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The care of older patients diagnosed with type two diabetes mellitus is one of the hardest tasks in nursing care. These patients are sensitive to medication, and they tend to portray higher cases of fatal risks associated with treatment. The mortality rate of the older patients is relatively higher than that of the younger patients. It is for this reason that the physician prefers prudent measures of nursing care for the old patients. This paper focuses on two of the subtle measures for treating old patients diagnosed with type 2 diabetes mellitus. The two widely used aspects are the control of risks and dietary management. In the control of risks, certain aspects are of more importance, one of them being metabolic control. The blood sugar level of these patients is usually either unmanageable thus predisposing them to a number of risks. As a result, these patients are prone to suffer from hypoglycemia hence the call for metabolic control. The use of hypoglycemic agents is the most effective measure taken in metabolic control. The metabolic control also focuses on keeping the hemoglobin level at a controlled level to prevent adve4rse effects such as suffocation. Another aspect of risk control is the control of blood pressure. This is important as the patients normally suffer from cardiovascular arrest. The cause of this is the glucose level which predisposes them to weight gain. As a result, the control of blood pressure aims at maintaining it at a level of 140/80 mmHg. The use of aspirin therapy and β blockers is also a significant risk control strategy for old patients. These two strategies induce chemicals that are favorable for the control of common vascular problems, as well as stroke in old patients.

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Dietary management is another key measure taken for old patients. The patient’s lack of exercise together with the fluctuating blood sugar level is the leading cause of weight gain. As a result, dietary management keeps them healthy and improves their immune system. The diabetic patients portray a weakened circulatory system which is a threat of heart failure and cardiovascular arrests. The diet for these patients has to constitute high fiber content to strengthen their circulatory system. In the dietary management of the patients, the carbohydrates are to be kept at a minimum as a way of reducing the threats of glycosuria. This will also help in the weight control of the patients. Proteins are an important part of dietary management. The physician watches the protein content closely as it will also help in the determination of the weight of the patient.

Nursing Biological and Scientific Theory

Patient SK is a 75 year old patient diagnosed with type 2 diabetes mellitus three months ago. The patient has complained about a difficult life since the initial diagnosis with the disease. The glucose level of the patient seems to change with time and medication. The diagnosis of SK revealed that he was indeed asymptomatic. SK is also facing a high hypoglycemic risk. The oral administration of medicine has produced some adverse effects because of the age of the patient. This has created a need to establish a different therapy for the patient. He has become overweight with the increase of medication. After discussion with the physician, the right choice of therapy and medication takes place. SK reported to the physician that he had gained a lot from the support provided by family members. However, SK reported to the physician that he could not afford to take intensive medication as this would weigh him down and prefers a simpler form of medication and therapy. The therapist explored various options to achieve the desired level of glucose content for the patient. The physician chose that option after analyzing available options which included:

  • Insulin: the use of this medicine results to weight gain. However, the mealtime insulin injection could be increased.
  • Sulfonylurea: potential risks include hypoglycemia and weight gain. However, it has a lower cost than other medications and can be administered orally (Zdravkovic 2005).
  • Pioglitazone (TZD): potential risks include retention of fluid as well as weight gain. It can be administered orally and may reduce health risks involving myocardial infarction.
  • Glucagon-like-peptide 1 agonist: it can be administered through injections and it promotes the loss of weight. It also lowers the hypoglycemia incidents and leads to an improvement of the functions of B-cells of the pancreatic organ (Zdravkovic 2005).
  • Dietary management: this lowers the risks of weight gain as well as mitigates conditions associated with weight gain such as high blood pressure. It also leads to a stronger immune system and general body strength.

After a close analysis of these options, the physician suggested to SK that the best option would be to control the risks associated with the condition considering the old age of SK. The physician revealed to SK that the control of risks will focus on three crucial areas which include metabolic control, blood pressure control, aspirin therapy, as well as the use of β blockers. The control strategy took place for a period of 2 months. On the second examination of SK after two months, the physician found out that SK had gained weight and cardiovascular problems were threatening. As a result, the physician recommended the adoption of a dietary management strategy to combat new threats (Taylor 2008).

