Understanding Type 2 Diabetes Mellitus: A Case Study
Pathophysiology of T2DM and Its Links to the Patient’s Case
Type 2 diabetes is a typical health problem globally. T2DM is a long-term metabolic ailment that is categorized by hyperglycemia, which arises from inadequate suppression of glucagon products, insulin resistance from peripheral tissues and insufficient pancreatic insulin secretion. Type 2 diabetes occurs because of inadequate production of insulin from the beta cells (Barrès, & Zierath, 2016). Insulin resistance is the inability of the cell to retort effectively to an average level of insulin within the fat tissues and liver. Usually, the suppression results in inadequate storage, disposal, and uptake of consumed glucose convoyed by a high hepatic production of glucose. Type 2 diabetes mellitus occurs as a result of lack of exercise and obesity. Recent studies have shown that people who come from families with the history of T2DM are at a higher a risk of getting the ailment (Barrès, & Zierath, 2016). Moreover, accumulation of genetic polymorphisms seems to be the driving force behind the increase rate of type 2 diabetes risks.
Typically, there are risk factors such as lifestyle and genes that will determine an individual chance of developing type 2 diabetes. One can change lifestyle risk factors around weight, eating, and physical activities. However, an individual cannot change risk factors associated with ethnicity, age and family history (Chamberlain, Rhinehart, Shaefer, & Neuman, 2016). It is essential for individuals to act in risk factors that they can change as it can help to prevent or reduce the chances of type 2 diabetes. Individuals at the age of 45 and above are at a higher risk of T2DM. For the case of Melania who is 65 years old, she is susceptible to type 2 diabetes mellitus. Also, family history of diabetes is a common risk factor of T2DM. For the case of Melania, both her sister and mother had type 2 diabetes thus, making Melania vulnerable to the ailment. Furthermore, obese individuals are at a higher risk of T2DM.
According to Farr, & Khosla, (2016) type 2 diabetes is associated with a series of pathophysiological changes that makes an individual susceptible to interruption of normal glucose homeostasis. Usually, insulin resistance is a common abnormality that leads to T2DM. The beta cell in individuals who are genetically vulnerable becomes impaired, therefore, leads to insufficient insulin secretion. Usually, insulin resistance is reversed by increased insulin which allows metabolism to remain normal (Farr, & Khosla, 2016). The primary symptoms of T2DM include increased thirst, feeling tired, sores that do not heal, and frequent urination. Past studies have shown that type 2 diabetes make up 90% of diabetes cases worldwide. Typically, the diagnosis of diabetes is by blood test such as glycated hemoglobin or fasting plasma glucose. Despite, it’s high prevalence among the overweight people the condition is partially prevented by eating correctly, staying normal weight and exercising frequently. Also, increased breakdown of lipids within the fat cell is associated with diabetes type 2.
Differences Between T2DM and T1DM
Short-term complication of T2DM is hypoglycemia and hyperglycemia while long-term complication includes kidney disease and heart diseases. High blood glucose level over a prolonged period can damage blood vessels resulting in microvascular and macrovascular complications (Gujral, Pradeepa, Weber, Narayan, & Mohan, 2015). When the blood vessels are damaged, they don’t deliver the blood adequately, therefore, resulting in kidney failure.
Type 2 diabetes can be treated in some options. For example, it can be managed through insulin therapy and diabetic medication. However, the decision to which drug is the best depends on the patient level of blood sugar or health issues. Metformin is a medication prescribed to improve the sensitivity of the body tissue to insulin. Moreover, bariatric surgery is another option of treating type 2 diabetes (Holman et al., 2015. If a patient body mass index is above 35, weight-loss surgery is the best treatment. Lastly, physical activity is exceptional to T2DM patients because it helps to control blood sugar more effectively. However, it is recommended to get your doctor’s advice before starting any exercise program.
Type 2 diabetes usually affects those at age 45 and above while type 1 is typical from early childhood to the late 30s. Also, the only treatment for type 1 diabetes is through insulin injection whereas for T2DM it can either be through medication or physical activities. Also, type 1 diabetes occurs when the body immune system destroys and attack the insulin-producing cells. On the other hand, T2DM occurs when the cells in the body become resistant to insulin (Kautzky-Willer, Harreiter, & Pacini, 2016). Also, type 2 diabetes symptoms develop slowly while sign for T1DM develops fast. In type 1 diabetes some genes are linked to the condition while for type 2 family history is critical. Type 2 diabetes is related to aging and inactive lifestyle while type 1 might emerge after a viral infection.
Hyperglycemia is a condition in which sugar level in one’s blood is high. The body uses chemical within the muscles and the liver to make its glucose. Usually, when the blood sugar remains high for an extended period, it can result in severe complications and dehydration. Blood sugar fluctuation is common among diabetic people. It is critical for them to regulate the BGL through exercise, medication, and diet. One of the causes that leads to high blood pressure is diabetes mellitus. In the case of Melanie T2DM contributed to high blood glucose level. Also, Melanie was stressed because of her surgery and she could not walk because of the pain. Emotions play a role in causing high blood glucose level (Low, Hess, Hiatt, & Goldfine, 2016). When a person is stressed the body produces a high level of stress hormones which elevates the body sugar level.
