Problem and Background: Millions of people are diagnosed with type 2 diabetes and should live with this disease, focusing on management and regular checkups. When a diabetic person needs surgery, certain conditions have to be assessed. It is important to manage blood sugar levels in people with diabetes before and after surgical procedures to avoid complications and lethal outcomes.
Literature Summary: Diabetes is characterized by the lack of insulin in the body that is responsible for controlling and managing glucose. There is no cure for diabetes, and people have to know how to live and follow all glycemic control recommendations.
Intervention: To manage glycemic control among diabetic patients before and after surgery, it is recommended to stop taking all medications and use insulin only.
Conclusion: Diabetes regimes are crucial for patients before and after surgeries, and such factors as pharmacological treatment, lifestyle changes, family support, and education cannot be ignored.
Keywords: diabetes, type 2 diabetes, management, blood sugar, preoperative, postoperative.
Today, the burden of diabetes type 2 cannot be ignored because it influences the quality of life of many people around the globe. This condition is characterized by the impossibility of the body to produce enough insulin or to respond to insulin properly. Therefore, multiple organizations are involved in discussions about how to predict diabetes, develop effective treatment plans, and help diabetic patients avoid complications. The American Diabetes Association (2020) focuses on a patient-centered approach to choose appropriate pharmacological and non-pharmacological treatment in order to control blood glucose (sugar) levels and consider certain patient-related factors. In this paper, the analysis of diabetic patients before and after surgical procedures will be introduced. Patients with type 2 diabetes who need surgery face certain challenges and have to adjust their diabetes regimes. In addition to the awareness of the characteristics of this disease, its signs, and causes, attention should be paid to patients and the type of surgery. The implementation of special inhibitors, initial and combination therapies, and in-hospital management techniques should protect patients and provide the medical staff with enough background information about the condition of a patient and blood sugar levels.
Significance of the Project
In this paper, the goal is not only to describe the main characteristics of diabetes but also to underline the role of the population in managing blood sugar levels for diabetic patients. People who are involved in diabetes care are not only patients who have to focus of self-care and glycemic control. They are also doctors and nurses who are responsible for diagnosing, the development of treatment plans, education, and support. At the same time, there is the necessity of regular checkups to follow health changes and identify the urgency of operative interventions. Families of patients may play a crucial role in managing type 2 diabetes because their emotional support and understanding help people to live with this disease and maintain a high quality of life. In the United States, more than 34 million people have diabetes, and 95% of them are type 2 (Centers for Disease Control and Prevention, 2019). Although people under 45 years are at risk of having this diagnosis, many children and young adults can develop it under today’s environmental conditions and health-related risks. Racial factors are considered when talking about the prevalence of the disease.
Diabetes may co-exist with many other diseases, which influences the progress of health conditions and human reactions on the offered treatment methods, and patients need surgeries and other treatments. Preoperative and postoperative management of blood sugar levels gains high importance among these patients. Nurses and doctors promote training and control not to cause additional problems and observe how diabetes influences the condition of a patient who has another disease and health problem. The role of families depends on many factors, but, in the majority of cases, relatives may report on recent health or behavioral changes if patients miss something, and patients make sure to follow all recommendations. In this project, the progress of diabetes and the role of the population are explained, along with the guidelines for diabetic patients to manage blood sugar levels prior to and after operative procedures. With the help of these findings, the theme of type 2 diabetes and the importance of glycemic control before and after surgery will be thoroughly investigated and serve as a background for other projects. Nursing interventions, organizational changes, and training courses may be developed on the basis of this essay.
Type 2 Diabetes Characteristics
Insulin is an important hormone in the human pancreas, the goal of which is to regulate the level of glucose in the blood. As soon as some problems with this hormone’s functioning are observed, people consider the possibility of diabetes. Nowadays, more than 400 million individuals live with this condition (Chatterjee, Khunti, & Davies, 2017). Its prevalence is expected to grow (approximately 550 million) by 2030 (van Baar et al., 2020). There are several types of diabetes mellitus, including type 1 (no insulin), type 2 (lack of insulin), prediabetes (changes in blood sugar levels), and gestational diabetes (cells are resistant to insulin due to pregnancy hormones). Type 2 diabetes is the most common type that is frequently diagnosed in 90% of patients with diabetes (Chatterjee et al., 2017). Although many studies about diabetes risk factors and complications exist, it is hard for people to predict the development of this disease due to family history or racial/aging risks. At this moment, there is no specific cure for diabetes, and, as a result, people have to live with diabetes, make life adjustments, and depend on multiple pharmacological interventions.
Symptoms of Diabetes
Some people admit that they live with diabetes and observe no critical symptoms. However, this metabolic disease happens because of problems with insulin secretion, and it can stay asymptomatic in the early stage only. The length of this period usually depends on many individual factors, but with time, health changes cannot be ignored. Still, asymptomatic diabetes is considered as one of the risks for people because the impact of this condition on human health remains unpredictable. Regarding the spread of this disease around the globe, much attention is paid to the public’s awareness of the symptoms and risk factors of diabetes (Kayyali et al., 2019). Most people know that increased thirst and urination are common signs of type 2 diabetes. These changes are explained by the impact of excessive glucose in the blood. Kidneys have to work hard to absorb glucose and extract it into the urine, which causes dehydration, the feeling of thirsty, and the need to urinate often. One should remember that these changes could be the signs of other infectious or chronic diseases, and it is important to take tests and analyze the results before worries occur.