Control of Risks. Metabolic Control. The physician decided to take advantage of the onset of microalbuminuria which aimed at producing the best results in the control of metabolic conditions. Metabolic control focuses on the control of blood sugar level to the desired level that the physician will adopt. Lack of control of blood sugar level can be fatal to SK due to his old age. This may lead to a high chance of complications or death. The physician administered medicine to control the hemoglobin range of patient SK to about 6% to 7% to reduce the risk of anemia, as well as suffocation. The metabolic control also ensured control of the level of glycosylated hemoglobin to a level below 9% (Spijker 2010). A level higher than this can make SK experience complications known as hyperosmolarity as well as an acute decrease of functions of the renal organ. For SK the oral administration of hypoglycemic agents such as thiazolidinediones, glipizide, repaglinide, or gliclazide may not have been effective due to a reduction of functions of the renal organ. Therefore, the physician suggested insulin therapy for the metabolic control of SK (Taylor 2008).

Blood Pressure Control. Hypertension control adopts the approach that considers weight gain that may occur in the process of treatment. This helps reduce the risks involved with the cardiovascular system as well as to slow down the progress of nephropathy. The physician used angiotensin II receptor blockers to prevent the decline of glucose levels to critically low levels. The use of blockers also reduces the risk for the progress of type 2 diabetes mellitus. The physician revealed that there were numerous benefits of the control of the blood pressure of the patient. Blood pressure control seemed to produce better results in the control of other cardiovascular conditions than metabolic control. After the onset of the control of blood pressure, subsequent checkups revealed a number of improvements regarding the control of risks in the patient. The risk for cardiovascular problems as well as the probability of stroke reduced significantly by 22% and 39% respectively. The physician saw that it was more beneficial to decrease the risks of stroke and other cardiovascular conditions rather than focus on treating microvascular conditions. The physician decided to obtain an acceptable blood ratio of about 140/80 mmHg. The physician suggested the use of several types of antihypertensive agents. This would be more effective than the use of single agents. The physician was using diuretics which are one of the best blood pressure regulators (Porte et al 2008).

However, the physician was cautious about the use of antihypertensive agents as these could have adverse effects on SK due to his old age. The physician used β blockers as additional agents to regulate SK’s blood pressure to the desired level. The physician discouraged the use of alpha adrenoreceptor blockers as well as calcium channel blockers since these blockers proved to be ineffective during treatment. However, the physician used calcium antagonists, which proved to be more effective in the treatment.

Aspirin Therapy. Because of the high risk that SK faced due to his old age, the physician prescribed aspirin therapy. The therapy reduces the number of deaths caused by cardiovascular problems, as well as stroke occurrence. Chances of patients’ vascular problems reduced by a third after the physician adopted the use of aspirin therapy. Treatment with aspirin resulted to a reduction of cardiovascular risks significantly by 41% (Pardini et al 1999). The fear that aspirin could cause bleeding or hemorrhage was not a factor of consideration since SK did not suffer from an acute reduction of renal functions.

Blockers. The physician used β blockers after finding out that they were highly effective in the reduction of the effects of cardiovascular conditions. Blockers served well in preventing primary forms of microvascular negative effects. Contrary to the general belief, the use of β blockers did not result to an increase of risks associated with the hypoglycemic increase.

Dietary Management of Type 2 Diabetes Mellitus. Based on the theory of planned management of Type 2 diabetes mellitus and the corresponding wellness program, it has become quite easy to manage this not curable disease.  Focus is on dietary management. However, exercise and medication are indispensable aspects in the management of the disease (Schwanstecher 2011).

Dietary management of diabetes mellitus helped maintain a close to normal blood sugar level of the patient. This aims at availing the symptoms relief approach for the patient, maintaining the patient's body weight, and preventing the onset of possible degenerative complications. The physician used a diet that was high in fibre to improve SK's health condition. The diet had low fat content with the least amount of saturated fats. The physician advised SK to avoid carbohydrates contained in foods with high glycemic index (GI) (Schwanstecher 2011).

The physician should have assessed the energy requirement of SK in accordance to his body weight, focusing on the reduction of fats content in the patient's diet, given that the research confirms that diabetic patients are prone to develop atherosclerosis condition. The physician focused on providing small meals 5 to 6 times a day to manage the patient's sugar level. The small portions and frequent meals were necessary given that the patient was constantly hungry and craved for sugar. The hunger and cravings of SK could only be attributed to the fact that the lack of insulin made cells starve for energy.

