Type 2 Diabetes Nursing Diagnosis and Care Plan

Type 2 Diabetes Nursing Care Plans Diagnosis and Interventions

Type 2 Diabetes NCLEX Review and Nursing Care Plans

Type 2 diabetes mellitus is characterized by a malfunction in how the body controls and utilizes blood glucose as an energy source. This health condition is a long-term chronic disorder that causes excess sugar to circulate in the bloodstream.

High blood glucose levels will eventually result in cardiovascular, neurological, and immunological system problems. Two connected complications also happen in type 2 diabetes mellitus; the pancreas does not create sufficient insulin, a hormone that modulates the transport of sugar into the body cells, and the cells respond poorly to insulin, allowing the body to consume less sugar.

In addition, type 2 diabetes mellitus was previously referred to as adult-onset diabetes since it is more common in older adults. However, an increase in obese children has led to the growth of type 2 diabetes mellitus cases in younger people.

Furthermore, type 2 diabetes mellitus currently has no cure, although decreasing weight, eating healthily, and exercising can help a diabetic individual manage the disease. If food and exercise are not enough to keep the blood sugar under control, the patient may need diabetic medication or insulin therapy.

Signs and Symptoms of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus can progress slowly. Initially, the symptoms may be mild and easy to ignore. The following are examples of early symptoms:

  • Polyphagia (persistent hunger)
  • Polydipsia (extreme thirst)
  • Polyuria (recurrent urination)
  • Lack of strength
  • Lethargy
  • Hazy vision
  • Hand or foot pain, tingling, or numbness
  • Unintentional weight loss
  • Slow-healing wounds
  • Infections that occur frequently
  • Darkened skin patches around the armpits and neck – this symptom is frequently associated with insulin resistance

As the condition advances, the symptoms worsen and lead to potentially fatal complications. If blood glucose levels have been elevated for an extended period, the following issues may occur:

  • Eye disorder (diabetic retinopathy)
  • Numbness in upper extremities, also known as neuropathy
  • Kidney disorder (nephropathy)
  • Gingivitis
  • Stroke or heart attack

Causes of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is caused mainly by two interconnected problems:

  • Insulin resistance develops in muscle, fat, and liver cells. These cells do not consume enough sugar because they do not generally interact with insulin.
  • The pancreas cannot produce adequate insulin to keep blood sugar levels under normal levels.

It is unclear why this happens, but being overweight and inactive are significant contributors.

Risks Factors for Type 2 Diabetes Mellitus

Among the factors that may raise the risk for developing type 2 diabetes mellitus are the following:

  • Weight – obesity is one of the significant risk factors of Type 2 diabetes.
  • Body fat distribution – storing fat primarily in the midsection instead of the hips and thighs implies a greater danger. If an individual is a man with a waist circumference greater than 40 inches (101.6 centimeters) or a woman with a measurement higher than 35 inches (88.9 centimeters), the risk of type 2 diabetes mellitus increases.
  • Inactivity – the more an individual is less engaged in physical activities, the more vulnerable they are. Physical activity helps lose weight by burning glucose for energy and making cells more responsive to insulin.
  • Family History of Type 2 diabetes – if the parent or sibling has a medical history of type 2 diabetes, the chance of having the disorder increases.
  • Ethnicity and race. It is unclear why people of various races and ethnicities, including Black, Hispanic, Native American, Asian, and Pacific Islander people, are more prone to develop type 2 diabetes than white people.
  • Serum cholesterol levels – below normal levels of “good” cholesterol or high-density lipoprotein (HDL) cholesterol and high levels of triglycerides are linked to an increased risk.
  • Age -the probability of acquiring type 2 diabetes rises with age, significantly beyond 45 years old.
  • Prediabetes – a medical condition wherein the blood glucose level is more significant than usual but insufficient to diagnose diabetes. Prediabetes frequently evolves to type 2 diabetes if it remains unattended.
  • Risks associated with pregnancy – if a woman had gestational diabetes while pregnant or gave birth to a baby weighing more than 9 pounds (4 kilograms), the risk of developing type 2 diabetes rises.
  • Polycystic ovarian syndrome (PCOS) – a common illness characterized by irregular menstrual cycles, excessive hair growth, and obesity, raises the risk of diabetes.

