Type 2 Diabetes (Tablet Controlled)

The Condition

The client has type 2 diabetes mellitus which is controlled with tablets. As a result his blood sugar
control is poor. Complications of prolonged poor blood sugar control include heart disease, strokes,
kidney failure, peripheral vascular disease (PVD) and eye complications. To help control the blood
sugar his prescribed medication (500mg of Metformin) must be given regularly at the same time in
relation to their meals. The timing of the tablets in relation to the meals should be sought from the
GP. A diary should be kept to record blood sugars as this will inform the GP about the success or
failure of current management. This diary should include the timings of meals and the blood sugar
recording.

The Risks

Heart disease - may manifest acutely as chest pain, shortness of breath, collapse,
palpitations, irregular heart rhythms, nausea, light headedness or sweating.
of note, diabetes can mask the symptoms of a heart attack (a silent heart
attack) and so extra vigilance is needed.

Strokes - common signs include slurred speech, a fallen face and weak arms. This
is an emergency and an ambulance must be called

Kidney failure - picked up by blood tests by a medical professional. However, symptoms
include changes in urination, swelling, fatigue, itching, bad breath,
nausea and vomiting and shortness of breath.

PVD - leg pain on movement, relieved by rest, numbness or tingling in the legs,
poor healing after injury, the skin going pale and cold

Eye complications - any worsening off vision or oaters in the visual eld reported must be
reported to the GP

Potential Emergencies

If his diabetic medication is given and meal is not taken there is a risk of a dangerously low blood
sugar as a result. A glucose containing solution (liase with GP) should be available in place of care.
Alternative sugary snacks may also be acceptable. Symptoms may include feeling light headed,
sweating, mood changes and a drop in consciousness. If these do not resolve after measures have
been taken to give glucose then emergency help should be sought.

Also if there any signs of stroke an ambulance should be called

Other ongoing issues

Their GP will need to do regular blood tests to ensure kidney function is preserved, as well control
their blood pressure more aggressively than a non - diabetic patient and refer them to eye
specialists for inspection of the back of the eyes. if blood sugar is problematic than specialist
diabetologist advice may be needed. A normal blood sugar is 4 - 7 mmil/L although the GP should
offer a wider range which is considered acceptable management.