The patients with the diagnosis of Diabetes type 2 require complex care of the professionals in different spheres, of the so-called diabetes care team, as the psychological, sociological and physiological causes of the disease are interconnected and interdependent, and it is impossible to separate them. The care plan is to be aimed at reducing the patient’s weight, working out the balanced diet and creating the conditions for providing social and psychological support to the patients, involving the family and social institutions.
Investigating the reasons for Grace’s diagnosis it should be noted that most of them could be avoided and the disease could be managed on the pre-diabetes stage. Goldstein, Muller-Wieland (2007) noted that “It is estimated that the risk of type 2 diabetes attributable to obesity is as great as 75 %” (p. 60). But the obesity, in this case, has sociological and psychological roots; on one hand, the change in the accustomed way of life, when her husband died, resulted in the shift of her consciousness, while she was unable to compensate for the loss of the dearest person and isolated from the rest of the world, unable to identify the new social role of a widow.
The stress itself could play an important role in the case report, as it changes the level of blood sugars and is dangerous in pre-diabetes conditions. Goldstein and Muller-Wieland (2003) stated that “Psychological stress has significant effects on the metabolism of individuals without diabetes by increasing counter-regulatory hormones, which could result in elevated blood sugars, among other impacts” (p. 69).
The stress became only one more precondition for the diagnosis, besides gender, age and eating habits. The ethnicity, inheritance and cultural level appear to be the optional pre-conditions of type 2 Diabetes. Sinclair (2009) noted that “It is well documented that the prevalence of diabetes varies among the different ethnic groups, and this difference is also evident in older people living in the same country” (p. 14).
The son ignored the mother’s condition, neither supporting her morally nor caring for her health. Arriving once a month and supplying the ready meals means that he was indifferent to his mother’s feelings and general state, while the early diagnosis could help, type 2 Diabetes requires a certain period of time to develop and can be diagnosed at early stages. Fox and Kilvert (2007) noted that “Obesity is linked to insulin resistance, a root cause of Type 2 diabetes and insulin resistance occurs many years before diabetes itself begins. After a few years, people with type 2 Diabetes nearly always need to use insulin” (p. 6).
In other words, the disease is of progressive character and requires intervention as early as it is possible; the diagnosis demonstrates the patient’s negligence of one’s health and ignorance of the relatives.
Type 2 Diabetes is associated with a certain lifestyle, behavioral and demographic characteristics of the population. Aging, obesity and lack of physical activity are among the main factors causing type 2 diabetes. Goldstein and Muller-Wieland (2007) noted that “Several characteristics of the western lifestyle predispose to overnutrition and obesity, which in turn increases the risk of developing insulin resistance and type 2 diabetes – particularly in individuals or populations with a genetic predisposition for diabetes’ (p. 59). It means that Grace, who is 70, has a BMI of 32 and is overweight, has all the pre-conditions for the diagnosis of type 2 Diabetes.
She was gaining weight due to her depressed condition after her husband’s death, while Brill (2007) noted that “women who gained between 24 and 44 pounds (11 to 20 kg) (over a fourteen-year period) had five times the risk of developing diabetes” (p. 27). The depressed condition led to the development of the disease, gaining weight, while the symptoms of the disease worsened the situation, depriving her of physical activity and the ability to buy the foods for a balanced diet. The fact, that her son brought her sweet things and ready meals, proves that the members of the family lack knowledge about the balanced diet and these were the family eating habits and disregard of the other’s needs that resulted in disease.
The diet is to be rich in carbohydrates, containing beans, starchy vegetables, fruit, dairy products, combining them with proteins, containing meat, eggs, soy products. Goldstein and Muller-Wieland (2007) noted that “There is support for the suggestion that foods rich in slowly digested starch or high in fiber might be protective’ (p. 60). The significance of the balanced diet is to be explained to Grace and her son as it can reduce the risk of the disease’s progress.