Diagnosis of Type 2 Diabetes

  1. Glycated hemoglobin (A1C) test – this blood test determines the average blood sugar level during two to three months. The following is how the results are interpreted:
    1. Less than 5.7 percent – signifies an average result.
    1. 5.7 to 6.4 percent – indicates prediabetes
    1. 6.5 percent or above – indicates diabetes
  1. Random blood sugar test – regardless of when the last meal was, a result of 200 mg/dL (11.1 mmol/L) or above indicates diabetes, especially if the patient also has diabetic clinical manifestations such as Polyuria (increased urination) and Polydipsia (excessive thirst).
  1. A fasting blood sugar test. -following an overnight fast, a blood sample was obtained, and the results were analyzed as follows:
    1. Below 100 mg/dL (5.6 mmol/L) – considered normal.
    1. 100 up to 125 mg/dL (5.6 to 6.9 mmol/L) – signifies prediabetes
    1. 126 mg/dL (7 mmol/L) or greater on two separate tests – indicates Diabetes
  1. Oral Glucose Tolerance Test -except during pregnancy, this test is less usually utilized more than the other tests for type 2 diabetes mellitus. Blood sugar levels are checked periodically over the next two hours. The following is how the results are interpreted:
  • Less than 140 mg/dL (7.8 mmol/L) -indicates normal results.
    • 140 to 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) – signifies prediabetes.
    • 200 mg/dL (11.1 mmol/L) and above after two hours – indicates diabetes.
  1. Screening Tests. The American Diabetes Association recommends routine screening for type 2 diabetes with diagnostic testing in all individuals 45 and older, as well as in the following groups:
  • People under the age of 45 who are significantly overweight and have one or more diabetes potential risks
    • Women who have experienced diabetes during pregnancy
    • Individuals who have been diagnosed with prediabetes
    • Overweight or obese children with a family history of diabetes or other lifestyle factors.

Treatment for Type 2 Diabetes Mellitus

  1. Well-balanced and healthy diet. Contrary to popular belief, there is no such thing as a diabetes diet. However, it is critical to center the diet of the patient on the following:
    • A consistent schedule of healthy meals and snacks
    • Smaller portion sizes of foods
    • Increase the intake of high-fiber foods such as fruits, non starchy vegetables, and whole-grain products.
    • Reduced consumption of refined grains, starchy vegetables, and sweets
    • Small portions of low-fat dairy, low-fat meats, and fish
    • Cooking oils that are good for the health, like olive oil or canola oil
    • Lower caloric intake
  2. Increased Physical Activity. Exercise is essential for losing or maintaining a healthy weight. It also aids in the regulation of blood glucose levels. Here are some physical activities that are recommended for Type 2 diabetes mellitus patients:
    • Resistance Training
    • Aerobic Exercises
  1. Maintaining a healthy weight. Maintaining a healthy weight improves blood sugar, cholesterol, triglycerides, and blood pressure regulation. If a patient is overweight, they might notice a difference in these factors after losing as little as 5% of the body weight. However, the more weight a patient loses, the better the health and disease management will be.
  2. Monitoring of blood sugar at home using a glucometer regularly.
  3. Taking antidiabetic medications or opting for insulin therapy as prescribed.

Nursing Diagnosis for Type 2 Diabetes Mellitus

Diabetes Type 2 Nursing Care Plan 1

Risk for Unstable Blood Glucose Level

Nursing Diagnosis: Risk for Unstable Blood Glucose Level related to insufficient blood glucose monitoring and lack of compliance to diabetes management and medications secondary to Type 2 diabetes mellitus as evidenced by increased thirstiness and persistent urination.

Desired Outcome: The patient will strive to attain an acceptable glucose range and recognize critical variables contributing to varying glucose levels.