Another symptom of diabetes is connected to weight loss and hunger. According to Kayyali et al. (2019), obese people are about 80 times likely to have diabetes compared to people who keep to a healthy diet. However, when abnormal glucose levels provoke frequent urination, a person also loses calories. In addition, the lack of insulin does not make it possible for the glucose to reach the cells, which results in the feeling of hunger and the inability to maintain a normal weight. Sometimes, people connect their dietary habits with different events and external factors and neglect the possibility of having diabetes as their diagnosis. They fail to address a therapist and try to stabilize their conditions at home. As a result, they miss an opportunity to manage diabetes at the early stage and predict the development of new problems.
Dietary changes also influence the mood of a person and cause new behaviors and emotions. It is hard for an ordinary person to understand why they are not able to respond to the outside world properly and try to find out the explanations at work or in family relations. However, mental health disorders may not be the root problem, and diabetes can provoke behavioral changes. Therefore, such signs as fatigue and irritability should also be taken into consideration. Extensive energy needs cannot be met, and the feeling of tiredness constantly increases. It is not enough to think that age, the environment, or personal problems lead to physiological changes but address a local therapist as soon as possible.
Finally, in the majority of cases, diabetes influences the quality of vision. The same way blood glucose provokes changes in the urination process, it also affects the ability to focus because of tissues in the eyes, which is also known as blurred vision (Kayyali et al., 2019). If people fail to diagnose diabetes in the early stage, and this condition remains untreated for some time, new vision complications may occur because of poor work of the blood vessels. The outcomes may be dangerous for people because they could lose their vision and become blind, without the possibility of restoring it.
Along with these main signs, people should be careful about other health changes that are usually uncommon for them. For example, infections are frequent because the body cannot heal the wounds due to poor blood flow. Loss of sensation in hands or legs is explained by high levels of glucose in the blood. Sweating can be a sign of a low level of blood sugar. There is no need to wait for several symptoms being identified, and it is better to see a doctor as soon as possible to decrease the chance of complications, start treatment, or understand the nature of health problems.
Causes of Diabetes and Risk Factors
As it has already been mentioned, diabetes is explained by an abnormal level of sugar in the blood. The lack of insulin results in this chronic condition, when the pancreas is not able to secrete the hormone. In other words, sugar does not reach cells but stays in the blood. Due to no or poor production of insulin, the cells do not receive enough blood sugar, as well as energy that makes tissues work. Pancreatic β-cell dysfunction and insulin deficiency are the main causes of type 2 diabetes (Chatterjee et al., 2017). Compared to type 1 diabetes when absolute insulin deficiency and β-cell destruction cannot be treated, type 2 diabetes is characterized by resistance to insulin, and the destruction can be prevented (American Diabetes Association, 2017). Therefore, type 1 and type 2 diabetes are heterogeneous diseases, and the classification of its signs and causes is necessary for the development of a treatment plan.
Many studies are developed to understand the nature of type 2 diabetes, but its true reasons and pathogenesis remain poorly explained, and it is recommended to focus on its risk factors’ awareness. Kong et al. (2020) underline genetic predisposition, the environment, and lifestyle habits as the main causes of diabetes in young people. If a parent or another sibling was diagnosed with diabetes, there is a chance for other family members to have the same problem. The exposure to endocrine-disrupting pollutants can provoke oxidative stress and pancreatic complications (Kong et al., 2020). Sedentary behaviors and unhealthy (sugar excessive) diets also provoke changes in the production of insulin. As a result, obesity makes human cells resistant to insulin. Physical activities are used to control weight and predict obesity, and if a person neglects following simple recommendations and rarely moves, glucose cannot be properly regulated in the body.
There are also several ethnic and racial groups of people who are at risk of having diabetes because of their genes. Many epidemiological studies suggest adult people taking diabetes tests regularly because of the inability to continue physical exercises regularly and control muscle mass (American Diabetes Association, 2017). Non-Hispanic populations seem to be less affected by the environmental and demographic factors that increase their diabetes risks. However, such groups as African-Americans, Asian Americans, and Native American are at high risk (American Diabetes Association, 2017). According to the studies of the National Institutes of Health, weight and fat around the abdomen are the main biological risk factors of African Americans (Hicklin, 2018). Current findings show that Asian populations before the age of 40 (about 0.4 million) are affected by diabetes frequently because of genetics and lifestyles (Kong et al., 2020). Thus, racial health disparity remains a common theme for investigations around the globe. The presence of high blood pressure and high cholesterol levels may also serve as possible triggers for diabetes at any age because these conditions influence the work of the blood flow.
Complications Associated with Diabetes
There are many reasons for people to be careful with diabetes diagnosis, and the presence of severe complications is one of them. In addition to the fact that this chronic condition influences the quality of life, it also provokes a number of health complications. Healthcare workers aim at predicting problems by providing appropriate treatment, assigning operative procedures, and educating patients. One of the evident long-term complications of type 2 diabetes is the development of cardiovascular risks, including coronary artery disease, stroke, heart attack, and congestive heart failure (Mazer et al., 2020). A high level of blood sugar may destroy the heart muscles’ cells or make the heart work harder to replace the functions of damaged blood vessels. Hypertension, as an independent condition or an outcome of diabetes, also influences the condition of artery walls, which contributes to an unpredictable heart problem. In the majority of cases, patients with heart diseases are in need of surgery, and diabetes complicates the situation before and after such a procedure.
