Common Nursing Diagnoses and Care Plans for Type 2 Diabetes

Diabetes is a chronic disease where the body either doesn’t produce enough insulin or develops resistance to insulin, leading to high blood sugar levels. Insulin is a hormone made by the beta cells in the pancreas that helps glucose in the blood to enter cells for energy.

Type 2 diabetes is a chronic condition that affects the way your body processes blood sugar (glucose). It is the most common form of diabetes and is often linked to lifestyle factors such as diet, physical activity, and weight. With proper management, individuals with type 2 diabetes can lead healthy and active lives. Diagnosing diabetes involves assessing symptoms and blood sugar levels through specific tests.

Symptoms: Increased thirst, frequent urination, fatigue, blurred vision, and slow-healing wounds. However, patients may be asymptomatic, especially in type 2 diabetes.
Diagnostic Tests:

Fasting Plasma Glucose (FPG): A level ≥126 mg/dL (after 8-hour fasting) on two occasions confirms diabetes.
Haemoglobin A1C Test: Haemoglobin A1C ≥6.5% on two tests indicates diabetes.
Oral Glucose Tolerance Test (OGTT): Blood sugar level ≥200 mg/dL 2 hours after a glucose drink confirms diabetes.
Random Plasma Glucose: A random plasma glucose level ≥200 mg/dL with symptoms suggests diabetes, requiring further testing.
Prediabetes: Hemoglobin A1C= 5.7-6.4%, FPG 100-125 mg/dL, or OGTT 140-199 mg/dL is considered as prediabetes. This patient should be followed regularly.

Types of Diabetes: Overview

Type 1 Diabetes: An autoimmune condition where the immune system destroys insulin-producing beta cells in the pancreas. It typically starts in childhood or young adulthood, requiring lifelong insulin therapy. About 5-10% of diabetes cases are type 1 diabetes.
Type 2 Diabetes: The body becomes resistant to insulin, or the pancreas doesn’t produce enough insulin. This type is linked to genetics, obesity, and lifestyle factors. It usually develops in adults but is increasing in younger people. Type 2 diabetes can be managed with diet, exercise, medications, or insulin. It accounts for 90-95% of cases.
Gestational Diabetes: This develops during pregnancy in women who didn’t previously have diabetes due to hormonal changes causing insulin resistance. It usually resolves after birth but raises the future risk of type 2 diabetes. It affects about 2-10% of pregnancies.
Monogenic Diabetes: Caused by single-gene mutations affecting insulin production. Includes forms like Maturity-Onset Diabetes of the Young (MODY) and neonatal diabetes. Often misdiagnosed as Type 1 or 2. It accounts for Less than 5% of cases.
Secondary Diabetes: Results from other diseases affecting insulin-producing cells (e.g., cystic fibrosis, pancreatitis) or medications (e.g., steroids) damaging the pancreas or affecting insulin function.

Causes of Diabetes

The causes of diabetes vary according to the type of diabetes:

Type 1 Diabetes: The immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas. The exact trigger is unknown but may involve genetic predisposition and environmental factors like viral infections.
Type 2 Diabetes
- Insulin Resistance: Cells become less responsive to insulin, often linked to obesity, particularly abdominal obesity.
- Genetics: A strong family history increases risk, with specific gene variants affecting insulin production or function.
- Lifestyle Factors: Poor diet (high in processed carbs and sugars), physical inactivity, and weight gain are the major causes.
- Age and Ethnicity: Risk rises after age 45; certain ethnic groups are more susceptible (e.g., African, Hispanic, Asian, Native American).
- Medical Conditions: Conditions like hypertension, high cholesterol, or polycystic ovary syndrome (PCOS) contribute to type 2 diabetes
Gestational Diabetes:
- Hormonal Changes: Pregnancy hormones from the placenta cause insulin resistance, especially in the second or third trimester.
- Genetics: A family history of diabetes raises the risk of gestational diabetes.
- Risk Factors: Obesity, previous gestational diabetes, or PCOS increase the likelihood.
Monogenic Diabetes:
- Genetic Mutations: Single-gene defects (e.g., in HNF1A for MODY or KCNJ11 for neonatal diabetes) impair insulin production or function. These are inherited and not lifestyle-related.
Secondary Diabetes:
- Medical Conditions: Diseases like pancreatitis, cystic fibrosis, or hemochromatosis damage the beta cells in the pancreas, reducing insulin output.
- Medications: Drugs like corticosteroids, antipsychotics, or HIV treatments can induce insulin resistance or impair beta-cell function in the pancreas.
- Hormonal Disorders: Conditions like Cushing’s syndrome or acromegaly cause excess hormones that disrupt insulin action.