Goldstein and Muller-Wieland (2007) noted that “A number of studies have demonstrated improvements in metabolic parameters after interventions aimed at reducing energy intake and increasing physical activity, suggesting that it may be possible to reduce the incidence of type 2 diabetes” (p. 59). Diet is a very important means of managing the patient’s condition, but it should be as close to her eating habits as it is possible, in order not to provide additional psychological pressure. Lack of physical activity is interconnected with the factors of excess weight and social support, not less important for the patients with the type 2 diabetes diagnosis.
Staying at home, unable even to go shopping, Grace was not utilizing the energy received from food, her muscles were atrophied and she had no opportunity to communicate with other people, feeling depressed and helpless. At the present moment, it is advisable for Grace to choose a suitable program and do the physical exercises, corresponding to her present-day condition. Physical activity is to improve her general state and provide opportunities for communication with the outer world, with the other patients in the group or the instructor. Though not taking pills or insulin injections may be regarded as doing nothing by the uninformed people, following the advice of the nutritionists and choosing the exercise program may help Grace to manage type 2 Diabetes.
The effective care plan should involve the social institutions, the family members and motivate Grace to participate in her treatment. The psychological aspect is very important considering the patients with type 2 Diabetes. Krentz and Bailey (2005) noted that “Helping the patient to understand and contribute fully to the management of their condition (“empowerment”) through education and support measures is a valuable means of realizing diabetes control and other objectives” (p. 53).
It is important for all the participants of the Diabetes team to be aimed at the positive results and motivate the woman to take pains for her recovery. Communicating with her will not only inform her of the symptoms and the ways to manage them but will also compensate for the lack of communication and socialize the isolated woman. Weiner and Freedheim (2003) noted that “Depression is directly associated with obesity, physical inactivity, and treatment noncompliance” (p. 198).
The depressed condition, caused by the symptoms of the disease may prevent the diabetes team from the successful implementation of the care plan and it will reduce the care plan effectiveness significantly. At the same time as cited in Weiner and Freedheim’s work (2003) Bradley (2000) noted that “Identifying depression in diabetes can be problematic since somatic symptoms of depression usually included in assessment scales are often similar to the somatic symptoms of diabetes” (p. 198) It is difficult to differentiate between the symptoms of the type 2 Diabetes and the depression itself, it is the evidence for the complex character of the disease.
Besides the work of the specialists, the patients should be provided with social support, as in this particular case the woman’s isolation appeared to be one of the pre-conditions of the diagnosis, but the role of the social institutions can not be underestimated. Weiner and Freedheim (2003) noted that “Patients with diabetes may be in special need of both instrumental and emotional support to allow them to maintain appropriate levels of adherence and psychological adjustment” (p. 199). The family environment is one of the most important factors, as the family members are expected to care for the regimen of the patient and encourage them to struggle against the difficulties of their condition. Unfortunately, Grace was deprived of both of the factors and the present care plan is aimed at improving the situation.
The most important points of the care plan for the patients with the diagnosis of type 2 Diabetes are the balanced diet, rich in carbohydrates, and the exercise program, the social support of the family members and the diabetes team, while the emphasis should be put onto the patient’s education, psychological condition and feelings.
References
Brill, Marlene. (2007). Diabetes. Twenty-First Century Books.
Fox, Charles and Kilvert, Anne (2007). Type 2 Diabetes. 6-th edition. Health Class.
Goldstein, Barry and Muller-Wieland, Dirk. (2003) Textbook of Type 2 Diabetes. Martin Dunitz.
Goldstein, Barry and Muller-Wieland, Dirk. (2007) Type 2 Diabetes: Principles and Practice. 2-nd edition. Informa Healthcare.
Krentz, Andrew and Bailey, Clifford. (2005). Type 2 Diabetes: In Practice. 2-nd edition. Royal Society of Medicine Press Ltd.
Sinclair, Alan (2009). Diabetes in Old Age. 3-rd edition. John Wiley and Sons.
Weiner, Irving, Freedheim, Donald, Nezu, Arthur et al. (2003). Handbook of Psychology: Health Psychology. John Wiley and Sons.