Diabetes Type 2 Nursing InterventionsRationale
Keep an eye out for signs of hyperglycemia in the morning.  Daytime hyperglycemia, as the name implies, is an elevated blood glucose level that occurs in the morning due to a lack of insulin. The dawn phenomenon (average blood sugar until 3 a.m then levels rise sharply), insulin waning (substantial increase in blood glucose from bedtime to morning), and the Somogyi effect (nocturnal hypoglycemia then sudden increase of blood sugar in the morning) are all possible causes. That is why this intervention aims to prevent severe complications of sudden periods of hyperglycemia, especially during the daytime.  
Teach the patient how to monitor his or her blood glucose levels at home.  Blood glucose levels should be checked before meals and before bedtime. Insulin doses are adjusted based on glucose levels.  
Report a blood pressure of more than 160 mm Hg (systolic).  Administer hypertensive medication as directed. Diabetes is frequently correlated with hypertension. Controlling blood pressure helps prevent cardiovascular disease, blood clots, diabetic neuropathy, and retinopathy.  
Educate the patient on how to administer insulin accurately.  Insulin absorption is more consistent when insulin is administered at the same anatomical site than any body parts. The abdomen absorbs the most, followed by the arms, thighs, and buttocks. The American Diabetes Association recommends injecting insulin into the subcutaneous tissue of the abdomen with insulin syringes.  
Explain to the patient the significance of weight loss to obese diabetic patients.  Weight loss is critical in the management of diabetes. Weight loss of 5-10% of total body weight can minimize or remove the need for medications while vastly improving blood sugar levels.  
Explain to the patient the significance of sustained meal composition or timing.  The ideal diet for diabetic patients is three meals of similar size, uniformly distributed meal times (5-6 hours apart), or one or two snacks. Hence, pacing food intake throughout the day reduces the pancreas’s workload.    
Educate the patient on the health advantages and significance of exercise in diabetes management.    Exercise can help diabetic patients lower their blood sugar levels and lower the risk factors for cardiovascular disease. Exercise lowers blood glucose levels by increasing glucose metabolism and enhancing insulin utilization.
Give patients guidelines on utilizing self-monitoring blood glucose levels (SMBG).  Another significant element in diabetes management is frequent SMBG. Patients can adjust their medication regimen and achieve optimal blood glucose control once they know their SMBG results. Furthermore, SMBG encourages patients to continue their treatment. It can also aid in evaluating the efficacy of aerobic activity, nutrition, and oral diabetes medications.  

Diabetes Type 2 Nursing Care Plan 2

Fatigue

Nursing Diagnosis: Fatigue related to reduced metabolic energy production, as well as changes in body chemistry such as inadequate insulin secondary to Type 2 diabetes mellitus as evidenced by immense exhaustion, failure to sustain usual routines, and impaired concentration.

Desired Outcome: The patient will be able to verbally express an increase in energy and demonstrate an enhanced capacity to perform desired activities.

Diabetes Type 2 Nursing InterventionsRationale
Explain the need for activity with the patient. Strategize the patient’s schedule and identify activities that may lead to fatigue.  Even if the patient initially feels too weak, education can motivate them to increase their activity level.  
Alternate periods of activity with relaxation and unhindered sleep.  This approach aims to avoid unnecessary exhaustion.  
Discuss energy-saving techniques for taking a bath, transporting, and other activities.    The patient will be able to achieve more with less energy consumption.
Ensure the comfort and safety of the patient while executing physical activities.    Diabetic patients need to be engaged in physical activities, but the nurse or care provider must ensure the safety and welfare of the patient.
Before and after activity, check the patient’s pulse, respiration rate, and blood pressure.    These vital signs indicate the physiological levels of activity tolerance. Diabetic patients’ vital signs may fluctuate, that is why it is necessary to monitor them first before engaging in physical activities to avoid fatigue.

Diabetes Type 2 Nursing Care Plan 3

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to the patient’s lack of understanding in insulin administration and the health condition itself secondary to Type 2 diabetes mellitus as evidenced by insufficient instruction follow-through and the emergence of avoidable complications.

Desired Outcome: Prior to actual discharge, the patient will be knowledgeable about insulin injection, low blood sugar clinical manifestations, and appropriate diet for the condition.

Diabetes Type 2 Nursing InterventionsRationale
Explain to the patient that long-acting insulin should only be administered once or twice a day.  Long-acting insulin has no peak of action and is efficacious for more than 24 hours.    
Explain to the patient that regular prandial insulin should be injected 30 minutes before meals, whereas rapid-acting insulins can be injected before or after meals.      Since rapid-acting insulin can be given after a meal, the dosage can be adjusted depending on the food consumed.
Inform the patient that insulin dosages may have to be adjusted.  When fasting for a surgical procedure or experiencing hypoglycemia, insulin dosage should be reduced. Thus, illness or infection may necessitate more insulin.  
Instruct the patient to alternate the locations of insulin injections.    This intervention aims to prevent lipodystrophy by rotating injection sites regularly.
Explain to the patient why it is critical to insert the syringe perpendicular to the skin.    The best insertion angle is a 90-degree angle because it guarantees deep subcutaneous insulin administration. An injection that is too deep or too superficial may affect the rate of insulin uptake.
Use various tools to supplement teaching while remaining flexible about the teaching strategy.  When utilizing various teaching materials, ensure that they are appropriate for the patient’s needs, language, and reading comprehension. Furthermore, use the American Diabetes Association’s (ADA) available services to supplement or outline the diabetes lesson plan.  
Educate the patient to eat a low-sugar, low fat, and high fiber diet.  A low-fat, high-fiber diet aids in the regulation of cholesterol and triglycerides. Three meals per day, plus a late-night snack, are advised. Refined and simple sugars should be limited, while complex carbohydrates like cereals and rice should be increased.    
Teach the patient and family how to acknowledge hypoglycemia symptoms.  Shaking, perspiration, nervousness, lack of strength, hunger, and changes in the level of consciousness are all symptoms of hypoglycemia. Hypoglycemia happens when blood glucose levels fall below 60 mg/dL. It is necessary to explain to the patient how hypoglycemia occurs when there is excessive insulin, not enough food, too many oral antidiabetic agents, or too much physical exercise.  
Educate the patient on how to dispose of syringes and needles properly.    Insulin syringes, test strips, pens, and needles must be disposed of in accordance with local laws. Sharps should be disposed of in a puncture-resistant container.
Provide the patient with written diabetes management information that he or she can refer to.      This approach reinforces learning and conveys the most beneficial information possible.