Another field of damage caused by diabetes is nephropathy or kidney problems. Albuminuria is frequently observed in young and adult patients with albumin loss in the urine (Graves & Donaghue, 2019). As soon as urine tests show changes, specific inhibitors are prescribed to control the albumin ratio. However, as soon as the treatment begins, it is also important to observe the signs of proteinuria, when the levels of protein in the urine increase (Graves & Donaghue, 2019). One of the roles of kidneys is to filter waste from the blood. Because of hypertension, the blood vessels do not work well and damage kidneys, which makes impossible for the body to remove waste from the body. Diabetic nephropathy can progress if no glycemic control is promoted.
In addition to nephropathy, neuropathic complications in diabetic patients should be mentioned. The condition of blood vessels determines the condition of the nervous system in the body (Kayyali et al., 2019). Diabetes provokes sensory loss in hands and legs and motor dysfunction with time. Sometimes, numbness is associated with pain and commonly observed in old male patients who smoke (Graves & Donaghue, 2019). Retinopathy complications (blindness or low-quality vision) have already been discussed in the paper as the sign of diabetes. Such diseases as cataracts and glaucoma emerge with age, and diabetic adults should check the condition of their eyes regularly. Some mental health disorders are also observed because of the necessity to change lifestyle habits, avoid preferred food or activities, and manage diabetes regularly. Due to a number of self-care obligations, some patients feel depressed and anxious.
In fact, physiological changes because of diabetes vary, and people have to be ready to cooperate with doctors to choose an appropriate care plan. Diabetes could cause hearing problems because of the inability to predict the damage of the blood vessels. Skin infections may occur because of the impossibility of the body to resist external threats. Finally, diabetes is one of the leading causes of death among the global population. Associated complications, the necessity to manage glycemic control, and pharmacological dependence reduce the quality of life in diabetic patients.
Blood Sugar Level in Diabetes
Today, people have access to a variety of diagnostic tools to check their predisposition to diabetes. Glycated hemoglobin test, also known as A1C, is used to indicate the level of blood sugar during the last two-three months. Compared to other diabetes tests where fasting is required, this test allows to eat or drink before taking it. A normal level is about 5.7%, pre-diabetic condition is between 5.7-6.4%, and diabetes is more than 6.4%. The goal of diabetic adult patients for their A1C level is about 7% (Centers for Disease Control and Prevention, 2020). In addition, regarding personal characteristics of patients, medical workers may recommend using the oral glucose tolerance test (overnight fasting) or the random blood sugar test (no fasting) to measure the level of sugar. The awareness of these tests is crucial because patients should know how to keep their blood sugar levels and prevent serious health problems. When diabetes is diagnosed, doctors check all the vital signs of their patients and identify the range in terms of which energy is enough to make the body work.
To facilitate the process of management blood sugar, diabetic patients may buy individual glucometers to check their blood sugar any time they feel it necessary. A small sample of blood is taken from a finger, and the results are known in several minutes. If there are no special prescriptions, patients make these checks up when they wake up, eat (before and after), and go to bed. Before taking a meal, the recommended target is between 80 and 130 mg/dL, and after two hours of taking a meal, the target should be less than 180 mg/dL (Centers for Disease Control and Prevention, 2020). The measurement of blood sugar levels is important because it could explain the differences in health conditions of patients. For example, according to the research of the Centers for Disease Control and Prevention (2020), shaking, sweating, and dizziness occur if the level of blood sugar is low. As soon as these signs are identified, and the test proves the lowering, treatment must be taken as soon as possible to avoid complications.
There are many ways to treat low blood sugar levels. First, pharmacological interventions include taking corticosteroids, beta-blockers, inhibitors, and statins (Genser, Wanner, & März, 2020; Mazer et al., 2020). Sometimes, it happens that no medications are at hand, but the need to increase blood sugar is burning. In such cases, the representatives of the Centers for Disease Control and Prevention (2020) recommend eat several hard candies and drink fruit juice or soda (not a diet one). In other words, it is expected to put the right fuel in the body with the help of resources available at hand. If the condition does not change within the next 15-20 minutes (that is possible in rare cases), medical help or the repetition of the same interventions is required.
High blood sugar levels are also dangerous to diabetic patients because they cause ketoacidosis. Ketones are produced in the liver if the body lacks insulin and cannot convert glucose into energy, and its increased number may lead to coma or death (Centers for Disease Control and Prevention, 2020). The mortality rates of this condition vary among diabetic patients. Although ketoacidosis is more common in type 1 diabetic patients (8 per 1000 patients annually), type 2 diabetic patients are also at risk (2 per 1000 patients annually) (Mazer et al., 2020). The symptoms of this condition are fast breathing, dry skin, and flushed face, and the urine test for ketones is taken to check the diagnosis. The control of blood sugar is important either for type 1 or type 2 diabetic patients. It helps to understand what physical activities are appropriate and which ones are dangerous. Taking medications is an obligatory step, but it has to be regulated. Finally, diabetes treatment is a life-long process, and its impact on the quality of human life is recognized and studied by many scientists and medical workers worldwide.
As there is no cure for diabetes, people should know how to live with this disease and follow prescribed treatment plans. There are several pharmacological and non-pharmacological approaches that are characterized by specific medications and physiological interventions. Medications like metformin and insulin therapy are necessary to control the level of glucose. Healthy eating and physical exercises turn out to be the main parts of managing diabetes in patients as it is a good way to keep the energy balance (Marín-Peñalver, Martín-Timón, Sevillano-Collantes, & del Cañizo-Gómez, 2016). However, it is also necessary to remember that rest is crucial for controlling diabetes complications, including healthy sleep and relaxation. Therefore, to manage diabetes, it is expected to study all its signs and outcomes and consider patients’ characteristics to find out what steps are effective.
