week 6: diabetes and obesity

1. describe the pathophysiology and clinical manifestations of Type 2 Diabetes Mellitus and Obesity. 2. describe the role of the nurse in coordinating and supporting person centred care for a person living with Type 2 Diabetes Mellitus and Obesity. 3. demonstrate the principles of motivational interviewing and health coaching

describe the normal anatomy and physiology of the endocrine system

anatomy

• A network of ductless glands that release hormones directly into the bloodstream

• Main glands:

  • Hypothalamus (brain)

  • Pituitary gland (master gland)

  • Thyroid & parathyroids (neck)

  • Adrenal glands (above kidneys)

  • Pancreas (abdomen)

  • Gonads: ovaries/testes

physiology

• Produces hormones (chemical messengers)

• Hormones travel in blood to target organs

• Regulates body functions:

  • Metabolism and energy balance (thyroid hormones)

  • Stress response (adrenaline/cortisol)

  • Blood glucose control (insulin/glucagon)

  • Growth and development (growth hormone)

  • Fluid/electrolyte balance (ADH, aldosterone)

  • Reproduction (oestrogen, progesterone, testosterone)

Key mechanism:

• Controlled by negative feedback loops

• Hypothalamus and pituitary regulate most endocrine glands

• Maintains homeostasis (stable internal environment)

describe the normal anatomy and physiology of the digestive system

anatomy

• Gastrointestinal (GI) tract:

  • Mouth

  • Pharynx

  • Oesophagus

  • Stomach

  • Small intestine (duodenum, jejunum, ileum)

  • Large intestine (caecum, colon, rectum)

  • Anus

• Accessory organs:

  • Salivary glands

  • Liver

  • Gallbladder

  • Pancreas

physiology

• Ingestion: food enters the mouth

• Mechanical digestion: chewing (mastication) + stomach churning breaks food into smaller pieces

• Chemical digestion: enzymes break down food into nutrients

  • saliva (amylase), gastric acid/enzymes, pancreatic enzymes, bile (fat emulsification)

• Motility:

  • Peristalsis moves food along the GI tract

  • mixing movements help digestion and absorption

• Secretion: release of digestive juices (enzymes, acid, bile, mucus)

• Absorption:

  • mainly in the small intestine (nutrients into blood/lymph)

  • large intestine absorbs water and electrolytes

• Elimination:

  • waste formed in large intestine → stored in rectum → expelled via anus (defecation)

explain the digestive process and include the absorption of carbohydrates, proteins and fats

1. Mouth

• Chewing breaks food down (mechanical digestion)

• Saliva contains amylase → starts carbohydrate digestion

2. Oesophagus

• Moves food to stomach via peristalsis

• No major digestion or absorption

3. Stomach

• Churns food (mechanical digestion)

• HCl + pepsin start protein digestion

• Food becomes chyme

4. Small intestine (main site of digestion + absorption)

Duodenum:

• Pancreatic enzymes + bile added

• Major chemical digestion occurs:

  • Carbs → simple sugars

  • Proteins → amino acids

  • Fats → fatty acids + glycerol (emulsified by bile)

Jejunum & ileum: absorption site

Absorption of nutrients:

• Carbohydrates:

  • absorbed as glucose into blood capillaries

  • transported to liver via portal vein

• Proteins:

  • absorbed as amino acids into blood capillaries

  • carried to liver for use in tissue repair, enzymes, etc.

• Fats:

  • broken into fatty acids + glycerol

  • absorbed into lymphatic system (lacteals) as chylomicrons

  • then enter bloodstream

5. Large intestine

• Absorbs water and electrolytes

• Forms faeces

6. Rectum & anus

• Storage and elimination (defecation)

what is T2DM?

a chronic metabolic disorder characterised by:

• Insulin resistance

• Relative deficiency of insulin production

the body cells do not respond effectively to insulin, resulting in elevated BGL (hyperglycaemia)

T2DM is strongly associated with:

• Obesity

• Physical inactivity

• Poor diet

• Genetic predisposition

if unmanaged, it can lead to:

• Neuropathy, retinopathy

• Cardiovascular disease

symptoms of T2DM

• Polyuria (frequent urination)

• Polydipsia (increased thirst)

• Polyphagia (increased hunger)

• Fatigue and lethargy

• Blurred vision

• Slow wound healing

• Recurrent infections

• Unexplained weight changes

formal diagnostic techniques of T2DM

• Fasting blood glucose test

• Oral glucose tolerance test

• Glycated haemoglobin

• Random blood glucose level

describe the underlying pathophysiology of T2DM

Develops through a combination of:

• Insulin resistance

• Progressive pancreatic beta-cell dysfunction

Peripheral tissues like skeletal muscle, adipose tissue and the liver become less responsive to insulin, thus impairing glucose uptake and utilisation.

In response, the pancreas compensates by increasing insulin secretion.

Chronic metabolic stress can lead to beta-cell exhaustion and dysfunction, reducing insulin production.

This dysregulation results in chronic elevated BGL which drive long-term complications via mechanisms such as oxidative stress, inflammation and vascular damage.

what are the modifiable risk factors of T2DM?

• Overweight and obesity

• Physical inactivity

• Poor diet

• Smoking

• Excessive alcohol consumption

• Chronic stress

what are the common treatments and management strategies for T2DM?

• Dietary changes

• Regular physical activity

• Weight management

• Metformin

• Insulin therapy

• BGL monitoring

• Patient education

• Comorbidity management

role of the nurse in the management of T2DM

• Provide a structured framework for diabetes knowledge and skill development

• Support progression and career pathways in diabetes care

• Ensure consistent, evidence-based standards of care

• Promote lifelong learning and professional development

• Improve patient outcomes and community health

 

what is obesity?

a chronic, complex medical disease characterized by an accumulation of excess body fat that negatively impacts overall health

describe the underlying pathophysiology of obesity

obesity is characterised by excessive accumulation of adipose tissue resulting from a sustained energy imbalance (caloric intake exceeding expenditure).

adipose tissue functions as an active endocrine organ, releasing substances such as leptin, adiponectin, and pro-inflammatory cytokines.

in obesity, there is often leptin resistance, where satiety signalling is impaired, leading to continued food intake despite adequate energy stores.

clinical manifestations of obesity

• Increased BMI

• Central adiposity

• Reduced mobility and exercise intolerance

• Fatigue and decreased physical endurance

• Breathlessness on exertion

• Increased risk of comorbidities

• Psychosocial impacts

role of the nurse in the management of obesity

• Holistic assessment

• Person centred education and support

• Promoting self-management

• Care coordination

• Advocacy to reduce stigma

describe the challenges of prompting behavioural changes

Involves altering deeply ingrained habits, beliefs and lifestyle patterns and individuals may experience:

• Ambivalence

• Low motivation or readiness to change

• Emotional barriers

• Limited health literacy

• Environmental or social constraints

what is the aim of motivational interviewing?

It is a person centred, collaborative communication approach designed to:

• Enhance intrinsic motivation

• Help individuals explore and resolve ambivalence

• Support autonomy by allowing the person to identify their own reasons for change

what are the 4 processes of motivational interviewing?

• Engaging

• Focusing

• Evoking

• Planning

define health coaching

• Set meaningful goals

• Develop self-management skills

• Make sustainable lifestyle changes