St.

Paul University Philippines

Tuguegarao City, Cagayan 3500

SCHOOL OF NURSING and ALLIED HEALTH SCIENCES

Nursing Program

GOAL: To provide knowledge on prevention, management, and control of diabetes mellitus type 2

THEME: Sweet Life of Preventing and Managing Diabetes Type 2

TOPIC/S: Diabetes Mellitus Type 2 and its prevention and management techniques

PARTICIPANTS: Staff and Employees of St. Paul University Philippines

OBJECTIVE CONTENT METHODOLOGY TIME PERSON RESOURCES EVALUATION

FRAME RESPONSIBLE NEEDED METHOD
At the end of the
session the student
nurses will be able to:

Provide an introduction INTRODUCTION Using the visual 5 mins. Health Educator Pamphlet, Powerpoint Recitation among
about T2DM There is growing burden of Type 2 aids to be provided, presentation participants and ice
Diabetes Mellitus (T2DM) in the student nurses breaker games
Philippines and is a major public health will discuss the containing the
issue. The transition of traditional introduction on contents of the
teaching to online teaching and T2DM teaching plan
adjustments of staffs and employees due
to the ongoing pandemic may cause
stress. According to research studies,
identified stressors such as family losses
and workplace stress as factors
triggering the onset of diabetes, both
type 1 and type 2. Today, we will talk
about the modifiable and non-
 modifiable risk factors that contribute to
having T2DM, its prevention, and its
management and control.
Provide an overview on WHAT IS DIABETES TYPE 2? The student nurses 10 mins. Health Educator Pamphlet, Powerpoint
diabetes mellitus type 2 defining T2DM and presentation
and its causes Type 2 diabetes (also called type 2 discuss its causes
modifiable and non- diabetes mellitus) is a disorder that is will be enumerating
modifiable risk factors known for disrupting the way your body the modifiable and
uses glucose (sugar); it also causes other non-modifiable risk
problems with the way your body stores factors/causes
and processes other forms of energy,
including fat.

WHAT IS THE CAUSE OF T2DM?

In prediabetes — which can lead to type
2 diabetes — and in type 2 diabetes,
your cells become resistant to the action
of insulin, and your pancreas is unable
to make enough insulin to overcome this
resistance. Instead of moving into your
cells where it’s needed for energy, sugar
builds up in your bloodstream. Exactly
why this happens is uncertain, although
it’s believed that genetic and
environmental factors play a role in the
development of type 2 diabetes too.
Being overweight is strongly linked to
the development of type 2 diabetes, but
not everyone with type 2 DM is
overweight.

Genetic causes — Many people with

type 2 diabetes have a family member
with either type 2 diabetes or other
medical problems associated with
diabetes, such as high cholesterol levels,
high blood pressure, or obesity.

Researchers don’t fully understand why

some people develop prediabetes and
type 2 diabetes and others don’t. It’s
clear that certain factors increase the
risk, however, including:

Weight. The more fatty tissue you have,

the more resistant your cells become to
insulin.

Inactivity. The less active you are, the

greater your risk. Physical activity helps
you control your weight, uses up
glucose as energy and makes your cells
more sensitive to insulin.

Family history. Your risk increases if a

parent or sibling has type 2 diabetes.

Race or ethnicity. Although it’s unclear

why, certain people — including Black,
Hispanic, American Indian and Asian
American people — are at higher risk.

Age. Your risk increases as you get

older. This may be because you tend to
exercise less, lose muscle mass and gain
weight as you age. But type 2 diabetes is
also increasing among children,
adolescents and younger adults.

Gestational diabetes. If you developed

gestational diabetes when you were
pregnant, your risk of developing
prediabetes and type 2 diabetes later
increases. If you gave birth to a baby
weighing more than 9 pounds (4
kilograms), you’re also at risk of type 2
diabetes.

Polycystic ovary syndrome. For

women, having polycystic ovary
syndrome — a common condition
characterized by irregular menstrual
periods, excess hair growth and obesity
— increases the risk of diabetes.

High blood pressure. Having blood

pressure over 140/90 millimeters of
mercury (mm Hg) is linked to an
increased risk of type 2 diabetes.

Abnormal cholesterol and triglyceride

levels. If you have low levels of high-
density lipoprotein (HDL), or “good,”
cholesterol, your risk of type 2 diabetes
is higher. Triglycerides are another type
of fat carried in the blood. People with
high levels of triglycerides have an
 increased risk of type 2 diabetes. Your
doctor can let you know what your
cholesterol and triglyceride levels are.

