The nurse is working with an overweight client who has a high-stress job and smokes. This client has just received a diagnosis of type 2 diabetes mellitus and has just been started on an oral hypoglycemic agent. Which of the following goals for the client which if met, would be most likely to lead to an improvement in insulin efficiency to the point the client would no longer require oral hypoglycemic agents?
A. Comply with medication regimen 100% for 6 months
B. Quit the use of any tobacco products by the end of three months
C. Lose a pound a week until the weight is within the normal range for height and exercise 30 minutes daily
D. Practice relaxation techniques for at least five minutes five times a day for at least five months
Correct Answer: C. Lose a pound a week until the weight is within the normal range for height and exercise 30 minutes daily
When Type II diabetics lose weight through diet and exercise they sometimes have an improvement in insulin efficiency sufficient to the degree they no longer require oral hypoglycemic agents. A diet low in saturated fat, refined carbohydrates, high fructose corn syrup, and high in fiber and monounsaturated fats needs to be encouraged. Aerobic exercise for a duration of 90 to 150 minutes per week is also beneficial. The major target in T2DM patients, who are obese, is weight loss.
Option A: If adequate glycemia cannot be achieved, metformin is the first-line therapy. Following metformin, many other therapies such as oral sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors. Glucagon-like peptide-1 (GLP-I) receptor agonists, Sodium-glucose co-transporter-2 (SGLT2) inhibitors, pioglitazone, especially if the patient has fatty liver disease, alpha-glucosidase inhibitors, and insulin, are available.
Option B: Smokers are 30 to 40 percent more likely to develop type 2 diabetes than nonsmokers. Smoking can also make managing the disease and regulating insulin levels more difficult because high levels of nicotine can lessen the effectiveness of insulin, causing smokers to need more insulin to regulate blood sugar levels.
Option D: Techniques for stress reduction without a full-body movement component that have been studied in diabetes include stress management training, biofeedback training, and progressive muscle relaxation. Techniques that also include a movement component include yoga, Tai Chi, and Qigong.
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