The promotion of healthy diets is recommended for diabetic patients, either inpatients, surgical, or outpatients. The main idea is to achieve the required blood glucose level and control blood pressure and weight. Due to insulin-related problems, many people with diabetes are obese or overweight, and it is important for them to control their calories (Marín-Peñalver et al., 2016). Carbohydrates are effective for determining glycemic control, and the consumption of fruits, vegetables, dairy products, and grains supports the balance. The presence of fiber in food is also beneficial for diabetic patients because it has a positive effect on the prediction of cardiovascular risks and the control of glucose in the blood. Refined sugar is the product to avoid; as a result, such food as cakes, biscuits, and sweets or sugary drinks may be dangerous for people who aim at controlling their blood sugar levels. Salt is one of the triggers for blood pressure changes. There is no need to remove it completely, but restrictions must be considered. Alcohol is not a taboo for diabetic people, but to keep a healthy lifestyle means to limit alcoholic drinks up to one per day.
Physical activities create a favorable environment for diabetic patients to maintain glycemic control, as well. The benefits include the possibility to increase insulin sensitivity, control blood pressure, and maintain psychological well-being (Marín-Peñalver et al., 2016). To decrease HbA1, patients must exercise, and aerobic and resistance interventions are offered either individually or in groups. However, despite the setting that is chosen for physical activities, doctor’s recommendations cannot be ignored and should be based on individual characteristics and co-morbidities of patients. There is no one specific treatment for all type 2 diabetes patients, and every journey is based on an individual approach that include available resources, families, and healthcare providers.
Attention is also paid to medications that can help people with type 2 diabetes to reduce complications. Metformin is one of the common drugs that is initiated as the first-line treatment option and continued as long as it is tolerated (American Diabetes Association, 2020). Patients choose this medication due to its price and accessibility. Still, such adverse effects as gastrointestinal intolerance (discomfort or diarrhea) may occur, and if the dosage change is not effective, other options are considered. Sulfonylureas and meglitinides aim at stimulating the pancreas and producing insulin, but their main difference is the speed of acting and the duration of effects. All these medications work as independent agents of insulin therapy or the components of combination therapy. There is a group of alpha-glucosidase inhibitors that promote the concentration of glucose in the blood. Sodium-glucose cotransporter 2 (SGLT2) inhibitors prevent kidney failures, modify the rise of plasma glucose levels, and lower systolic and diastolic blood pressure (Mazer et al., 2020). Injections with glucagon-like peptides stimulate insulin release, and insulin injections help to reduce pressure on the pancreas and create appropriate conditions for glucose to reach cells and promote energy.
Diabetes and Surgery
There are situations when diabetic patients require surgery at some time, and adjustments in the diabetes regime are important. The Hamilton Health Care System authors (n.d.) admit that the risks of infections and heart problems, as well as slow healing, are the major complications after surgery, and blood sugar monitoring is an obligatory care step. It is not enough to prepare a patient for surgery physically, following all medical and physiological instructions. Many things depend on how ready the patient is for this operation, and emotional support, understanding, and communication have their outcomes. According to Marks (2003), it is difficult to maintain glycemic and metabolic control in patients with diabetes when they have to undergo surgery. In the middle of the 1900s, it was reported that only 50% of diabetic patients were able to survive operative procedures and avoid serious complications (Hirsch, McGill, Cryer, & White, 1991). Today, due to a number of available medical advances and options, people with diabetes successfully survive such surgeries as vitrectomy, kidney transplantation, or vascular repairs (Hirsch et al., 1991). Preoperative evaluation, appropriate anesthesia, and post-operative care have to be properly planned and explained.
Prior to Surgery
Preoperative manipulations are used to identify if patients could have complications on the basis of diabetes. For example, there is a threat of cardiovascular diseases, neuropathy, and nephropathy, and, to reduce these risks, several tests are required. Resting electrocardiography is performed before the intermediate-risk procedure to detect silent ischemia (Marks, 2003). Stress tests are necessary to identify id cardiovascular disease may cause perioperative hypotension. Kidney functions may be challenged by the outcomes of surgery, and diabetic patients may not survive such changes; therefore, electrolyte and serum creatinine levels should be measured to predict renal dysfunction. Twenty-four hours before surgery, the patient’s urine is collected and analyzed, using creatinine clearance formulas (Marks, 2003). In the medical card, attention is paid to the medications taken by patients and other historical findings that might influence the results of the test.
Glycemic control includes the necessity of balancing insulin and the counterregulatory hormones in order to identify metabolic abnormalities and focus on them during surgery. If the patient takes insulin, its dosages should be adjusted to the current health conditions. Blood glucose levels are assessed before and after meals one-two days before surgery. A1C tests are common for these procedures, but random plasma glucose tests are also applicable if surgery is unplanned and urgent. If the patient has already been diagnosed with diabetes, the comparison of test results before and after surgery helps to understand the main aspects of perioperative care management. In case of emergency, preoperative patients need to take a complete blood count tests to measure their hemoglobin levels and hematocrit values. The prevalence of anemia predicts the possibility of significant blood loss and makes surgeons and nurses prepared for extra-activities in the operating room.