To list out and explain T2DM SYMPTOMS The student nurses 30 mins. Health Educator Pamphlet, Powerpoint
the manifestations and will be discussing to presentation
laboratory tests of Symptoms — Before being diagnosed the participants on
diabetes mellitus type 2 with type 2 diabetes, most people have how to identify
no symptoms at all. In those who do symptoms and what
have symptoms, the most common to vital sign to
include: monitor which is
affected by diabetes.
 Increased thirst Laboratory
 Frequent urination exams/tests will
 Increased hunger also be enumerated
 Unintended weight loss and will be
 Fatigue explained along
 Blurred vision with its preparation.
 Slow-healing sores
 Frequent infections
 Areas of darkened skin, usually
in the armpits and neck
BLOOD PRESSURE is also affected
by prolonged untreated diabetes.
Diabetes damages arteries and makes
them targets for hardening, called
atherosclerosis. That can cause high
blood pressure, which if not treated,
can lead to trouble including blood
vessel damage, heart attack, and kidney
failure.
LABORATORY EXAMS and TESTS

Laboratory tests — The main test

doctors use to diagnose diabetes is a
blood glucose (sugar) test. This can be
done in several different ways:

●Random blood sugar test – For a

random blood sugar test, you can have
blood drawn at any time throughout the
day, regardless of when you last ate. A
normal random blood sugar level is
between 70 and 140 mg/dL (3.9 to 7.8
mmol/L).
●Fasting blood sugar test – A fasting
blood sugar test is a blood test done
after not eating or drinking for 8 to 12
hours (usually overnight). A normal
fasting blood sugar level is less than 100
mg/dL (5.6 mmol/L).
●Hemoglobin A1C test – The "A1C"
blood test measures your average blood
sugar level over the past two to three
months. Normal values for A1C are 4 to
5.6 percent. The A1C test can be done at
any time of day (before or after eating).
●Oral glucose tolerance test – Oral
glucose tolerance testing (OGTT) is a
test that involves drinking a special
glucose solution (usually orange or cola
flavored). Your blood sugar level is
tested before you drink the solution and
then again one and two hours after
drinking it. Because of its
inconvenience, OGTT is not commonly
used for testing, except in pregnant
women.
To explain the COMPLICATIONS OF T2DM The student nurses 15 mins. Pamphlet, Powerpoint
complications of Long-term complications of diabetes will be discussing to presentation
untreated and poorly develop gradually. The longer you have the participants on
managed diabetes diabetes — and the less controlled your the complications of
mellitus type 2 blood sugar — the higher the risk of T2DM which is
complications. Eventually, diabetes caused by prolonged
complications may be disabling or even uncontrolled BP and
life-threatening. Possible complications Blood sugar.
include:

 Cardiovascular
disease. Diabetes dramatically
increases the risk of various
cardiovascular problems,
including coronary artery disease
with chest pain (angina), heart
attack, stroke and narrowing of
arteries (atherosclerosis). If you
have diabetes, you're more likely
to have heart disease or stroke.
 Nerve damage
(neuropathy). Excess sugar can
injure the walls of the tiny blood
vessels (capillaries) that nourish
your nerves, especially in your
legs. This can cause tingling,
numbness, burning or pain that
usually begins at the tips of the
 toes or fingers and gradually
spreads upward.
Left untreated, you could lose all
sense of feeling in the affected
limbs. Damage to the nerves
related to digestion can cause
problems with nausea, vomiting,
diarrhea or constipation. For men,
it may lead to erectile dysfunction.

 Kidney damage
(nephropathy). The kidneys
contain millions of tiny blood
vessel clusters (glomeruli) that
filter waste from your blood.
Diabetes can damage this delicate
filtering system. Severe damage
can lead to kidney failure or
irreversible end-stage kidney
disease, which may require
dialysis or a kidney transplant.
 Eye damage
(retinopathy). Diabetes can
damage the blood vessels of the
retina (diabetic retinopathy),
potentially leading to blindness.
Diabetes also increases the risk of
 other serious vision conditions,
such as cataracts and glaucoma.
 Foot damage. Nerve damage in
the feet or poor blood flow to the
feet increases the risk of various
foot complications. Left untreated,
cuts and blisters can develop
serious infections, which often
heal poorly. These infections may
ultimately require toe, foot or leg
amputation.
 Skin conditions. Diabetes may
leave you more susceptible to skin
problems, including bacterial and
fungal infections.
 Hearing impairment. Hearing
problems are more common in
people with diabetes.
 Alzheimer's disease. Type 2
diabetes may increase the risk of
dementia, such as Alzheimer's
disease. The poorer your blood
sugar control, the greater the risk
appears to be. Although there are
theories as to how these disorders
might be connected, none has yet
been proved.
  Depression. Depression
symptoms are common in people
with type 1 and type 2 diabetes.
Depression can affect diabetes
management