Diabetes Type 2 Nursing Care Plan 4

Powerlessness

Nursing Diagnosis: Powerlessness related to a chronic or progressive disease that is incurable and reliance on others secondary to Type 2 diabetes mellitus as evidenced by depression related to physiological deterioration or complications despite patient compliance with the treatment plan and a hesitancy to convey genuine emotions.

Desired Outcome: The patient will be able to recognize feelings of hopelessness and identify healthy coping strategies.

Diabetes Type 2 Nursing InterventionsRationale
Recognize the normalcy of the patient’s emotions.  Recognizing that responses are normal can assist patients in problem-solving and seeking assistance as needed. Diabetes management is a full-time job that provides an ongoing reminder of illness and a possible danger to a patient’s health.  
Allow the patient’s significant other to voice their concerns and suggest ways to assist the patient.  Strengthens the sense of involvement and allows the significant other to problem-solve solutions to assist the patient in preventing a repetition of the disease.  
Motivate the patient and their significant other to express their thoughts about the hospital treatment and disease overall.  This approach identifies issues and makes problem-solving easier.  
Examine how the patient has dealt with problems over the years. Determine the locus of control.  Understanding an individual’s personality style aids in determining the needs for clinical consequences. A patient with an internal locus of control usually seeks ways of gaining control over their treatment plan. The patient with an external locus of control desires to be cared for by others and may start blaming their situations on external forces.    
Determine the patient’s and significant other’s expectations and goals.    Unreasonable expectations or tension from others or oneself can lead to disappointment and a sense of powerlessness. These can impair one’s ability to cope.
Determine whether there has been a change in the patient’s relationship with his or her significant other.  Diabetic control necessitates consistent energy and thought, which frequently marks the transition of a relationship. The emergence of psychological issues that affect self-concept may put additional pressure.    

Diabetes Type 2 Nursing Care Plan 5

Risk for Fluid Volume Deficit

Nursing Diagnosis: Risk for Fluid Volume Deficit related to polyuria and uncontrolled gastric losses secondary to Type 2 diabetes mellitus.

Desired Outcome: The patient will demonstrate stable vital signs, perceptible peripheral pulses, good skin turgidity and vascularity, satisfactory urine output, and electrolytes within normal ranges.

Diabetes Type 2 Nursing InterventionsRationale
When oral intake is resumed, sustain a fluid intake of at least 2500 mL/day within cardiac tolerance.  This method manages to maintain hydration and volume circulation.  
Look into modifications in mentation and consciousness.  Modifications in mentation can occur due to unusually high or low glucose levels, electrolyte imbalances, acidosis, reduced cerebral perfusion, or the development of hypoxic conditions.    
Examine the patient’s history to determine the duration or intensity of symptoms such as vomiting or increased urination.  This intervention assists in calculating total volume depletion. Symptoms could have been present for various lengths of time (hours to days). When a highly contagious process is present, it causes fever and hypermetabolism, which increases imperceptible fluid losses.    
Encourage the patient to check his or her weight on a daily basis.  This intervention provides the most accurate assessment of current fluid status and fluid replacement sufficiency.  
Make the patient’s environment more comfortable by covering him or her with light sheets.    This intervention prevents overheating, which could lead to additional fluid loss.
Insert and keep an indwelling urinary catheter in place as required.    This intervention gives an accurate ongoing urinary output measurement, mainly if autonomic neuropathies cause neurogenic bladder (urinary retention/overflow incontinence). Thus, reduce the risk of contamination by eliminating the catheter once the patient is stable.
Take note of any changes in orthostatic blood pressure.    Hypovolemia can cause low blood pressure and palpitations. The intensity of hypovolemia can be estimated when a patient’s systolic blood pressure declines more than ten mmHg from a recumbent to a sitting and then a standing position. It should be noted that cardiac neuropathy can impair reflexes that usually cause an increase in heart rate.  

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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