In addition to operative procedures that are prescribed to diabetic patients to solve their non-diabetic health problems, there is also an intervention to improve glycemic control. van Baar et al. (2020) introduce the duodenum as a metabolic treatment target and use duodenal mucosal resurfacing (DMR) to improve glucose control. This procedure includes the implementation of special catheters during a minimally invasive endoscopic procedure with circumferential hydrothermal ablation of the mucosa (van Baar et al., 2020). Its goal is to elicit metabolic improvement and control blood sugar levels safely and easily feasibly.
Intraoperative Management of Diabetic Patients
The main idea of blood sugar management during surgery is insulin control. If diabetic patients do not require regular insulin intake in their regular life and rely on diets, physical activities, and small dosages of oral agents, there is no need for insulin during a short surgery. However, if test results show poor glycemic control, insulin has to be provided to avoid other metabolic disturbances. Some anesthesia could release stress hormones that influence the sensitivity to insulin, which results in elevated blood sugars (Hamilton Health Care System, n.d.). Besides, most oral diabetic medications have to be stopped the night before surgery, so the body may be unprepared for the lack of substances. The patient should discuss blood sugar targets that were measured beforehand, so the surgical staff control its level during the surgery and take measures if necessary. As soon as vital signs change because of surgery, insulin, glucose, or glucose-insulin-potassium infusion could help to stabilize the situation (Marks, 2003). If a surgical operation is long, the glucose level must be measured every two hours to make sure it is able to constantly keep between 160-180 mg per dL.
Blood Sugar Management After Operative Procedures
When surgery is over, patients demonstrate different reactions to the offered intervention. Depending on the anesthesia type, patients wake up at different times. In many cases, an individual is not able to eat or drink for several hours, and it is hard to check the condition immediately after the procedure. Therefore, frequent blood glucose monitoring is one of the main responsibilities of nurses before patients could do the same checkups on their own. In the beginning, the blood sugar is checked every one-two hours; then, its frequency is decreased up to five times per day (Hamilton Health Care System, n.d.; Marks, 2003). To control blood sugars, special diets are offered by hospitals. Patients should also know about such side effects as trouble eating, vomiting, discomfort, and the lack of activities. It is normal to feel fatigued and weak, and doctors understand that diabetic patients need more time for healing compared to non-diabetic patients. The rise of infection and fever can be observed, and the use of antibiotics is discussed with a doctor. Sometimes, surgeons recommend moving around the hospital to prevent bedsores and stabilize sensation in legs and hands.
Population in Managing Blood Sugar Levels
Diabetes is a complex disease due to the inability of finding a specific cure. The quality of life may be improved with the help of medications, physical exercises, and diets, but the role of the population cannot be ignored. Within the frames of this project, there are four groups of people who could make contributions to managing diabetes and controlling blood sugar levels in surgical patients. Due to the fact that self-care plays a crucial role in managing diabetes, patients need to understand their responsibilities and tasks. However, it could be hard to follow all prescriptions without support of the relatives, and the functions of a family have to be recognized. There are also doctors and nurses, who use their knowledge and practice to help patients live with diabetes and choose appropriate therapies. Finally, the role of students cannot be ignored because this part of the population is responsible for sharing information and discussing the current achievements in diabetes management and sharing recommendations.
The Role of Patients
If there is no diabetes family history, people are still at risk of having type 2 diabetes because of external factors like the environment or surgical complications and internal factors like obesity, race, or age. The description of the population, i.e. patients, is crucial in any research project. Type 2 diabetes usually develops in people over 45, but the Centers for Disease Control and Prevention (2019) states that children, teenagers, and young adults could have it as well. Although the black population is characterized by high rates of diabetes in their anamnesis, sometimes, whites have the symptoms of the disease and worry about their health conditions. Therefore, a diabetic patient can be any person who presents to a hospital with such complaints as frequent urination, thirst, hunger, and fatigue. Besides, this population may suffer from unplanned and unexplainable weight loss or blurred vision. During the examination, the patient’s task is to answer the questions of a medical employee in a clear way and share true information. It is also necessary to be ready for taking simple blood tests that show if there are some abnormalities with the blood sugar level.
Self-care in diabetes management is one of the most critical aspects because of the necessity to control glucose levels out of a hospital. There are also many responsibilities that cannot be ignored, including healthy eating, physical activities, and medication control. In addition to glycemic control, patients have a need to prevent complications and follow rehabilitation recommendations. In case of diabetes, it is impossible to take a medication or be assigned to surgery and forget about this disease. It is a long-life condition, and as soon as it is diagnosed, patients must change their lives and become dependent on insulin. Certain food restrictions exist, and the role of a patient is to remember them and avoid unhealthy products. Increasing the participation of patients in decision-making and treatment interventions during doctor visits helps to improve the quality of care and enhance the possibility of effective monitoring of blood sugar levels.
To live with diabetes should not mean to live in constant fear or worry. Patient satisfaction with health and medical care turns out to be a significant determinant of disease adherence. Anxiety and depression are common conditions in diabetic patients that are associated with hypoglycemia and hyperglycemia (Kong et al., 2020). Not to promote their progress, people should control the level of glucose and think about some positive aspects of care. Patients’ awareness of diabetes is a serious weapon in managing blood sugar levels. However, there is no need to learn as much information as it is available. It is enough for a person to communicate with a healthcare provider, analyze personal symptoms, and decide on what treatment should be followed. Self-efficacy is an important psychological and organizational factor in diabetes care. It is a good chance to predict behaviors, enhance interventions, and analyze health changes to understand the impact of diabetes. No one but a patient is a direct recipient and manager of care.