Follow-up Care Plan for Diabetes

Follow-up includes monitoring blood sugar levels, adjusting treatment, preventing complications, and supporting overall health. A concise framework for follow-up based on the American Diabetes Association is listed below:

Frequency of Follow-Up

Newly Diagnosed or Uncontrolled Diabetes: Every 1-3 months until stable.
Stable patient: Every 3-6 months
Gestational Diabetes: Weekly or biweekly during pregnancy; postpartum follow-up at 4-12 weeks.
Complications/Comorbidities: More frequent if issues like kidney disease or hypoglycemia arise.

Key Components of Follow-Up Visit

History:
- Symptoms: Hypoglycemia symptoms (shakiness, sweating), hyperglycemia symptoms (thirst, fatigue), or new complications (e.g., numbness, vision changes).
- Adherence to lifestyle modification: Medications, diet, exercise, and monitoring habits.
- Lifestyle: Stress, sleep, smoking, or weight changes.
- Psychosocial: Depression, anxiety, or barriers to care (e.g., cost, access).
Physical Exam:
- Vital Signs: Blood pressure (target <130/80 mmHg for diabetic patients, <140/80 mmHg for the normal population), heart rate.
- Weight/BMI: Aim for 5-10% weight loss if overweight (in type 2 diabetes).
- Foot Exam: Check for wounds neuropathy.
- Skin/Other: Look for injection site issues or infections.

Laboratory Tests

A1C: Check every 3-6 months and target A1C for <7%.
Lipid Panel: Annually if on statins; target LDL <100 mg/dL (<70 mg/dL if high cardiovascular risk).
Kidney Function: Annual urine albumin-to-creatinine ratio (UACR) and eGFR; more frequent if abnormal.
Other (as needed): Liver function if on certain meds (e.g., metformin, statins), c-peptide or autoantibodies if type unclear (initial follow-up), thyroid function ( in type 1 diabetes)

Complication Screening

Eye: Annual dilated eye exam for retinopathy. Immediately if vision changes.
Neuropathy: Annually. Also, assess for autonomic issues (e.g., gastroparesis, orthostasis).
Cardiovascular: ECG or stress test if symptoms or high risk (e.g., age >40, long diabetes duration), manage risk factors (BP, lipids, smoking).
Dental Health: Encourage biannual dental visits; poor glycemic control increases gum disease risk.

Common Symptoms of Diabetes

Symptoms of diabetes vary by type and can develop gradually or suddenly. Common ones include:

Increased Thirst (Polydipsia): High blood sugar causes dehydration, triggering thirst.
Frequent Urination (Polyuria): Excess glucose in the blood leads to more urine production.
Extreme Hunger (Polyphagia): Cells can’t use glucose effectively, causing persistent hunger.
Fatigue: Lack of glucose in cells reduces energy levels.
Blurred Vision: High blood sugar affects lens shape in the eyes, distorting vision. It can also cause retinal vasculopathy, resulting in impaired vision.
Slow-Healing Wounds: Poor blood flow due to vasculopathy and high glucose impair the healing of wounds.
Unexplained Weight Loss: It is common in Type 1, as the body cannot utilize glucose and breaks down fat and muscle for energy without insulin.
Tingling or Numbness: Long-term high sugar can cause nerve damage (neuropathy), resulting in tingling and numbness
Frequent Infections: High glucose weakens immunity, leading to frequent infections
Cardiovascular diseases and heart attack: Diabetes causes increased coronary artery disease and heart attack.
Type 1 Diabetes: Symptoms often appear suddenly and intensely, including nausea, vomiting, or abdominal pain in severe cases (e.g., diabetic ketoacidosis).
Type 2 Diabetes: Symptoms develop slowly and may go unnoticed for years.
Gestational Diabetes: Often asymptomatic but may show mild thirst or urination changes. Detected during routine pregnancy screening.
Monogenic and Secondary Diabetes: Symptoms resemble Type 1 or 2, depending on the cause, but may align with underlying conditions (e.g., pancreatitis).

Nursing Assessment for Type 2 Diabetes

Follow-Up Care for Type 2 Diabetes:

Regular Monitoring:
- Blood Sugar Checks: Daily for insulin users, less often for others.
- Hemoglobin A1C Tests: Every 3-6 months to assess average blood sugar. A1C<7% is targeted.
- Blood Pressure & Cholesterol: Checked at doctor visits (every 3-12 months) to manage cardiovascular risks.
Medical Appointments:
- Primary Care or Endocrinologist: Every 3-6 months to review A1C, adjust medications, and screen for complications.
- Eye Exams: Annual dilated eye exams to check for diabetic retinopathy.
- Foot Exams: At least yearly, or more if neuropathy exists, to prevent ulcers or infections.
- Kidney Function: Annual urine and blood tests (eGFR, albumin) to monitor for diabetic nephropathy.
Medications: Metformin, SGLT2 inhibitors, GLP-1 agonists, or insulin.
Lifestyle Management:
- Diet: Focus on low-glycemic foods, portion control, and balanced meals (e.g., veggies, lean proteins, whole grains).
- Exercise: Aim for 150 minutes/week of moderate activity (e.g., brisk walking) to improve insulin sensitivity.
- Weight Management: Losing 5-10% of body weight (if overweight) can significantly lower blood sugar.
- Stress & Sleep: Manage stress (e.g., meditation) and aim for 7-9 hours of sleep to stabilize glucose.
- Complication Screening: Regular checks for nerve damage, heart disease, and skin issues. Vaccinations (e.g., flu, pneumococcal) to prevent infections.
- Patient Education: Diabetes self-management education (DSME) programs teach skills like monitoring and stress management. Counselling or support groups address barriers like emotional eating or motivation.

