Question

Your patient is a newly diagnosed Type II diabetic that is overweight and confides in you that he is still smoking and that the drug (Metformin) gave him diarrhea. As an LPN, you play a vital role in reinforcing patient education. What would you say to encourage compliance? What resources can you think of that would be helpful for your patient?

Answer 1

Type II diabetes mellitus (Type II DM) is non-insulin dependent. Means in the patients with Type II DM the beta cells secrete insulin but the insulin cannot bind to the receptor sites to exert its effect. So, the drugs that increase insulin sensitivity and glucose uptake by the muscles (Eg: metformin, glibenclamide) are helpful for these patients. The risk of Type II DM increases with age and obesity. However, because of genetic abnormalities, this occurs in young people and children also (juvenile diabetes).

The normal blood sugar levels are 120 mg/gl. During fasting, the blood glucose levels range from approximately 80 to 100 mg/dl. The normal postprandial blood glucose levels are 140 mg /dl. If the fasting blood glucose levels exceed 130 mg/dl or the postprandial blood glucose levels exceed 180 mg/dl. the condition is known as diabetes.

Patient education:

• The patients must be explained about how the blood glucose levels change in these patients and the basic measures to regulate the blood glucose levels
• The importance of changing the diet plan and maintaining the normal body weight and its relevance to the pathophysiological changes in diabetic patients must be explained.
• The patient must be asked to stop smoking and include regular exercise
• The medications must be taken as prescribed and the blood glucose levels must be checked at regular intervals. Diarrhea is a common adverse effect with metformin that occurs in some patients, the drug must not be discontinued.
• The patient must be advised to have eye checkup at least once in a year