Running Head: CAM DIABETES THERAPY

Nurses Role in CAM Diabetes Therapy

Andrew Smith
NURS 351

Running Head: CAM DIABETES THERAPY

Nurses Role in CAM Diabetes Therapy

Diabetes and other chronic illnesses are on the rise throughout the world and not just in
the US. Over 80% of all the diabetics in the world today live in developing countries. While the
mainstay for diabetic treatment in the US may be interventions such as insulin and oral
medications such as metformin, developing countries like Sri Lanka also rely on the use of
complementary and alternative medicine (CAM). In the Sri Lankan culture they use a traditional
Hindu medicine technique called Ayurvedic, which promotes the use of herbalism. Some
commonly used CAMs for diabetes management include cinnamon, garlic, fenugreek, and multivitamins. This paper will look into cultural awareness and the use of CAMs in diabetes
management which is a major focus for nurses and their practice.
The study out of Sri Lanka performed a cross-sectional survey between April and August
of 2012 at a diabetes clinic in Sri Lanka. The survey was given to 252 randomly selected Type 2
diabetics who attended the clinic, out of a total clinic patient population of 2,250. The survey
was comprised of three sections including demographic data, diabetes related information, and
information on their use of CAMs just for diabetes use. The demographic data section included
the important topics such as their current medications, last reported fasting plasma glucose
(FPG), and HgbA1C.
Results from the study showed that all patients, 254 of them, in the survey were on some
form of hypoglycemic medication, with most of them being on metformin. One hundred and
ninety-two patients stated that they used some form herbal supplement in combination with their
oral hypoglycemic medications as well. The most common CAMs used by the survey
participants were bitter gourd (Momordica charantia), ivy gourd leaves (Coccinia grandis),
crepe ginger leaves (Costus speciosus), Salacia reticulate, and fenugreek. During the study,

Running Head: CAM DIABETES THERAPY

hypoglycemic episodes were experienced by 16.6% of patients on conventional medication, like

metformin, while 21% of patients on conventional medications with additional CAMs had
hypoglycemic episodes. The authors postulate that the episodes could be due to the direct action
of the CAMs or the potentiation of their conventional medications from the CAMs. The CAM
crepe ginger showed the biggest effects when it comes to hypoglycemic episodes.
As a nurse, properly diagnosing a diabetic patient is a priority of the care they receive. An
example of a nursing diagnosis in this situation would be: imbalanced nutrition less than body
requirements r/t insulin deficiency. As an outcome of this I would want the patient to ingest the
appropriate amounts of calories and nutrients that they need. I would use interventions towards
food preferences that take into account the patients cultural practices such as Ayurvedic. I would
also administer the CAMs, if ordered by the physician, according to the patients wishes and
preferences. Another nursing diagnosis could be deficient fluid volume r/t osmotic diuresis (from
hyperglycemia). An outcome from this diagnosis that I would want to see is for the patient to
demonstrate adequate hydration and electrolyte levels within a normal range. Interventions I
would take towards this would be to monitor their I/O, including their CAM use to measure its
effectiveness, and to assess their peripheral pulses and skin turgor. As a final nursing diagnosis I
would say risk for infection r/t hyperglycemia and/or preexisting conditions (such as a UTI). An
outcome that I would want to see from this is for the patient to identify ways to prevent and
reduce the risk of infections for themselves. Interventions that I would take as the nurse would be
to observe for signs and symptoms of infection in the patient and encourage the patient to have
an adequate dietary and fluid intake for their needs, this can include CAM therapy if appropriate.
With the rise of chronic diseases, such as diabetes, occurring worldwide, it is imperative
that nurses and other healthcare professionals remain competent both knowledge wise and

Running Head: CAM DIABETES THERAPY

culturally as well. With the Asian country of Sri Lanka, the use of oral medications such as
metformin is common but also is the use of CAMs. Sri Lankans often use CAMs and traditional
oral medications during the same time. The study that was the subject of this paper showed that
patients who used both a CAM and traditional oral medication had higher incidences of
hypoglycemia, at 21%, when compared to the patients using just an oral medication, at 16.6%.
The results from this study show that nurses and healthcare professionals need to be culturally
competent and learn from wishes of their patients regarding the use of CAMs to manage their
diabetes and other diseases.

Running Head: CAM DIABETES THERAPY

References
Abeysekera, R.A., Bandara, R., Imbulpitiya, B., Medagama, A.B., & Pushpakumari, T. (2014).
Use of complementary and alternative medicines (CAMs) among type 2 diabetes
patients in Sri Lanka: a cross sectional survey. BMC Complementary and Alternative
Medicine 2014, 14:374, 1-11. doi:10.1186/1472-6882-14-374