Nursing Interventions for Type 2 Diabetes

Lifestyle Interventions:

Diet: Focus on low-glycemic foods, portion control, and balanced meals (e.g., veggies, lean proteins, whole grains).
Exercise: Aim for 150 minutes/week of moderate activity (e.g., brisk walking) to improve insulin sensitivity.
Weight Management: Losing 5-10% of body weight (if overweight) can significantly lower blood sugar.
Stress & Sleep: Manage stress (e.g., meditation) and aim for 7-9 hours of sleep to stabilize glucose.
Behavioural Support: Diabetes self-management education (DSME) programs teach skills like monitoring and stress management. Counselling or support groups address barriers like emotional eating or motivation.

Medical Interventions:

Medications:

Metformin: First-line therapy to reduce liver glucose production and improve insulin sensitivity.
Others: SGLT2 inhibitors (e.g., empagliflozin), GLP-1 receptor agonists (e.g., semaglutide), DPP-4 inhibitors, or sulfonylureas, based on needs and comorbidities.
Insulin therapy (e.g., basal or bolus) for advanced cases or poor control.
Dosing is adjusted based on A1C, blood sugar trends, and side effects.

Monitoring:

Regular blood glucose checks (glucometer or CGM) to guide treatment.
A1C testing every 3-6 months; target often <7% (individualized).

Complication Prevention:

Manage blood pressure (<130/80 mmHg) and cholesterol to lower cardiovascular risk.
Annual screenings for retinopathy, nephropathy, and neuropathy to catch issues early.
Surgical Interventions (if applicable): Bariatric Surgery is considered for BMI ≥35 with poor diabetes control or BMI ≥30 in some cases.

Emerging Interventions:

Digital Health Tools: Apps for tracking diet, exercise, and glucose can improve adherence. Telemedicine can support remote consultation and coaching.
Medtech: Continuous glucose monitors (CGMs) and insulin pumps for real-time management. Closed-loop systems (“artificial pancreas”) are gaining popularity for precise insulin delivery.

Psychosocial Interventions:

Address mental health (e.g., depression, diabetes distress) with therapy or mindfulness. Stress reduction (e.g., yoga, meditation) can lower cortisol and stabilize glucose. Ensure adequate sleep (7-9 hours) to support metabolic health.

FAQS on Diabetes

What foods should Type 2 diabetics avoid?

Type 2 diabetics should avoid or limit:

Sugary foods/drinks: Soda, candy, desserts, sweetened beverages.

Refined carbs: White bread, pasta, rice, pastries.
Processed foods: Chips, fast food, packaged snacks high in sugar/salt.
High-fat meats: Fried meats, fatty cuts, processed meats like bacon.
Trans fats
Excessive alcohol

Which type 1 or type 2 diabetes is more complicated to manage?

Both Type 1 and Type 2 diabetes present unique challenges, and the complexity of management depends on individual circumstances.

Type 1 Diabetes: The risk of hypoglycemia (low blood sugar) is higher, especially during sleep or intense activity. Long-term complications (e.g., nerve damage and kidney issues) are a concern if glycemic control is poor. It’s often diagnosed in childhood, so lifelong adaptation is needed.
Type 2 Diabetes: Strongly related to lifestyle, so maintaining a consistent diet, weight, and exercise habits is critical, but adherence is an issue for many. Comorbidities like obesity, hypertension, or heart disease often complicate treatment. It’s typically diagnosed in adults, but younger people are increasingly affected.

Type 1 is often more complicated due to its immediate and total reliance on external insulin and tighter monitoring. However, Type 2 can become equally complex if poorly controlled or paired with other health conditions.

Can you manage type 2 diabetes without insulin?

Many people manage Type 2 diabetes without insulin through diet, exercise, and medications except insulin(e.g. metformin), especially if caught early. Success depends on consistency and lifestyle modification like obesity or physical inactivity. Regular checkups with a doctor are crucial to adjust the plan and detect complications (e.g., kidney, eye, or nerve issues) in time.

Is fasting good for type 2 diabetes?