To explain HOW TO MANAGE/CONTROL The student nurses 15 mins. Health Educator Pamphlet, Powerpoint
interventions that help T2DM? will be discussing to presentation
control and manage In type 2 diabetes, your pancreas is still the participants on
T2DM to prevent working but not as effectively as it maintaining BP and
complications and needs to. This means your body is blood sugar through
further damage building insulin resistance and is unable lifestyle
to effectively convert glucose into modifications in
energy leaving too much glucose in the order to control the
blood. Type 2 diabetes can sometimes diseases and prevent
initially be managed through lifestyle complications
modification including a healthy diet,
regular exercise and monitoring your
blood glucose levels.

 Eating well helps manage your

blood glucose levels and your
body weight
 Exercising helps the insulin
work more effectively, lowers
your blood pressure and reduces
the risk of heart disease.
 Regular blood glucose
monitoring tests whether the
treatment being followed is
helping to manage blood
glucose levels or whether you
need to adjust your treatment.

The aim of diabetes management is to

keep blood glucose levels as close to the
target range between 4 to 6 mmol/L
(fasting), this will help prevent both
short-term and long-term complications.

However, sometimes healthy eating and

exercise is not enough to keep blood
glucose levels within target range. Type
2 diabetes is a progressive condition.
Over time the pancreas produces less
insulin and the body may continue to be
resistant to insulin if lifestyle changes
such as weight loss and increased
physical activity are not made. Insulin
helps convert glucose into energy,
which means that as type 2 diabetes
progresses, the pancreas may not be able
to produce enough insulin to meet the
body’s requirements. To help the
pancreas produce more insulin, or to
make the insulin that the body produces
work better, people with type 2 diabetes
are often prescribed tablets to keep their
blood glucose levels in target range.

Eventually it may be necessary to start

taking insulin to manage blood glucose
levels. This is when your body is no
longer producing enough insulin of its
own. Sometimes tablets may be
continued in addition to insulin.

If you require medication as treatment,

it is important to note that this is part of
the natural progression of the condition,
and taking medication when required
can result in fewer complications in the
 long-term.

The tablets or injections are intended to

be used together with healthy eating and
regular physical activity, not as a
substitute.

Monitoring of BP and Blood Glucose

Levels
This helps provide information about
the current condition of clients and aids
in early treatment to prevent
complications.

Daily Weight Monitoring

Weight gain could affect diabetes
progression. It is of importance to
monitor weight every morning before
eating breakfast to gather accurate data
and help with adjustments of treatment
regimen.
To provide information The American Diabetes Association has The student nurses 15mins. Pamphlet, Powerpoint
based on research on made a diabetes type 2 risk calculator will be enumerating presentation
the prevention of which asks for the client’s simple possible
diabetes mellitus type 2 age, gender, family history, blood ways to help reduce
and stress its pressure, wellness/activeness, the risk of having
importance. race/ethnicity, and Weight and Height T2DM
This has the advantage of being able to
treat the disease much earlier. However,
treating a disease at an early stage only
makes sense if it leads to a better health
outcome than treating it at
a later stage. (Site for the RISK TEST
CALCULATOR:
https://www.diabetes.org/risk-test)

The tool results can be correlated with

current client condition and assessment
such as the blood pressure, current BMI
and symptoms felt by the client.
Therefore, BP monitoring for client is
an essential assessment to help diagnose
T2DM.

Simple steps to lower risk and prevent

T2DM according to Harvard
University

Control your weight

Excess weight is the single most
important cause of type 2 diabetes.
Being overweight increases the chances
of developing type 2 diabetes seven-
fold. Being obese makes you 20 to 40
times more likely to develop diabetes
than someone with a healthy weight.

Losing weight can help if your weight is

above the healthy-weight range. Losing
7-10% of your current weight can cut
your chances of developing type 2
diabetes in half.

Get moving—and turn off the television

Inactivity promotes type 2 diabetes.
Working your muscles more often and
making them work harder improves
their ability to use insulin and absorb
glucose. This puts less stress on your
insulin-making cells. So trade some of
your sit-time for fit-time.