Based on the theory of Bouchard at who claimed that elimination of rancid types of fats from the diet and control of consumption of carbohydrates were effective in the reduction of glycosuria condition among patients, the physician employed this approach of controlled consumption of carbohydrates in the management of diabetes mellitus. However, the controlled consumption of fat, as well as carbohydrates in patient's diet, should be well monitored so as to help maintain the patient's body weight and muscle tissue. This is because Type 2 diabetes mellitus predisposed SK to become overweight, hence the need to lose at least 10% of the total body weight (Regensteiner 2009). The food intake of the patient should be regulated in such a manner that it balances well with the physical activity of the patient. Balancing energy consumption and physical activity, subsequent reduction of saturated fats, as well as sodium consumption, come in handy in the management of hyperlipidemia and hyperglycemia. The physician should ensure that patient's diet is high in soluble fiber and is low in GI carbohydrates. This will help to manage the hyperglycemia and hypertension conditions of the patient.

In order to improve lipid sensitivity and reduce the level of blood lipid as well as to reduce general cardio-vascular related complications, the physician should ensure that the patient does not under any circumstances consume trans fats and saturated fats. Carbohydrates reveal energy that spreads evenly during the day provided that the consumption of carbohydrates is in the right amount. This is effective in maintaining blood glucose level at the desired level (Regensteiner 2009).

Type II diabetic condition of SK required a defined set of objectives by the physician to establish an effective dietary management program that was patient specific. Some of the set objectives included a reduction of glycemic as well as lipid levels as well as a reduction of hypoglycemia attacks. It is a fact that starchy foods are an essential part of a healthy diet. However, strong emphasis should be placed on controlling the portion of served carbohydrates in patient's diet. The limited amount of carbohydrates should be represented by whole grain bread, rice, cereals as well as starchy types of vegetables such as peas, sweet potatoes, and corn. This is because starchy foods and whole grains are foods that are rich in fibre. Fibre is necessary for healthy peristalsis as it cleans up the gut (Feinglos & Bethel 2008).

The physician should include a controlled amount of fruits in the diet of the patient, given that fruits are rich in antioxidants. Antioxidants are crucial in the diet of the diabetic patient as the antioxidants have a therapeutic effect that is more efficient than the CHO content of carbohydrates in bread. The combination of controlled portions of fruits and carbohydrates in patient's diet is effective in controlling overall glycemic oriented load in the system of the patient (Zdravkovic 2005).

During the actual implementation of an effective Type 2 diabetes mellitus management program which will be effective in improving SK’s health, the physician should pay extra attention to glucose levels in the blood of patients. Attention should also be paid to heart protection strategies as well as to measures that check actual blood pressure of the patient (Feinglos & Bethel 2008). In addition, the physician should design a diet plan that will help in maintaining a reasonable weight of the patient in terms of achievable as well as a sustainable possible weight. This is because the main goal of dietary management programs of patients with Type 2 diabetes mellitus is to maintain the desired weight of the patient.

Consumed amount of calories should be sufficient to maintain the desired weight of the patient and prevent weight gain. The control and management of patient's diet should be carried out in a way that maintains normal blood sugar level, blood pressure, and lipid level. This reduces the risk of developing long-term diabetic related complications.

There exists no proved recommendation to modify the total amount of protein consumed by a patient suffering from diabetes mellitus. The portion of proteins consumed during the dietary management program can be maintained at the normal amount on a normal day. The physician is to maintain the proteins in a diet to constitute 15 to 20 per cent of the total amount of calories consumed per day. Therefore, there is the need to consider the actual amount of protein components in the dietary management program (International Conference on Recent Advances in Diabetes Mellitus 2006).

Bearing in mind that the most life-threatening conditions related to diabetes are in every sense related to cardio vascular diseases, dietary management strategy must increase the nutritional value that enhances a health circulatory system. This can only be attributed to the fact that diabetes itself is in more than one way an independent risk element of cardiovascular diseases. Finally, the consumption of alcohol by the patient should be limited to 5 per cent of the total standard norm set at 2 drinks per day (Pasupuleti & Anderson 2008).


This paper reflects the two aspects vital in the treatment of old patients with type 2 diabetes mellitus. The two aspects of therapy are risk control and dietary management. Risk control includes aspects such as metabolic control, blood pressure control, the use of aspirin therapy as well as β blockers. The risk control measures reduce the death threats, as well as predisposition to fatal conditions such as cardiovascular problems and stroke. The other aspect of treatment is the use of dietary management strategies. This focuses on the use of healthy meals such as foods with high fibre content and fruits. Keeping the carbohydrate at a minimum level helps in the control of blood sugar and prevents conditions such as glycosuria. Still under dietary management, protein and fat level control with the aim of watching the weight gain of the patient takes place. Dietary management focuses on maintaining the health as well as boosting the immune system.

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