The Role of Doctors and Nurses
Diabetes care is never simple for nurses and doctors because a number of factors and contributions have to be analyzed. In general, it is possible to divide their roles into three main sections: education, prevention, and treatment. In its turn, treatment may vary, depending on the current situation and the condition of a patient, including surgical patients, health complications, or outpatients who are in need of frequent checkups. The medical staff tries to involve patients in diabetes self-care because of the necessity to manage glycemic control. However, these experts cannot ignore their direct functions and should assist patients and their families in accepting the diagnosis of diabetes and following changes in daily activities.
One of the initial responsibilities of nurses and medical workers in a diabetes care team is to educate patients on how to manage their disease. Nikitara, Constantinou, Andreou, and Diomidous (2019) observe positive outcomes of education of patient condition if nurses are involved and explain the peculiarities of glycemic control. The participation of pharmacists, technicians, specialists, and nutritionists is also characterized by healthy changes because patients are educated about how to organize their dietary habits and physical activities. As educators, nurses should support patients and provide them with the initial background information about the disease. In other words, it is necessary to give a clear explanation of diabetes and mention the current statistics to prove that diabetes is common for the population and that millions of people live with it. The first goal of education is to calm down a patient and demonstrate that everything is manageable. In addition to learning the basics of diabetes, patients are informed about applicable diabetes devices that can help in care management. They include blood glucose meters, special insulin pens, and monitors with the help of which patients are able to control their conditions.
The next step in education is to develop skills for dealing with stressful situations and problem-solving strategies. Non-adherence of patients and frustration with the offered options may be observed in patients, and doctors or nurses must listen to and analyze all complaints (Nikitara et al., 2019). Sometimes, it is necessary for a patient to react to health change quickly, without appropriate medical help. Therefore, a nurse or a doctor should talk to a patient and give general recommendations on how to make decisions, how to establish priorities, and what side effects are expected. Education may consist of one session for patients to cover the main aspects of diabetes management. Still, some patients are in need of regular communication with nurses to learn about new achievements in the field or additional options to improve the quality of care and life.
Prevention of diabetes and its complication is another responsibility of nurses and doctors. The indirect impact of this population group includes recommendations on how to avoid pre-diabetic conditions. When nurses cooperate with patients, they mention the necessity of reducing sugary food, avoiding sedentary behaviors, and supporting a healthy, physically active style of life. It is also beneficial to drink much water because of the possibility to avoid the use of other beverages that harm health. Finally, such habits and conditions like smoking, alcohol, and obesity cause many serious health diseases and increase exposure to type 2 diabetes. Nurses must consult patients about potential harms of these factors on glycemic control. Balanced diets are used to prevent diabetes, and not many people are aware of their chances to reduce diabetes progress by choosing fruits or vegetables over fast-food and coke. Along with a healthy lifestyle, doctors suggest checking the risks of diabetes at different ages because environmental factors or other diseases may provoke this illness with time. It is always easier and effective to treat pre-diabetic patients or recognize type 2 or 1 at its early stage.
To provide a patient with good care is the goal of nurses and doctors. As soon as the staff comes into contact with a diabetic patient, it is expected to carry out regular food and blood checks. Screening and supporting people with diabetes helps to identify the stage of the disease and choose the required treatment. Meeting nutritional needs and urine monitoring are important for predicting other diseases. If patients are prescribed some drugs, a nurse should explain dosage peculiarities and predict medication misuse. The mental health of diabetic patients could change, and nurses are able to report evident changes and add medications. If a person cannot perform tests to monitor blood glucose, nursing staff assists and supervise to understand when glycemic control is no longer effective, and additional interventions are required.
The Role of Families
Today, many families demonstrate their desire to support their diabetic relatives. However, sometimes, nurses and doctors need to explain the importance of their support in diabetes management. Therefore, studies aim at discussing the role of families in diabetes treatment and identifying the pros and cons of such cooperation. Family members and friends are able to promote positive changes in patients, and such contributions cannot be ignored. Their responsibilities include assistance in regular activities, emotional support, and social cooperation.
One of the simplest tasks a family member can perform is to drive a patient to a hospital in case of an emergency. There are situations when ambulances cannot reach a person in a short period, but blood sugar is out of control. A quick reaction of family members and assistance in filling papers at the emergency department are essential in managing diabetes and predicting negative health outcomes. Communication and meetings have a positive impact on dealing with diabetes because it is possible to observe recent behavioral or mood changes, which are frequent in this disease. Besides, sometimes, patients may forget about taking medications or taking a test, and a family member serves as an additional reminder about this crucial step. In diabetes, well-being is not only the ability to take medications or following dietary rules. The creation of a favorable social environment has its benefits on emotional stability and patient satisfaction (Baig, Benitez, Quinn, & Burnet, 2015). Family cohesion promotes positive self-care and the desire to live and enjoy every day.
Some patients have vision problems and cannot inject insulin properly. They also face difficulties in reaching hospitals and need the help of a professional nurse at home. However, it may be enough to involve a family member to do this manipulation and make an injection as per the instructions. There are no complex calculations, and the location for injection is easily accessible. It is recommended to take several brief sessions to understand what kind of help is reliable. According to the study by Ahmed and Yeasmeen (2016), the family system has no direct relation to glycemic control, but its impact on emotional and economic support may change the treatment process. It is easier for patients to fight depression when family members support them, and the effect of stress on glycemic control remains evident. Rising self-esteem, coordination, and mutual entertainment are the options that are not obligatory but helpful. Diabetic people who receive support from their friends and families are defined as properly motivated in their care (Ahmed & Yeasmeen, 2016). They face fewer challenges and accept change successfully because additional support is enough to identify expectations and choose behaviors.
