Diabetes Mellitus-Type II

What is Diabetes Mellitus-type II?

Diabetes Mellitus-type II is a disorder with hereditary and environmental factors characterized by abnormal insulin secretion, elevated blood glucose levels, and a variety of potential complications of various organ systems . A person with type II diabetes mellitus is not dependent on insulin (non-insulin-dependent diabetes mellitus, NIDDM) as is someone with type I (insulin-dependent diabetes mellitus, IDDM). Diabetes may be a primary or secondary diagnosis.

Cause?

This disease has no distinct etiology, pathogenesis, specific clinical findings or laboratory tests. The clinical syndrome always involves hypergylcemia, large vessel disease, disease of the retina and kidney, and neuropathy. Onset is usually after age 30.

ASSESSMENT

Areas:

• muscle strength by groups of muscles.
• fine motor skills, manipulation, dexterity, and bilateral coordination.
• grip and pinch strength .
• balance and postural control.
• sensory registration.
• sensory processing ( tactile, pain, proprioceptive, vibration) of the feet, hands, and limbs.
• perception skills, especially visual
• self concept.
• role behavior.
• daily living skills.
• productivity history, skills, interests, and values.
• leisure interests and skills.

Instruments

No specific instruments developed by occupational therapists were identified in the literature. The following types instruments may be useful:

• dynamometers and pinch meters.
• two-point discrimination tool, such as Disk-Criminator or Boley gauge.
• coordination/dexterity tests, such as the Purdue Pegboard Dexterity Test.
• balance beam and tilt board.
• activities of daily living scale.
• occupational history.
• leisure checklist.

PROBLEMS

Motor:

• The person may have general weakness and loss of weight.
• The person usually has decreased endurance and physical tolerance and fatigues easily.
• The person may have loss of reflexes or reactions.
• The person may have muscle aches and pains.
• The person may have specific muscle weaknesses, such as in the intrinsics of the foot (diabetic neuropathy).
• The person may have flexion contractures in the hand.
• The person may have impaired circulation associated with diabetes, which may cause myocardial or cerebral infarction or result in amputation of a leg.
• The person may have renal disease associated with diabetes.

Sensory:

• The person may have loss of vision and other eye changes (diabetic retinopathy, diabetic retinitis, diabetic cataract).
• The person may have loss of the sense of touch.
• The person may experience paresthesia, hyperesthesia, or hypoesthesia.
• The person may lose vibration and position sense.
• The person may have decreased sensitivity to pain in the extremities but experience chronic pain in other parts.
• The person may have decreased temperature sensation.

Cognitive:

Cognitive faculties are not affected directly by the disorder.

Intrapersonal:

• The person mat fear being dependent on insulin.
• The person may have anxiety about living with diet restrictions.
• The person may become depressed or angry. (why me?)
• The person may become irritable.
• The person may be easily be discouraged.
• The person may worry about the future.

Interpersonal:

The person may have decreased social activities due to fatigue or diet restrictions.

Self-Care:

The person may learn to administer insulin, whether orally or by injections.

Productivity:

The person may be unable to perform productive activities due to fatigue.

Leisure:

The person may have stopped participating in his/her favorite leisure activities due to fatigue.

TREATMENT/MANAGEMENT

Models of treatment do not appear to be well established but include aspects of compensation/substitution, biomechanical, and human occupation models.

Motor:

• Increase muscle strength through the use of specific activities.
• Increase endurance and physical tolerance through the use of functional activities.
• Provide a home program to maintain movements of feet and ankles and decrease edema, such as picking up small objects with the toes or rolling a bottle back and forth with the feet.
• Biofeedback ma be helpful in increasing circulation, maintaining temperature in the extremities, decreasing heart rate and pressure; and maintaining or increasing muscle contraction.
• Serial casting may be used to prevent contractures and increase joint mobility during or after ulcer healing of the foot.

Sensory:

• Maintain sensory awareness, especially in the feet,through the use of foot activities and games or biofeedback.
• If sensory loss has occurred, provide opportunity to practice compensatory skills using remaining sensory systems as backups or substitutes.

Cognitive:

• Instruct the person on concepts of energy conservation and work simplification.
• If sensory loss has occurred, instruct the person on safety requirements necessary to avoid injury.
• Instruct the person in time management to organize cycles of rest and activity.
• Assist in instructing the person to modify diet according to recommended guidelines,including changing recipes and planning meals menus.
• Assist in instructing the person secondary complications of diabetes, such as decreased tactile awareness(routine visual inspection especially of the feet needed), circulation impairment ( shoes designed to protect against pressure should be worn), and visual problems (relationship of increased systolic pressure to retinal aneurysms).
• Instruct the person on the relationship of exercise to blood sugar level.

Intrapersonal:

• Maintaining or increase the person's self-concept and sense of mastery.
• Maintaining or increase the person's self-identity and sense of self-responsibility.
• Increase the person's coping skills needed to adjust to life with disability but not a handicap.
• Provide instruction and practice in relaxation techniques to reduce stress.

Interpersonal:

• Encourage the person to maintain dyadic relationship.
• Support group interaction, including a support self-help group for persons and families with diabetes.
• Assist the family to adjust roles and functions to maintain the person's active participation in the family unit.

Self-Care:

• Provide adapted equipment, if neccessary, to facilitate performance of self-care activities.
• Encourage the person to maintain independence in activities of daily living.

Productivity:

• Explore possible needs for modifications in the work or home environment to conserve energy and simplify work tasks.
• If the current jobs situation is dangerous to the person's health, explore alternative vocational interests.
• Encourage the person to participate in home-management tasks.

Leisure:

• Assist the person to determine which leisure interests must be modified or discontinued.
• Assist the person to explore new interests to replacethose that cannot be continued.
• Provide information on available community programs and resources.

PRECAUTIONS :

• Observe the person for symptoms of insulin shock
• Observe safety rules.

PROGNOSIS AND OUTCOME:

• The person has sufficient strength and endurance to perform activities of daily living.
• The person demonstrates the use of good energy-conservation and work-simplification techniques during functional activities.
• The person demonstrates time-management skills in regulating physical activities according to rest and activity cycles based on insulin and diet considerations.
• the person demonstrates knowledge regarding skin care to prevent skin breakdown.
• The person has learned compensatory skills for any sensory loss and can perform activities safely.
• the person has learned coping skills to live within restrictions of the disease without becoming handicapped.