NursingLevel: Intermediate

Type 2 Diabetes Nursing Care Plan and Patient Education

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Problem Statement / Assignment Scope

Mrs L, 54, has had type 2 diabetes for six years. Her HbA1c is 9.8% (84 mmol/mol), fasting glucose 210 mg/dL (11.7 mmol/L), she has reduced feeling in both feet, and she isn't sure how to count carbohydrates. Write an evidence-based care plan focused on self-management.

Prerequisites: How insulin and glucose regulation work, current glucose targets, and diabetes medicines.

Step-by-Step Worked Solution

1. What's happening

In type 2 diabetes the body's cells respond poorly to insulin and the pancreas gradually makes less of it. Months of high blood glucose damage small blood vessels and nerves, leading to kidney disease, eye disease and peripheral neuropathy, which is what has dulled the feeling in Mrs L's feet.

2. Nursing diagnoses

Deficient knowledge of diabetes self-management related to a complex treatment plan, as shown by an HbA1c of 9.8%.
Risk for impaired skin integrity related to peripheral neuropathy and reduced sensation in both feet.

3. Interventions and rationales

Foot care teaching: check both feet every day, using a mirror for the soles; never walk barefoot; test bath water with an elbow or thermometer. Without normal sensation, small injuries go unnoticed and can become ulcers.
Home glucose monitoring: show her how to test and record readings before meals and at bedtime. The record lets the team adjust her medicines safely.
Carbohydrate awareness: work with a dietitian on simple portion guides she can use at home, then check her understanding with teach-back.

Key Takeaways & Core Principles

An HbA1c below 7.0% (53 mmol/mol) is a common target for most non-pregnant adults, adjusted to the person.
Neuropathy removes the warning signal of pain, so daily foot checks are key to preventing ulcers and amputation.
Use teach-back to confirm the patient has understood, rather than asking "Do you understand?"
Give glucose values in the units your course uses: mg/dL or mmol/L.

Frequently Asked Questions

What is the 15-15 rule for low blood glucose?

If glucose is below 70 mg/dL (3.9 mmol/L), take 15 g of fast-acting carbohydrate, such as about 120 ml of fruit juice, wait 15 minutes and test again. Repeat if it's still low, then have a snack or meal once it has recovered.

Academic References & Standards

[1]American Diabetes Association. (2024). Standards of Care in Diabetes—2024. Diabetes Care, 47(Suppl. 1), S1-S345. Source Link

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