Managing Patients With Diabetes Mellitus
critical thinking managing patients with Diabetes Mellitus
The main goal of managing patients with diabetes mellitus is to eliminate symptoms and prevent the development of complications. There are differing methodologies that could be applied in the management of the disease. The type of diabetes affecting a patient determines the methodologies employed. Different health professionals who have the expertise in diabetes care and management best provide management of diabetes. American Diabetes Association (2010) states that the management of diabetes will include setting of appropriate goals, modifications to the diet and exercise of the patient, medications, regular monitoring of the patient for any complications, laboratory assessments, and employing self-monitoring of blood glucose. For an ideal management of diabetes, the levels of blood glucose should be near-normal levels. However, focusing on the management of glucose alone will not provide enough treatment for diabetic patients. Proper management and treatment will involve multiple goals. The mainstays for diabetic care are exercise, weight control, diet, and medications. When managing patients with diabetes mellitus, the care provider should insist on the need for the above mentioned. This will ensure that the patient is able to maintain a healthy diet and control their weight. Regular exercise is vital in the management of diabetes. Numerous publications that have recommended regular aerobic exercise, but the patient should avoid injury as this might have negative effects. Management of diabetes mellitus will ensure that a patient does not suffer from the macrovascular and microvascular complications associated with the disease. There are two main methods for managing diabetes namely taking oral agents and insulin injections.
Strengths of the argument
The management of diabetes in patients has been shown to be most effective in the prevention of development of complications. Diabetes mellitus is a disease that a patient can survive with all their life provided they regulate their haemoglobin and blood glucose levels regularly. To minimize the risks of a patient suffering from the complications associated with diabetes, proper management of the patient is critical. Proper management will involve regular screenings, promotion of a healthy diet, and regular exercise. All this will ensure that the patient is has the opportunity to reduce the risks of developing any complications. The use of multiple insulin injections was found to improve a patient’s nerve conduction velocities (Inzucchi et al., 2012). This demonstrated that with proper management, a patient is able to reduce the risks of suffering from the complications associated with diabetes. Reducing the risks ensures that a patient has an opportunity to continue living their life without the need for further specialized treatment. Intensively managing patients with diabetes has the potential to reduce the risk for the patient developing retinopathy by 76%. Symptoms and signs of neuropathy and nephropathy were decreased by 54 to 60% for the patients. The risk of the patient contracting macrovascular complications was decreased significantly. For patients with type 1 diabetes, attainment of blood glucose control should be the key strategy. Intensive management of type 2 diabetes has also been shown to have positive results. The maintenance of glycemia to near-normal levels resulted in the reduction of the risk of macrovascular and microvascular complications by up to 70% when compared to the patients who used conventional controls (Qaseem, Humphrey, Chou, Snow, & Shekelle, 2011).
Various trials and studies conducted over long periods have demonstrated that intensive-management of diabetes mellitus patients results in reduction of retinopathic events by 74%. This would demonstrate that it is good to manage patients with diabetes mellitus to ensure that they do not suffer from the complications associated with the disease. Reducing the risks associated enables the patient to live a long life with a manageable disease. Controlling blood pressure is shown to also reduce the risks of nephropathy and retinopathy. Sacks et al. (2011) indicated that the patients who were on a tight control for their blood pressure were able to reduce their risk of retinal photocoagulation by 35%. Management of diabetic patients would ensure that the patients are screened regularly. The screening would monitor their blood glucose levels, and insulin concentration. With regular screening, any changes would be detected early and allow the doctors to prescribe preventive measures. The risks associated with diabetes cannot be eliminated, but reducing the risks of a patient suffering from the risks is vital for the management of the disease. Diabetes being a disease that does not have a cure, it is vital that the disease be managed effectively. Effective management would incorporate different regiments and not only insulin injections. The incorporation if exercise and diet control would allow a patient to prevent the opportunistic ailments that might come about because of the disease.