Long bouts of hot, sweaty exercise

aren’t necessary to reap this benefit.
Findings from the Nurses’ Health Study
and Health Professionals Follow-up
Study suggest that walking briskly for a
half hour every day reduces the risk of
developing type 2 diabetes by 30%.
More recently, The Black Women’s
Health Study reported similar diabetes-
prevention benefits for brisk walking of
more than 5 hours per week. This
amount of exercise has a variety of other
benefits as well. And even greater
cardiovascular and other advantages can
be attained by more, and more intense,
exercise.

Television-watching appears to be an
especially-detrimental form of
inactivity: Every two hours you spend
watching TV instead of pursuing
something more active increases the
chances of developing diabetes by 20%;
it also increases the risk of heart disease
(15%) and early death (13%). The more
television people watch, the more likely
they are to be overweight or obese, and
this seems to explain part of the TV
viewing-diabetes link. The unhealthy
diet patterns associated with TV
watching may also explain some of this
relationship.

Tune Up Your Diet

Four dietary changes can have a big
impact on the risk of type 2 diabetes.
1. Choose whole grains and whole grain
products over refined grains and other
highly processed carbohydrates.

2. Skip the sugary drinks, and choose

water, coffee, or tea instead.

3. Choose healthy fats.

4. Limit red meat and avoid processed

meat; choose nuts, beans, whole grains,
poultry, or fish instead.

Don’t smoke

Add type 2 diabetes to the long list of

health problems linked with smoking.
Smokers are roughly 50% more likely to
develop diabetes than nonsmokers, and
heavy smokers have an even higher risk.

Light to moderate alcohol consumption

Evidence has consistently linked
moderate alcohol consumption with
reduced risk of heart disease. The same
may be true for type 2 diabetes.
Moderate amounts of alcohol—up to a
drink a day for women, up to two drinks
a day for men—increases the efficiency
of insulin at getting glucose inside cells.
 And some studies indicate that moderate
alcohol consumption decreases the risk
of type 2 diabetes but excess alcohol
intake actually increases the risk. If you
already drink alcohol, the key is to keep
your consumption in the moderate
range, as higher amounts of alcohol
could increase diabetes risk. If you don’t
drink alcohol, there’s no need to start—
you can get the same benefits by losing
weight, exercising more, and changing
your eating patterns.

Beyond individual behavior

Type 2 diabetes is largely preventable
by taking several simple steps: keeping
weight under control, exercising more,
eating a healthy diet, and not smoking.
Yet it is clear that the burden of
behavior change cannot fall entirely on
individuals. Families, schools,
worksites, healthcare providers,
communities, media, the food industry,
and government must work together to
make healthy choices easy choices.

To provide information The student nurses 15 mins. Health Educator Pamphlet, Powerpoint
on treatment goals and The main goals of treatment in type 2 will be explaining presentation
interventions to manage diabetes are to keep your blood sugar the goals and
and control diabetes levels within your goal range and treat interventions of
mellitus type 2. other medical conditions that go along clients who have
with diabetes (like high blood pressure); T2DM
it is also very important to stop smoking
if you smoke. These measures will
reduce your risk of complications.

Blood sugar control — It is important

to keep your blood sugar levels at goal
levels. This can help prevent long-term
complications that can result from
poorly controlled blood sugar (including
problems affecting the eyes, kidney,
nervous system, and cardiovascular
system).

Blood sugar testing - A random blood

sugar test is based on blood drawn at
any time of day, regardless of when you
last ate. A fasting blood sugar test is a
blood test done after not eating or
drinking for 8 to 12 hours (usually
overnight). A normal fasting blood
sugar is less than 100 mg/dL (5.6
mmol/L), although people with diabetes
may have a different goal.

Reducing the risk of cardiovascular

complications — The most common,
serious, long-term complication of type
2 diabetes is cardiovascular disease,
which can lead to problems like heart
attack, stroke, and even death. On
average, people with type 2 diabetes
have twice the risk of cardiovascular
disease as people without diabetes.

However, you can substantially lower

 your risk of cardiovascular disease by:

●Quitting smoking, if you smoke

●Managing high blood pressure
and high cholesterol with diet,
exercise, and medicines
●Taking a low-dose aspirin every
day, if your health care provider
recommends this

PREPARED BY: MARLCHIEL NATHAN S ARREGLADO BSN-V