Finally, as it has already been mentioned, diabetes management is based on dietary and physical interventions. Not many patients are eager to change their lives in a short period. However, if much time is spent to accept changes, more complications are developed. Therefore, dietary modifications are less complicated if they are implemented together with friends and relatives. For example, the lack of tempting but harmful food can be found in the fridge. Mutual physical exercises, yoga courses, and relaxation techniques reduce the chances of disabilities. It happens that patients do not observe changes in their life because of poor abilities or the lack of concentration, and, in this case, family support plays a critical role. External evaluations help to identify more symptoms (improvements or impairments) and report them to healthcare providers.
Analyzing the impact of diabetes on human life, not much attention is paid to the role that students can play when they develop their academic diabetes-related projects. Local hospitals usually introduce their guidelines on how to manage diabetes and ask patients to follow similar prescriptions. However, today, the theme of diabetes is commonly known about the globe, and many international scientists are involved in the evaluation of multiple practices. Students are able to gather enough information about different treatment approaches and publish their findings. It happens that a student has a family member with diabetes and shares the recent findings in the field. This diabetic patient consults his or her healthcare provider and discusses the possible improvements and opportunities. Additional tests and observations are imposed to check the appropriateness of a new idea to clarify its pros and cons for a particular patient. In total, students are responsible for information exchange at a global level.
There are also many nursing students who develop their Doctor of Nursing Practice projects within local hospitals and other clinical settings. As soon as approval is obtained from an ethical committer and administrators, interventions are proposed, participants are chosen, and changes are analyzed. In case positive outcomes are observed, there is a good chance to expand the boundaries of the research project and learn how to manage diabetes either independently, or with the help of families, or using professional nursing assistance. Recommendations on how to manage type 2 diabetes patients’ glucose levels in the blood are usually evidence-based and credible.
In this essay, one of the purposes is to review relevant literature and identify common approaches to help patients live with diabetes. Some recommendations are provided by professional organizations like the American Diabetes Association (2017; 2020). These guidelines are based on the experiences of generations in controlling diabetes and dealing with multiple outcomes that can be either predicted or identified and solved quickly. Researchers develop hospital trials and prospective studies to prove the appropriateness of their recommendations for surgical patients (van Baar et al., 2020; Pasquel et al., 2020). This approach to managing diabetes in surgical patients helps to compare observations and choose the method in regard to personal characteristics, available resources, and local standards. In general, all studies support the same idea that glycemic control is crucial for patients who undergo surgical procedures. Sometimes, it is better to stop using medications and identify how to body reacts to the lack of certain pharmacological support. However, some substances cannot be removed. Regarding the access to different resources, the conditions of patients, and the internal impact of diabetes on personal health, recommendations may vary but remain effective in all cases.
The American Diabetes Association is one of the common organizations that healthcare providers like to address in order to understand what kind of help is offered to patients and what guidelines must be followed. During the last several years, a team of researchers developed various pharmacological and behavioral interventions to glycemic treatment in regard to the type of diabetes patients could have (American Diabetes Association, 2020). The main idea of their study is to develop a guide where drugs are offered to patients in order to enhance antihyperglycemic treatment, taking into consideration their personal factors and the pharmacology of drugs. For example, glucagon-like peptide 1 (GLP-1) is characterized by high efficacy among diabetic patients who have hypoglycemia, continue gaining weight with no reason, and want to avoid serious cardiovascular effects (American Diabetes Association, 2020). Sulfonylureas of the second generation are recommended to patients with hypoglycemia and lost weight.
Metformin and Similar Medications
However, despite the appropriateness of the chosen drugs, metformin remains one of the best examples of first-line therapy to stabilize A1C and avoid cardiovascular mortality. If there are no contradictions, metformin is prescribed as soon as diabetes is diagnosed. It is not expensive, usually available, and safe for diabetic patients with cardiovascular risks. Metformin helps to control the level of blood sugar, and patients rely on its positive effects heavily. Still, before and after surgical procedures (around 48 -72 hours), many doctors find it necessary to stop taking it, as well as other long-acting sulfonylureas (van Baar et al., 2020; Marks, 2003). They explain such recommendations as the possibility of reducing the risk of lactic acidosis. At the same time, there are many medications like rosiglitazone and pioglitazone, the duration of action of which is long, and its termination has no rational before surgery (Marks, 2003). To manage glucose control effectively, patients should talk to doctors before surgery and mention all prescribed medications. As soon as their action characteristics are identified and compared, the decision either to stop treatment or not is made.
In case of insulin, its usage is crucial for diabetic patients who have to control their blood sugar. According to Marks (2003), insulin is generally used either before or after surgery alone with glucose monitoring because it is one of the safest ways to avoid complications. The same position is taken by Pasquel et al. (2020), who offer insulin glargine as a basal-bolus treatment to reduce hospital complications, infections, and renal failure in surgical patients. The use of insulin, and particularly glargine U300, is effective for lowering hypoglycemia and obtaining control over blood glucose due to its pharmacokinetics and pharmacodynamics (Pasquel et al., 2020). Some challenges may occur if insulin becomes a part of a complex regime, with a high level of patient participation and self-management (Kong et al., 2020). Surgery and anesthesia produce stress to the whole body, and hyperglycemia provokes insulin resistance and hyposecretion (Hirsch et al., 1991). If metformin is not effective during surgery, insulin continues playing a serious role in patients’ stabilization.
