Priority T2DM diagnoses: risk for unstable blood glucose → ineffective health self-management → risk for injury → risk for impaired skin integrity → deficient knowledge. Targets: A1C < 7% (individualized), BP < 130/80, LDL < 100. Metformin first-line; add GLP-1 RA or SGLT2 inhibitor for ASCVD/HF/CKD. Self-monitoring, MNT, daily foot inspection, and annual screening drive outcomes.
Assessment
Subjective: polyuria, polydipsia, polyphagia, fatigue, blurred vision, slow-healing wounds, numbness/tingling.
Objective: A1C ≥ 6.5%, fasting glucose ≥ 126, random ≥ 200 with symptoms, BMI ↑, decreased sensation on monofilament, microalbuminuria, elevated LDL, BP ≥ 130/80.
Priority NANDA-I diagnoses
- Risk for unstable blood glucose level.
- Ineffective health self-management.
- Risk for injury (falls, hypoglycemia).
- Risk for impaired skin integrity (foot ulcers).
- Deficient knowledge.
NOC outcomes
- A1C < 7% at 6 months (individualized).
- Fasting glucose 80–130; postprandial < 180.
- BP < 130/80; LDL < 100 (< 70 with ASCVD).
- Patient performs SMBG technique correctly.
- Demonstrates daily foot inspection.
NIC interventions and rationale (2024 ADA)
- Teach SMBG, injection technique, and sick-day rules — self-management is the highest-yield intervention.
- Metformin first-line; add GLP-1 RA or SGLT2 inhibitor for ASCVD / HF / CKD; insulin if A1C > 9%.
- Hypoglycemia protocol: 15 g fast carbs, recheck in 15 min; IM glucagon or IV dextrose if unconscious.
- Refer to registered dietitian for MNT — reduces A1C 1–2%.
- Refer to CDCES for DSMES.
- Annual dilated eye exam, monofilament foot exam, urine albumin, lipid panel.
- ACEi/ARB for BP or albuminuria; statin per risk.
- Vaccinations: flu, pneumococcal, hepatitis B, RSV.
Evaluation
3 months: A1C 6.5%, BP 128/78, patient logs SMBG twice daily, correct injection technique, no hypoglycemia. Outcomes met.