situations manifesting negative metabolic response (Cold et al., 2018). Alpha-glucosidase inhibitors such as Acarbose are essential to contain the sickly situation too.   
Steps for Self-Monitoring Blood Glucose (SMBG)
A glucometer is employed in the measuring of the levels of glucose in the blood. The gadget comes in various versions and models but they are used to achieve a common function.
Jaxson needs to understand fully the mechanics behind the functioning of the machine in order to obtain relevant and useful results. Some meters’ precision is affected by material substances such as medical substances, hematocrit level, user technique, and even temperature and hence one needs to follow the protocols as stipulated in the user manuals. The lancing process and the blood obtainment process is key to achieving the reliable feedback. Jaxson is supposed to master the art of the lancing process in order to avoid bruising or unnecessary pain when obtaining the blood sample (Wooldridge & Ranby, 2018). That is attained when Jaxson can adjust the depth of the lancing gadget in a practical scenario and s/he should be familiar with the various types of lancing tools available in the market. Jaxson should observe extreme hygiene and dry conditions when handling the meter to avoid contamination and errors in results respectively. The test strips are only used once for every meter. The strips are housed in the canister to avoid the effect of moisture interference that will compromise the result. Jaxson should check the expiry date to avoid errors (Das, 2016). Jaxson should then come with the table of results to the office in a meeting with diabetes educators for further advice.
Jaxson should clean the skin surface with warm and soapy water and then dry. Jaxson will then adjust the depth of the lancing device in order to control the penetration of the stick in order to foster comfort and also obtain the best-required blood sample. The sides of the finger are the most ideal sites for obtaining the sample since there is less pain and the process should be done gently via “milking” the site (Panchbhai, 2012). Alternative sites for tests are the upper arms, palms, and the thighs. The lancers should then be disposed of responsibly to avoid unnecessary injury or contamination.
Factors considered in the Acquisition of Devices for SMBG
The degree of dexterity of Jaxson, the sample size of the blood required to produce the desired result especially in situations where lancing hiccups and challenges with blood flow prevail, and the cost-effectiveness of the consumption of the tools especially with regard to the insurance coverage (Wu, 2014). The above factors help in counteracting any future problems that any arise either during or after the Self-management Blood Glucose level.
Bond, C., & Hewitt-Taylor, J. (2014). How people with diabetes integrate self-monitoring of blood glucose into their self-management strategies. Journal Of Innovation In Health Informatics, 21(2), 64-69. doi: 10.14236/jhi.v21i1.11
Cold, F., Health, E., Disease, H., Management, P., Conditions, S., & Problems, S. et al. (2018). Tests to Diagnose Diabetes. Retrieved from https://www.webmd.com/diabetes/type-2-diabetes-guide/diagnosing-type-2-diabetes
Das, S. (2016). Evaluating the Relationship of Fasting Capillary and Venous Blood Sugar Level in Self-Glucose Monitoring Device, Fasting Plasma Glucose Level and Glycosylated Hemoglobin (HbA1C). Nursing & Care Open Access Journal, 1(2). doi: 10.15406/ncoaj.2016.01.00011
Diabetes – issues for children and teenagers. (2018). Retrieved from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-issues-for-children-and-teenagers
Diabetes in Children | Type 1 Diabetes | Type 2 Diabetes | MedlinePlus. (2018). Retrieved from https://medlineplus.gov/diabetesinchildrenandteens.html
Diabetes Prevention and Control. (2018). Retrieved from https://www.mass.gov/diabetes-prevention-and-control
Information, H., Overview, D., Diabetes?, W., Diabetes?, W., Center, T., & Health, N. (2018). What is Diabetes? | NIDDK. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
Kids & Diabetes – Diabetes Self-Management. (2018). Retrieved from https://www.diabetesselfmanagement.com/about-diabetes/kids-diabetes/
Nazmi, A., Hadithi, D., & Khan, S. (2013). Self monitoring of blood glucose level among diabetic patients in Muscat, Oman: A pilot study. Saudi Journal For Health Sciences, 2(1), 54. doi: 10.4103/2278-0521.112632
Panchbhai, A. (2012). Correlation of Salivary Glucose Level with Blood Glucose Level in Diabetes Mellitus. Journal Of Oral And Maxillofacial Research, 3(3). doi: 10.5037/jomr.2012.3303
Sakurai, K., Kawai, Y., Yamazaki, M., & Komatsu, M. (2018). Prediction of lowest nocturnal blood glucose level based on self-monitoring of blood glucose in Japanese patients with type 2 diabetes. Journal Of Diabetes And Its Complications. doi: 10.1016/j.jdiacomp.2018.09.007
Sheila Walker, M. (2018). Self-management of Blood Glucose (SMBG) and Type 2 Diabetes. Retrieved from https://www.diabetescareguide.com/selfmanagement-blood-glucose-smbg-type-2-diabetes/
Sim, K. (2016). Effective Diabetes Self-Management Education: Focus on Blood Glucose Pattern Management. The Journal Of Korean Diabetes, 17(1), 35. doi: 10.4093/jkd.2016.17.1.35
Type 1 diabetes in children – Diagnosis and treatment – Mayo Clinic. (2018). Retrieved from https://www.mayoclinic.org/diseases-conditions/type-1-diabetes-in-children/diagnosis-treatment/drc-20355312
What Is a Normal Blood Sugar Level? – Diabetes Self-Management. (2018). Retrieved from https://www.diabetesselfmanagement.com/blog/what-is-a-normal-blood-sugar-level/
Wooldridge, J., & Ranby, K. (2018). Influence of Relationship Partners on Self-Efficacy for Self-Management Behaviors Among Adults With Type 2 Diabetes. Diabetes Spectrum, ds170069. doi: 10.2337/ds17-0069
Wu, Y. (2014). Application of Self-Regulatory Behavioral Management in Postprandial Self-Blood Glucose Monitoring for Noninsulin Treated Type 2 Diabetic Patients. Acta Endocrinologica (Bucharest), 10(4), 629-639. doi: 10.4183/aeb.2014.629

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