Primary Care Plan for a Patient with Type II Diabetes

Introduction and Primary Care

Primary care for a patient with type II diabetes requires treating the immediate physical symptoms of the illness, limiting risks for future exacerbation, and addressing the psychological and lifestyle factors contributing to the disorder. "In the UK the delivery of primary care is via GP services" (Primary Care, A Dictionary of Nursing, 2008). General Practitioners must prescribe a self-care regimen that a patient can use to manage diabetes on a daily basis. As Peeples and Seley (2007) observe, "If a patient sees a provider for a 10- or 15-minute office visit four times a year, that's equivalent to an hour of interaction annually. But the patient lives with diabetes 8,760 hours a year. Providers diagnose, prescribe and adjust medications, and monitor for complications, but it's the patient who manages the disease every day." It is therefore extremely troubling when a patient believes that the tablets she has been prescribed will cure her.

The GP must make the patient aware of the nature of diabetes: it can be controlled with dietary modifications and medication, but the medication manages blood sugar — it does not cure the disease. Weight loss, exercise, careful dietary management, and blood sugar control are all required to treat diabetes effectively. Unless the patient understands how the disease progresses, she will be unable to engage in appropriate self-monitoring. She also faces additional challenges due to linguistic and cultural barriers. As Peeples and Seley (2007) note, "fewer than one-third of people with diabetes reported that they were able to manage their disease themselves."

Secondary Care and Specialist Support

Diabetes treatment specialists have proven extremely useful in controlling the progression of the illness. Secondary or specialized care can help the patient develop a diet modification program that limits carbohydrates and calories. "Diabetes education has evolved to include systematic description, assessment, and measurement of outcomes related to the following self-care behaviors: healthful eating, being active, monitoring, medication taking, problem solving, reducing risks, and healthful coping" (Peeples & Seley 2007). It should be noted that the patient's difficulties are not entirely physical in nature. Her loneliness and isolation in a country in which she has limited command of English have led her to pour her energies into cooking traditional, hearty meals for her family and to use overeating as a coping mechanism.

Referral to a counselor who speaks her language and can help her address cultural adjustment issues therefore seems essential. Without psychological support, it is unlikely that the patient will feel sufficiently motivated to change her lifestyle. Ideally, diabetes education at the secondary level should also be culturally sensitive and provide dietary and exercise-related suggestions tailored to the patient's background. Proposed menus could reflect her cultural heritage — for example, Mediterranean dishes that emphasize vegetables and legumes rather than sugary sauces and meats. Similarly, walking rather than taking public transportation represents a realistic and accessible form of exercise. The patient should receive regular lipid screening and, where warranted, eye examinations and cholesterol screening.