Reasons for Patient’s High BGL and Two Blood Results
Moreover, it is clear that Melanie’s high blood glucose level was as a result of lack of exercise because of her knee condition. Regular exercise plays a critical role in the regulation of blood sugar level. Physical activity such as walking boost insulin action hence, lowering blood glucose. Furthermore, Melanie surgery is one of the contributing factors that leads to high level of blood sugar. Recent studies have shown that illness contributes to high blood sugar levels. Lastly, Melanie, most of the time ate ice cream which contains a high level of sugar content. For diabetic patients, it is critical for them to watch their diet so that they can regulate their blood glucose levels (Macaluso et al., (2016). Typically, ice cream can raise a person’s blood sugar hastily.
It must be known that all medicines have benefits and side effects. One of the medications of Melanie is cortisone injections (Kenacort-A 40). Typically, Kenacort-A 40 is a corticosteroid comprising triamcinolone acetonide as the active component. The drug is used to treat severe skin problems and allergic diseases, but for the case of Melanie, it was used to treat painful tendons or joints (Madias, 2016). The medication is injected directly into the aching muscles. The drug will help to relieve pain in Melanie’s knee. The drug was appropriate because Melanie did not have any allergies or history of past medicines. Usually, cortisone injection depends on the condition, the site of injection and the patient reaction to the medication (Madias, 2016). Despite, the benefit of Kenacort-A 40 it has some side effect such as muscles weaknesses, tiredness, headache, and numbness.
Moreover, another medication for Melanie is metformin (APO-Metformin Tablets) to help her manage her type 2 diabetes. APO-Metformin contains an active component called metformin. It is the first drug prescribed for the T2DM patient (Zimmet, Alberti, Magliano, & Bennett, 2016). The usual dose for adults is 500mg two times a day. However, the treatments depend on the level of body glucose. The medication works by improving an individual tissue sensitivity to insulin so that the body can use insulin adequately (Marso et al., 2016). Also, the drug lowers glucose production in the liver. The medication was appropriate in Melanie case because she could not do exercise because of her knee problem. Individuals with type 2 diabetes are unable to use the insulin their body produce or to make enough insulin which may lead to heart or kidney complication. For instance, in Melanie case, she did not have a liver ailment or server infection. Metformin helps diabetic people, but it may have side effects on some people (Pociot, & Lernmark, 2016). Vomiting, diarrhea, loss of appetite and stomach upset are some of the side effects that are associated with APO-Metformin. It is recommended for patients to take this medication with meals as it will help to reduce diarrheal and nausea.
Discussion of Three Medications Prescribed and Related Nursing Considerations
Glipizide (Minidiab Tablets) is the last medication that Melanie is on. Minidiab is used when exercise and diet are not enough to manage blood sugar in the T2DM patient. This type of diabetes is known as maturity-onset diabetes. In the case of Melanie, the medication is appropriate as she could not do regular exercise because of her knee problem. Also, it lowers high blood sugar by increasing insulin produced by the body. The nurses are supposed to consider some factors such as age and allergies of their patients to avoid the severe side effect of the drug (Rubino et al., 2016). Minidiab Tablets are beneficial to diabetic people. However, it is accompanied by side effects such as confusion, visual disturbances, and skin rashes.
On the visit, Melanie blood results were BGL 8.8 mmol/L and HbA1c: 8%. HbA1c is a blood pigment containing oxygen which is bound to glucose. HbA1c blood is essential as it reflects on how well diabetes is managed. Typically, the normal range of HbA1c is less than 6% (Steven et al., 2016). For Melanie case, her hemoglobin A1c was 8% which indicates that she was not managing her diabetes. For example, she was eating ice cream which contains a high content of sugar. Understanding blood sugar level is critical as it will help in self-management. Normal BGL for a healthy individual is 4.0 to 5.4 mmol/L, and for people with type 2 diabetes, it is between 8.5 to 9 mmol/L. Before the surgery, the Melanie blood result was 22.9 mmol/L; HbA1c: 11% which indicates that her blood glucose level was too high. In her case, she was stressed because of the surgery which increased her blood sugar level. Also, her HbA1c was too high this may be because of her lifestyle of eating foods that contain high sugar content.
Type 2 diabetes used to be known as non-insulin dependent diabetes because insulin medication was not part of its treatment. The term is misleading because people with type 2 diabetes still need insulin in their body to regulate the blood glucose level. Also, at early stages of diagnosis insulin content still circulate in the body, but with time the production of insulin dwindles (Watts et al., 2016) Furthermore, the term early onset diabetes is no longer used because it is inaccurate. For instance, insulin medication was used in Melanie case who was diagnosed with type 2 diabetes. Both terms are misleading because type 2 diabetic patients need insulin.
Insulin Dependent Diabetes Mellitus/Non Insulin Dependent Diabetes Mellitus and Early Onset/Mature Onset Misconceptions
Blood glucose level machines are equipment used to measures blood sugar level. The primary goal of treating diabetes is to keep blood glucose levels within a normal range. Recent studies have shown that the teach-back method is useful for patient self-management and education (Dinh et al., 2016). It is the role of the nurse to provide comprehensive training to their patients as it will improve the health outcome. Tech-back method is linked with person-centered communication approach. According to Dinh et al., (2016) Tech-back communication method closes the gap between physicians and their patients while adorning the client’s knowledge. For example, when explaining to Melanie that blood glucose level is measured in millimoles per liter then ask her to explain back the concept. Therefore, based on the response you will determine how well the patient has comprehended the concept. For Melanie case, teaching back method will help the nurse to avoid overwhelming the patient. Melanie needs to understand what type 2 diabetes is and how to check her blood sugar level at home. Also, Melanie needs to understand how to calculate the dosage based on her BGL and how to self- administer insulin. Also, the teaching method will help Melanie to understand how to read the results from the machine.
References
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