Introduction

The old proverb “Little learning is a dangerous thing” go well with the education regarding any health complication. Health, defined as the normal status of body both internal and external must be maintained in balanced way to remain in healthy state. To have a normal healthy life, the person must know and must have knowledge about his/her health, the complications, risk factors, why it occurred and how it can be treated or prevented.. Thanks to the advance in medical diagnosis and technology, today everyone has access to best medical facilities and consultations. But, we are still struggling with numbers. There are not enough doctors and other para medical staffs to meet the growing number of patients. One way of dealing such problem is to educate the patients so that they can self mange their disease or conditions. It can only happen when they have knowledge about the disease they are suffering from.. In this essay, the client or the subject of study is a person suffering from type II diabetes. So what is diabetes education? It is all about assisting the client, their family and their care takers to gain knowledge about the disease, and empower them with skills and motivation power that will help in self management of the disease. This provides them with certain knowledge of what to do, when to do, how to do, and when to seek the help of a professional health practioner? The next question in this field which emerge is who can be an educator? Those persons who are recognized by the medical council of the respective countries are eligible for providing education to the patient. A person must seek diabetes education when he/she being diagnosed with any type of diabetes, need of monitoring blood glucose level at home, difficulty to access the facilities , insulin therapy starting, hospitalization situation comes frequently etc. There are many other conditions apart from these which require the client must be equipped with well knowledge of diabetes so that at the time of need they can help themselves. In this essay the focus will be on diabetes education with which the client is suffering from.

BACKGROUND
Brief description of pathophysiology, treatment regimen and issues with self management of type two diabetes suffered by client
The pathophysiology of type II diabetes (previously known as non insulin type) is attributed by two factors- insufficient insulin secretion and insulin resistance by peripheral pancreatic cells. Due to the insulin resistance fatty acids level increases and proinflammatory cytokines are found in plasma. This hampers the glucose transport across the muscle groups and in turn the glucose production by hepatic muscles is increased to neutralize the previous issue. In this process fats breakdown increases. In this condition the relationships that exist in between th ebeta cells secreting insulin and glucagons secreting alpha cells are lost. This leads to a condition called hyperglucagonemia and hyperglycemia.
Treatment regimen
The first line of treatment is to control the diet, weight and go for physical activity. If this first line of defense fails, then pharmacologic interventions are sopught. If pharmacologic tablets fails to control the insulin and blood glucose level , insulin injections are given.
In the above case study, since the client or patient is a farmer, so the very first line of treatment is diet which can be well maintained. He can go for low fat diet , with high fibrous and starchy fruits and vegetables. The weight must be recorded if it high as pr the BMR then it must be controlled. Regarding physical activity, since he is a farmer so the amount of physical activity he is doing must be greater than a normal person. Even after this he is diagnosed with diabetes type 2 , so pharmacologic interventions must be taken.

Metformin is generally recommended which acts by decreasing the amount of blood glucose released into the blood stream by liver cells. If the client is diagnosed with any type of side effects, then sulphonylurea drugs may be prescribed which acts by increasing the insulin secretion by pancreatic cells. There is no need of rapid acton drugs such as Nateglinide or repaglinide which acts instantly. Another druig which should be given with Metformin is dipeptdyl peptidase 4 inhibitors, these drugs works by inhibiting the effect of DDP4 by increasing the secretion of incretin hormone . Glitazones are another group which are administered with insulin. So there are many other interventions available depending upon the severity of the condition and other medical complicacies associated.
The patient in this case study must be advised to cease from smoking and drinking.
Issues with self management
Self management of type 2 diabetes mostly includes three things, monitoring blood glucose level, doing regular exercise and controlling diet, and going for preventive approach rather than pharmacologic intervention. But the self management also depends upon many other factors ssuch as what is the exact severity of the condition nad what type of intervention is best required, what are the other complications rising from this and how to screen those complications, . Dietary habits also varry according to the patient needs. Research says the self management works at best when family members participate other than care takers , so there are many issues related to the type 2 self management.
SPECIFIC FOCUS ON EDUCATION
The first treatment which should start with the diabetes is monitor the blood glucose level, along with making changes in lifestyle. The specific focus in this case study will be lifestyle changes and issues related to diabetes. The main rationale of focusing this part in education is , the client or the subject in this case study even though not maintains a high profile life but his habit of chain smoking and drinking every evening is going to intervene in the treatment process. So the subject must get properly educated with the facts that what are the complications he is going to face due to such odd lifestyle habits.

EVIDENCE BASED EDUCATION STRATEGIES FOR TYPE 2 DIABETES PATIENT IN THE ABOVE CASE STUDY.
This condition prevalence has increased so much that it is considered to be an epidemic and evidence says iit is the fifth most cause of mortality occurring globally. (roglic et al, 2005).. So education is must to prevent this epidemic climbing the status of mortality causing epidemic. Educational strategies can be of many types, it can be of print and electronic media, one to one patient teaching and group based and community based. But evidence suggest structured education is an effective way to control type two diabetes which provides proper self management guidelines and promotes behavioral change among the patients.
It has been seen by evidences that when education is provided or facilitated in group based program, its effect are far more substantial than any other strategy on the behavioral change of the patients. This leads to self management of the disease as well as it is cost effective with comparison to the other strategies.
Various recommendations have been published by NICE in 2008 with relation to the group based education in type 2 diabetes.
The above education strategy must have the following components as per its recommendations –
A written version of the strategies required for self management based on the patient centered approach.
It must be based upon the psychological theories.
Trained educators must provide the education.
The educators providing education must be assessed qualitatively from time to time.
In countries like finland, Australia and Germany group based education programes have been very effective in controlling this epidemic. Another group based education program called PREPARE was run at UK, its result were extreme inspiring as a reduction in diabetes was observed after the group based program aimed at increasing the awareness of pedometer use and walking activity increasing in day to day life.
The group based program is effective because, it creates a sense of realization that what is wrong, and what needs to be done. Research says that when people are subjected to group study, they learn more than the one to one teaching. It is somewhat similar to school classroom teaching, where a sense of competitiveness prevails.
Conclusion and Recommendations
Educating the mass definitely help in reducing this epidemic, but the strategies must be feasible from all aspects. The participation is sought from all sections of society and from government also. The following recommendations are made to reduce the diabetes type 2 problem through educational strategy.
The government must strengthen the rules, policy and guidelines so that diabetes can be controlled.

Initiatives must be taken to educate the local communities and educator must be appointed from their community sso that, their cultural belief is not hurt.
People must be provided facts and figures concerned with the evidence based program. They must be taught how to creen, how to act and when to seek help of medical professionals.
With these recommendations being put into practice this problem of epidemic can be solved.