Weaknesses of the argument
Intensive diabetes management offers the patient many health benefits, but it also has some weaknesses. Intensive diabetes management is expensive and can only be afforded by a few patients. The patient will have to be screened and tested 3-4 times each day. All this tests would require the patient to visit a clinic or hospital, and they would have to pay for the tests and screening. Intensive management of diabetes also demands that a patient takes 3-4 insulin shots each day as compared to normal management that requires one shot a day. With the increased number of insulin shots, a patient will have to double their budget for the purchase of the medications. The overall benefits for intensive management are promising, but the costs associated are preventive and cannot be afforded by a large majority of patients. In order to maintain tight control over a patient’s blood pressure, the patient will have to undergo several tests in the course of the day and closely monitor their blood pressure. This monitoring would be time consuming and expensive. The patient would have to purchase the monitoring equipment and the necessary medication for reducing blood pressure in case of any spike. Diet monitoring is vital for diabetic patients. The kind of diet required by the patient would mean they have to forgo some foods and start taking more of certain foods. In a family setting, this would mean that the patient has their own food prepared separately, which would increase the family’s budget.
More effort and time is required in intensive diabetes management. A patient would need to have enough time to closely monitor all their levels and attend clinical visits. Close monitoring and recording of blood pressure has to be conducted at least 3 times a day. The patient will have to put in more effort to ensure that they do not forget to monitor their levels at the specified time. The amount if time needed by the patient to administer the shots is increased with each increment of shots. Insulin shots should only be administered in specific conditions. A patient would need more effort to ensure that they do not skip a shot nor do they administer the shot at the wrong time. Exercise for diabetic patients is highly recommended, but exercise could be time consuming and requiring more effort on the part of the patient. Some patients cannot maintain an exercise regime for long periods. In order for the patients to maintain their exercise regiment, they would require to put in more effort.
The possibility for the patient to suffer from hyperglycemia episodes is increased. This occurs because the patients have a low blood glucose level (Riddle, 2010). Intensive management might reduce the risks, but with an increase in the hyperglycemia episodes the patient would have to increase their medication to counter these episodes. The increase would deal a blow on the patient’s finances, and there is a chance that the episodes would further increase. Intensive management could result in weight gain by the patient. Research has shown that patients participating in intensive diabetic management are more likely to increase their weight as compared to those on conventional treatment. The weight increase is attributed to the fact that the patients are no longer losing calories. The calories are lost via their urine as glucose. The increased taking of insulin has made the patient’s body more effective at capturing and storing calories.
From the weaknesses, it is clear that normal management of diabetes mellitus would accord a patient better treatment. There complications associated with the disease and the risks a patient is likely to suffer are not reduced drastically. There is still a chance that a patient undergoing intensive management will suffer from the complications. Conventional treatment of diabetes would offer the patient less headache and they would be flexible provided they undergo monthly screenings. Intensive management is too involving for a patient, and it would result in discouragement for the patient. Allowing the patient to undergo conventional treatment instead of intensive will give the patient the opportunity to manage the disease in a comfortable setting without disrupting their daily routine. Conventional treatment has been in use for long periods, and the number of patients who suffer the complications is less. Provided a patient is able to undertake normal disease management, they can reduce the likelihood of themselves suffering the complications.
The management of diabetes is vital since the disease does not have any cure. Without proper management, a patient would not survive for long, as the disease would cause their organs to crush. Intensive management for diabetes has been proven to reduce the risks of suffering from complications associated with the disease, but the requirements for intensive management might be prohibitive for some patients. Reducing risks by up to 70% is commendable, but the costs associated, and the possibility that a patient would still suffer from the complications later on does not make intensive management a full proof method. Conventional management has demonstrated that it is easier for the majority of patients and is pocket friendly. Therefore, many patients are able to afford and are comfortable with conventional treatment.
American Diabetes Association. (2010). Diagnosis and classification of diabetes mellitus. Diabetes care, 33(Supplement 1), S62-S69.
Inzucchi, S.E., Bergenstal, R.M., Buse, J.B., Diamant, M., Ferrannini, E., Nauck, M., . . . Matthews, D.R. (2012). Management of hyperglycemia in type 2 diabetes: a patient-centered approach position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes care, 35(6), 1364-1379.
Qaseem, A., Humphrey, L.L., Chou, R., Snow, V., & Shekelle, P. (2011). Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 154(4), 260-267.
Riddle, M.C. (2010). Effects of intensive glucose lowering in the management of patients with type 2 diabetes mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Circulation, 122(8), 844-846.
Sacks, D.B., Arnold, M., Bakris, G.L., Bruns, D.E., Horvath, A.R., Kirkman, M.S., . . . Nathan, D.M. (2011). Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes care, 34(6), e61-e99.
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