Fasting can be a helpful tool for managing Type 2 diabetes for some, particularly for weight loss and insulin sensitivity, but it may not be suitable for all patients. It requires careful planning, monitoring, and medical guidance to ensure safety and effectiveness. Those with stable, early-stage Type 2 diabetes and no major complications may benefit most. Always discuss with a healthcare provider to tailor fasting to your needs and avoid risks.

Practical Tips:

Start Slow: Try time-restricted eating (e.g., 12-hour fasting window) before longer fasts.

Monitor Closely: Use a glucometer to track blood sugar during fasting to avoid lows or highs.
Stay Hydrated
Balanced Meals: Meals with nutrient-dense foods (e.g., vegetables, lean protein, healthy fats) to avoid blood sugar spikes.
Medical Supervision: Consult a doctor or dietitian before starting, especially if you are on medications. They may adjust doses to prevent hypoglycemia.

Is type 2 diabetes genetic?

Type 2 diabetes has a significant genetic component, but genes do not solely determine it. It results from a mix of genetics, lifestyle, and environmental factors.

Genetic component:

Family history is a strong risk factor. If a parent or sibling has Type 2 diabetes, your risk is higher.
Specific genes (e.g., TCF7L2, PPARG) are linked to insulin resistance or impaired insulin production, common in Type 2 diabetes.
These genes affect how the body processes glucose or responds to insulin, but they don’t guarantee diabetes.

Heritability: Studies estimate 20-80% of Type 2 diabetes risk is heritable, varying by population and study. Twin studies show that if one identical twin has it, the other has a 50-90% chance of developing it.

Ethnicity: Certain groups (e.g., African, Hispanic, Native American, South Asian, Pacific Islander) have a higher genetic predisposition to type 2 diabetes.

What are the 10 warning signs of diabetes?

Common warning signs of diabetes are as follows:

Increased thirst/ dry mouth: Excess glucose in the blood pulls water from tissues, causing dehydration and constant thirst (polydipsia).
Frequent Urination: Kidneys try to excrete excess sugar, leading to frequent urination (polyuria), especially at night. Unexplained Weight Loss: It is more prominent in type 1 diabetes. The body cannot use glucose due to no insulin production and starts to break down fat and muscle for energy.
Fatigue or Weakness: Cells can’t use glucose properly due to the lack of insulin, leaving you tired or sluggish.

Blurred Vision: High blood sugar affects the eye lens fluid levels, causing temporary vision changes. Long-standing diabetes also causes disruption in retinal vessels, impairing vision.
Increased Hunger: Without glucose, cells starve for energy, triggering hunger (polyphagia). More pronounced in Type 1; Type 2 may be subtler.
Slow-Healing Wounds or Frequent Infections: High glucose impairs circulation and immune function, delaying cuts/bruises healing or causing recurring infections (e.g., urinary, skin, or yeast infections).
Tingling or Numbness: Nerve damage from prolonged high sugar (neuropathy) causes tingling in hands/feet.
Darkened Skin Patches: Acanthosis nigricans dark, velvety skin (neck, armpits) signals insulin resistance.

How do you feel when your blood sugar is too high?

When blood sugar levels rise above normal (typically >180 mg/dL post-meal or >130 mg/dL fasting), you might feel:

Thirst and Dry Mouth: Increased urination (to excrete excess glucose) leads to dehydration, making you very thirsty.
Frequent Urination: The kidneys work overtime to filter glucose, causing frequent urination.
Fatigue: Cells can’t use glucose effectively due to insulin resistance, leaving you tired or sluggish.
Blurred Vision: High glucose can affect the lenses in your eyes, causing temporary vision changes. Retinal vasculopathy may be another cause.
Hunger: Despite eating, cells may not get enough energy, triggering cravings (often for carbs).
Headaches: Dehydration and glucose imbalances can cause mild to moderate headaches.
Irritability or Brain Fog: High sugar can affect mood and mental clarity.
Slow-Healing Wounds: Elevated glucose impairs circulation and immune response leading to slow healing wounds.
Tingling or Numbness: Prolonged high blood sugar may cause neuropathy, leading to tingling or numbness in hands or feet.

What is a good diet for type 2 diabetes?

The diet for type 2 diabetes should include:

Non-Starchy Vegetables: Leafy greens (spinach, kale), broccoli, cauliflower, zucchini, peppers, mushrooms. The ingredients are low in carbs, high in fiber, vitamins, and antioxidants.
Whole Grains: Quinoa, brown rice, barley, oats, whole-grain bread.
Lean Proteins: Chicken (skinless), turkey, fish (salmon, tuna), eggs, tofu, legumes (lentils, chickpeas). Protein supports muscle health, keeps you satiated longer.
Healthy Fats: Avocado, nuts (almonds, walnuts), seeds (chia, flax),