Insulin Resistance: Risk Factors, Progression, and Prevention (Nursing)

by Rhonda Lawes, PhD, RN

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      Slides Nursing Diabetes Insulin Resistance.pdf
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    00:01 So, how do we end up here? What causes insulin resistance? Well, there's no known risk factors for insulin resistance.

    00:09 That is a good thing.

    00:10 You know, why? Because when we know what the risk factors are we can help mitigate those risk factors.

    00:16 We can help patients come up with a plan and a strategy to minimize the effect of these risk factors.

    00:23 So these are the same risk factors that we discussed for developing type ll diabetes.

    00:28 So the risk factors for insulin resistance are the same ones that we've discussed in this series for type ll diabetes.

    00:35 Now, we have modifiable ones.

    00:37 Those are on the left lifestyle and associated medical conditions are events.

    00:41 And non-modifiable ones that you see on the right race and ethnicity or family history.

    00:48 Ones on the left are the ones we really can focus on with patients to help them make healthier choices.

    00:54 That's kind of a funny title for that one, is it? The Road to Type ll Diabetes.

    00:59 Sounds like a trip you'd want to go on but really it is not.

    01:04 Let's review what we know.

    01:06 Remember the beta cells in the pancreas, will they can kind of secrete insulin? But the insulin released by the pancreas is variable.

    01:13 Sometimes it's a lot, sometimes it's not enough as it's wearing off.

    01:17 That's because the insulin resistance is likely present.

    01:21 So, this is a patient, we need them to monitor their blood sugar regularly and we need to change their meds as required.

    01:27 Now as this disease progresses that decides what the treatment plan needs to be.

    01:32 So initially it may be able to be treated with lifestyle or lifestyle plus oral meds.

    01:38 Eventually, if the disease is allowed to progress and we don't delay the onset, the patients eventually going to need the use of insulin.

    01:47 That's when the pancreas can no longer put out insulin and the body cannot use it.

    01:52 So we can help.

    01:54 But do we really? I put this title in here because I wanted you to pause for just a minute.

    02:01 We've talked about a lot about the physiology.

    02:03 Now, I want to talk about the psychology.

    02:06 Because see my role as a nurse is to use, use the spirit of motivational interviewing.

    02:13 See I'm not supposed to give the patient a list of things that they should and shouldn't do.

    02:18 My role as a health care provider and educator is to help them understand.

    02:25 Hey, what are the things that are most important to you in your life? Let me show you how making some simple choices can help you get there.

    02:33 See if your type ll diabetic or on your way to type ll diabetes, you're not going to have as much energy.

    02:39 So what are the things you really like to do? Sometimes we get so judgmental about things like excess body weight.

    02:46 We think about smoking, about lack of regular exercise or not enough sleep.

    02:51 These are all factors that can contribute.

    02:54 But the conversations that we have with patients about these factors have to be therapeutic.

    03:00 They need to come from a level playing field.

    03:03 Acknowledge these are difficult habits to tackle.

    03:06 If someone has struggles with body weight, that's very personal.

    03:09 It's also difficult for them to change smoking.

    03:12 Oh my, I have never had this challenge in my life.

    03:16 But man, I can imagine it is really difficult.

    03:19 Your brain loves nicotine.

    03:22 Lack of regular exercise, not getting enough sleep, these are classic problems of a busy society.

    03:28 So without judgment but with empathy and developing a therapeutic relationship, help your patient recognize what is the next best small step they can take in making progress in those areas? Because see, we are modifiers.

    03:44 We're not people that are in authority that tell them what they can and can't do.

    03:48 We're modifiers, we come alongside the patient and help them recognize the value of making small changes and when they're successful in that change, we celebrate with them and help them make the next changed.

    04:02 Always keeping in mind, it's the patient's right to choose how they want to care for themselves.

    04:08 So how do you help them take the next step? Well, you want to recognize that simple changes to diet and food choices can make a big difference and remember on a cellular level.

    04:20 We want to find them ways to help increase activity that are positive.

    04:24 Oh, there's so many programs, if this person has not been active at all.

    04:28 Look for programs that will reward them for taking a certain amount of steps a day or look for simple ways for them to just become more active.

    04:36 Now, have them work towards decreasing the amount of smoking.

    04:40 Very difficult habit to me.

    04:42 So don't criticize them, don't judge them.

    04:45 Recognize and acknowledge where they are validate, that this is a difficult choice but give them the support they need to take the steps.

    04:53 So help them identifying new patterns that will help increase their sleep.

    04:58 Maybe turn that cellphone off a little earlier decreasing the screen time.

    05:02 There's lots of simple things that you can do to help to increase sleep because see, we really can make a difference.

    05:10 We can help a patient reduce the risk factors for developing insulin resistance.

    About the Lecture

    The lecture Insulin Resistance: Risk Factors, Progression, and Prevention (Nursing) by Rhonda Lawes, PhD, RN is from the course Diabetes Type 1 and 2: Introduction and Risk Factors (Nursing).

    Included Quiz Questions

    1. Family history
    2. Lifestyle
    3. Associated medical conditions
    4. Weight
    1. Modify lifestyle
    2. Subcutaneous insulin
    3. Oral antihyperglycemic medication
    4. Insulin resistance cannot be treated
    1. Encourage the client to take small steps in making healthy modifications to their lifestyle
    2. Provide teaching about self-administration of subcutaneous insulin using the teach-back method
    3. Provide the client with a list of modifications they should make with specific deadlines
    4. Educate about diabetic ulcers and amputations to drive them into a healthier lifestyle

    Author of lecture Insulin Resistance: Risk Factors, Progression, and Prevention (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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