To manage blood sugar control in surgical patients, it is important to make correct calculations and provide clear information. Intravenous insulin infusion should be started the evening before surgery to prepare a patient and choose the safest regime and dosage (0.3-0.4 U per gram glucose per hour for stable patients, 0.5-0.6 U for obese patients, and 0.6-0.8 U for patients with serious infections) (Hirsch et al., 1991). If insulin is taken in the form of a bolus, similar effects could be achieved with a little bit longer period, but cardiac arrhythmia is a threat. Insulin pumps have to be disconnected in case of general anesthesia during surgery that lasts more than an hour. If the patient should stay in the hospital after a surgical procedure, enough supplies are necessary to reconnect the pump and manage glycemic control. Insulin-dependent patients are asked to keep a journal before and after surgery where they make notes about recently taken food, the dose of insulin, and the level of blood sugar before and after taking it. This information helps doctors understand what vital signs are normal for a particular patient.
Effects of Statins on Diabetic Patients
Among a variety of therapies that can be offered to diabetic patients to manage their glucose levels, statin therapy is highly recommended because of the possibility to predict cardiovascular risk factors. Statins aim at lowering lipids and reducing risks of chronic kidney disease in hemodialysis and surgical patients (Genser et al., 2020). Although there is no direct relation between statins and monitoring glucose levels, this type of therapy shows positive effects in cholesterol metabolism, protein energy control, and risk reduction (Genser et al., 2020). As soon as a patient is able to control diabetic complications, there are more chances to predict surgery-related problems with blood sugar levels. Atrial fibrillation and myocardial infarction are observed in diabetic patients after cardiac surgery, and the need for statins is explained by the possibility to reduce operative stress and infection growth. In their study, Genser et al. (2020) admit that positive effects of statins is observed only in case other risks are not too high, and doctors are able to control the condition of a patient during surgery.
Safe initiation of SGLT2 inhibitors helps to manage diabetes and treat high blood sugar levels. Their mechanism of actions includes the modification of raised plasma glucose levels and lowering them to the expected norms (Mazer et al., 2020). The potential risks of this medication include urinary tract infections, kidney failures, and hypotension. According to the Food and Drug Administration (FDA) (as cited in Mazer et al., 2020), such inhibitors like canagliflozin, dapagliflozin, and empagliflozin are added to diabetes care plans and provoke the reduction of cardiovascular risks. However, it is necessary to stop taking them three days before surgery to avoid ketoacidosis. In this case, monitoring blood glucose shows if this termination is dangerous for patients and gives some time to find an alternative. As a rule, attention is paid to drugs with adequate renal functions. In diabetic patients, kidneys cannot remove sugar from the organism, and urine is exposed to infections, with dialysis as the only treatment option.
General Recommendations with Preoperative and Postoperative Issues
Preoperative evaluation in diabetic patients cannot be ignored because it is necessary for metabolic and glycemic control. Surgeries may be emergency (appendectomy or amputation because of infection) or scheduled (that are planned several days or weeks before) (Hirsch et al., 1991). To avoid complications, diabetic patients try to plan their surgeries and monitor their glucose levels regularly because any unpredictable intervention requires discontinuation of taking one medication and searching for other less harmful options. Assessment includes plasma glucose immediate measurement, creatinine levels, and electrolytes (Marks, 2003). ECG and urine analysis shows if there are other risks for patients that can be revealed during surgery. Preoperative treatment to manage glycemic control and stabilize blood sugar levels includes saline infusion, bicarbonate infusion, or potassium infusion (Marks, 2003). If these infusions are not obligatory but recommended, if some problems are defined, insulin infusion remains the only constant intervention in preoperative management.
Postoperative management should begin with a check of the level of blood sugar and checking the moment when insulin was injected for the last time. When the correct medications are offered to patients, nurses should follow the condition and check upon all vital signs. Many patients continue liquid diets after surgery, and infusion allows absorbing enough insulin properly. After the first subcutaneous dose, injection is discontinued for one-two hours in order not to lose metabolic control. If the glucose level exceeds 250 mg per dL, a nurse should inform a doctor to take precautionary measures and clarify why the patient needs additional medications (Marks, 2003). Such aspects as dehydration, wound healing, infection, and sepsis have to be considered because diabetic patients face challenges in predicting complications compared to non-diabetic patients.
Diabetes management is one of the urgent public health concerns around the globe. Patients are educated on how to manage blood sugar levels and monitor glycemic control. Nurses and doctors help patients and their families to understand how to live with this disease and what signs, causes, and risk factors to identify. Compared to non-diabetic patients, people with type 2 diabetes face a number of serious challenges during their surgeries. Therefore, special organizations and associations develop their guidelines on preoperative, intraoperative, and postoperative management. One of the initial aspects of diabetes management is to test urine and blood and observe how diabetes changes the work of the body. Glycemic control is not always easy to manage, and the population is responsible for sharing correct information, noting recent changes, and memorizing dosages and periods not to misuse medications. Before surgery, diabetes drugs must be terminated, except insulin, to predict cardiovascular problems. After surgery, blood sugar should be checked because of postoperative stress, eating problems, lack of activity, and discomfort. Following these simple recommendations and managing blood sugars, it is possible to promote health among type 2 diabetic patients.
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