mood; quality of life experiences and expectations; financial, social, and emotional resources; and psychiatric history. Patients should also be routinely screened for such issues as depression and diabetes-related distress, anxiety, eating disorders, and impairment of cognitive functioning (ADA, 2021o; Grygotis, 2016). Support groups for diabetics may offer some therapeutic value. In addition, group exercise such as yoga, workout groups, or Hypoglycemia prevention Hypoglycemia is the primary factor limiting the glycemic management of type 1 and insulin-treated type 2 diabetes. It is imperative that nurses and other members of the health care team instruct patients and families how to recognize signs and symptoms of hypoglycemia, identify situations that increase their Immunizations There are several recommendations for adults who have diabetes mellitus (ADA, 2021c). ● Provide routinely recommended vaccinations for adults with diabetes by age. Children should also receive routine vaccinations by age. ● Administer Hepatitis B vaccine for persons less than 60 years of age. For persons over 60 healthcare providers should be consulted. ● Administer HPV vaccine to persons 26 years old and under. Persons between the ages of 27-45 years may also be vaccinated after consulting with their healthcare providers. ● Administer influenza vaccine to all patients annually. All patients should be advised not to receive live attenuated influenza vaccine. Obesity management Overweight and obesity contribute to a myriad of health problems. There is significant evidence that managing obesity can delay the progression from prediabetes to type 2 diabetes and may contribute to successful management of type 2 diabetes (ADA, 2021j). The ADA (2021j) recommends that BMI be calculated and documented at all patient visits. Additional recommendations state that overweight and obese patients should participate in a regimen of diet, physical activity, and behavioral therapy to achieve >5% weight loss. Furthermore, such interventions should be individualized to the patient. After weight loss goals have been achieved, diet, physical activity, and behavioral therapy should be continued to maintain weight loss and achieve treatment goals. Metabolic surgery Metabolic surgery is the phrase used to describe surgery and procedures that treat metabolic diseases, especially type 2 diabetes (ADA, 2021j). Bariatric surgery that aims to treat comorbid conditions, such as diabetes mellitus associated with obesity, is called as metabolic surgery. Metabolic surgery is usually limited to patients with a body mass index (BMI) >35. The surgeon typically connects one end of the stomach to an opening in the new stomach pouch. After this surgery, when you eat, food bypasses most of the stomach and the first part of the small intestines. That makes this surgery both restrictive and malabsorptive. Following are recommendations and suggestions for metabolic surgery (ADA, 2021j). ● Recommend metabolic surgery as an option for the treatment of type 2 diabetes in appropriate surgical candidates with BMI > 40 kg/m2 (BMI >37.5 kg/m2 in Asian Americans and in adults with BMI 35.0-39.9 kg/m2 (32.5-37.4 kg/m2 in Asian Americans. ● Suggest metabolic surgery as an option for adults with type 2 diabetes and BMI 30.0 to 34.9 kg/m2, (27.5 to 32.4 kg/m2 in Pancreas transplant A pancreas transplant is performed to implant a healthy pancreas from a deceased donor into a patient with diabetes. Almost all pancreas transplants are done to treat cases of type 1 diabetes and are usually reserved for those patients with serious diabetes complications because side effects of transplantation are
swimming exercise classes can provide both psychosocial support and a physical benefit for weight loss and improved cardiovascular condition. Meditation, pet therapy, behavioral therapy, and religious support may be of interest to some patients. Antidepressant medication may be considered if needed (ADA, 2021o; Grygotis, 2016).
risk for hypoglycemia such as fasting, during or after intense exercise, and during sleep. They must be taught to balance insulin use, carbohydrate intake, and exercise to prevent and reduce hypoglycemic episodes (ADA, 2021e).
● Administer pneumonia PPSV23 pneumovax to persons 19-64 years of age. Persons 65 and older should receive a second dose at least five years from prior pneumovax vaccine. ● There are no recommendations for the administration of pneumonia (PCV13 Prevnar) to persons 19-64 years of age. For persons 65 and older who are not immunocompromised, have a cochlear implant, or cerebrospinal fluid leak, decisions must made in conjunction with their healthcare providers. ● Administer tetanus, diphtheria, pertussis (TDAP) to all adults with a booster every 10 years. All adult pregnant women should have an extra dose of this vaccine. ● Administer Zoster vaccine to all persons 50 years of age or older (two-dose Shingrix even if previously vaccinated). ● COVID vaccinations for all patients, as permitted by age. Healthcare Professional Consideration: It is important that patients’ medication regimens be evaluated for their impact on weight. This evaluation should include all the medications the patient takes: prescription drugs, over-the-counter supplements, and herbal preparations. If necessary, weight loss medications may be prescribed to help lose weight. Potential benefits of these medications should be weighed against potential risks and side effects (ADA, 2021j). Patients should be cautioned not to take any weight loss products without prior consultation with their health care providers. Asian Americans, if hyperglycemia is inadequately controlled despite appropriate medical intervention. ● Metabolic surgery should be done in health care facilities that perform high-volume numbers of such surgeries and where multidisciplinary teams experienced in metabolic surgery work. ● Provide long-term support and monitoring of patients who have undergone metabolic surgery according to national and international standards. ● Perform a comprehensive mental health evaluation before surgery. ● Postpone surgery in patients with histories of alcohol abuse, substance abuse, depression, suicidal ideation, and other mental health concerns until these issues have been adequately addressed. ● Evaluate the need for ongoing mental health services to help with medical and psychosocial changes post-surgery. Research has shown that metabolic surgery leads to “superior glycemic control and reduction of cardiovascular risk factors in obese patients with type 2 diabetes compared with various lifestyle/medical interventions” (ADA, 2021j). significant. The pancreas must be meticulously matched to the recipient and is transported in a cooled solution that preserves the organ for up to approximately 15 to 20 hours. Once a pancreas becomes available, it must be transplanted into a recipient within 18-24 hours. Pancreas transplant is often done in conjunction
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