Conditions › Endocrine
Type 2 Diabetes Nursing Care Plan and Interventions
Type 2 diabetes nursing care starts with diet, activity and metformin, then adds drugs such as SGLT2 inhibitors or GLP-1 agonists to reach the A1C goal. Watch for highs, lows and HHS, and teach glucose monitoring and foot, eye and kidney checks.
Type 2 diabetes nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Risk for unstable blood glucose | A1C at the goal set by the provider. | |
| Risk for medication harm | Knows the side effects of each prescribed drug. | |
| Risk for long-term complications | Gets regular eye, foot and kidney screening. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
Type 2: what it is
Cells resist insulin. The pancreas makes extra insulin to keep up, then over time can't make enough, and glucose rises. 1,2
Some insulin is still made, so ketones are usually blocked; that's why DKA is less common.
Type 2 risk factors
Overweight, inactivity, older age, family history, prior gestational diabetes, and American Indian, Black or Hispanic descent. 3,4
Losing about 7% of body weight plus 150 minutes of activity a week can prevent or delay it.
Assessment: what you will see
Type 2 cues
Often no symptoms for years, so screening finds it. Later: thirst, polyuria, blurred vision, slow healing, infections, tingling feet. 4,3
Dark, velvety skin in the neck folds (acanthosis nigricans) is a sign of insulin resistance.
Diabetes diagnosis numbers
A1C 6.5% or higher, fasting glucose 126 mg/dL or higher, or random glucose 200 or higher with symptoms. Fasting normal: 70 to 99. 5,3
Prediabetes: A1C 5.7% to 6.4% or fasting glucose 100 to 125 mg/dL.
Complications and red flags
Long-term damage
High glucose damages small vessels (eyes, kidneys, nerves) and large ones (heart attack, stroke). Screen eyes and kidneys regularly. 3,4
Numb feet hide injuries: inspect feet daily and have them checked at visits.
Priority: what the nurse does first
Type 2 emergencies
Very high glucose over days with dehydration and confusion: HHS (see its deck). Insulin or a sulfonylurea: glucose under 70 mg/dL. 4
Low glucose is treated with the rule of 15; see the Hypoglycemia deck.
Nursing interventions and treatment
Type 2 first steps
Healthy eating, activity and weight loss are the base. Without heart or kidney disease, metformin is usually the first drug. 4
Heart or kidney disease? An SGLT2 inhibitor or GLP-1 agonist is recommended to protect them.
Metformin
Lowers the liver's glucose output. GI upset is common (give with meals). It rarely causes lows on its own. Lactic acidosis is rare. 4
Contrast scan: hold only if eGFR is under 30, there is AKI, or an arterial catheter is used.
Sulfonylureas (glipizide)
Push the pancreas to release more insulin. The main risk is hypoglycemia, worse with skipped meals or kidney or liver disease. 6,7
Beta-blockers can hide the shaky, fast-heart warning signs of a low.
-gliflozin (SGLT2 inhibitors)
Make the kidneys spill glucose into urine. They protect the heart and kidneys. Watch for genital yeast infections, UTIs and dizziness. 4
Can cause DKA with near-normal glucose; usually stopped during illness or before procedures.
GLP-1 agonists (semaglutide)
Boost insulin when glucose is high, slow stomach emptying and curb appetite. Mostly injected. Nausea and vomiting are common. 4
Severe belly pain: hold the dose and report it (pancreatitis risk).
Evaluation: is care working?
A1C: the 3-month average
Shows average glucose over about 3 months. The usual goal is under 7%, set individually (higher for older clients or those prone to lows). 4,3
Checked every 3 to 6 months to judge whether the plan is working.
NCLEX traps
Type 2 or type 1?
Type 2: insulin resistance, some insulin left, gradual, HHS risk. Type 1: autoimmune, no insulin made, often young, sudden onset, DKA risk. 4,2
Age can't decide it: adults get type 1, and children get type 2.
Try a type 2 diabetes question
NCLEX-style, approved by a licensed RN. Pick an answer, check it, then read the rationale.
Question 1 · Pharmacological and Parenteral Therapies
A client with type 2 diabetes is started on sitagliptin. The nurse understands this medication class carries which advantage over some other oral antidiabetics?
Show answer and rationale
Answer: B. DPP-4 inhibitors such as sitagliptin (-gliptin) have a low risk of causing hypoglycemia when used alone because they work in a glucose-dependent manner. High hypoglycemia risk is more characteristic of sulfonylureas or insulin. Lactic acidosis is a concern with metformin, not DPP-4 inhibitors. Weight gain and fluid retention are associated with thiazolidinediones (-glitazone), not DPP-4 inhibitors.
Checked against: OpenStax Pharmacology for Nurses, 28.3
Keep studying type 2 diabetes in NurseLingo Pro
Pro has 88 type 2 diabetes questions like these, with a rationale for every answer. Everything for type 2 diabetes in one place. A free account gets 5 free opens of any condition; Pro opens all 277.
Test yourself: free endocrine practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for type 2 diabetes?
Common nursing problems for type 2 diabetes include risk for unstable blood glucose; risk for medication harm; risk for long-term complications. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for type 2 diabetes?
Very high glucose over days with dehydration and confusion: HHS (see its deck). Insulin or a sulfonylurea: glucose under 70 mg/dL.
More endocrine
Related cheat sheets
Sources
- diabetes.org
- OpenStax Nutrition for Nurses, 8.2
- OpenStax Medical-Surgical Nursing, 21.2
- merckmanuals.com
- OpenStax Pharmacology for Nurses, 28.1
- dailymed.nlm.nih.gov
- OpenStax Pharmacology for Nurses, 28.3
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.