[SOLVED] Type 2 Diabetes Management and Cardiovascular Outcomes

The provided assignment is focused on type 2 diabetes management, cardiovascular outcomes, and related health issues. It includes a list of references to various studies and articles on the topic, including the effects of exenatide, liraglutide, and empagliflozin on cardiovascular outcomes in patients with type 2 diabetes. The assignment also touches upon insulin resistance, triacylglycerol/high-density lipoprotein (TAG/HDL) ratio, and thyroid hormone levels in obese and overweight individuals with type 2 diabetes. The references are from reputable sources such as the New England Journal of Medicine, Diabetes Care, and other prominent scientific journals.

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Institution

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Pathophysiology and Etiology of the patient’s condition
Kathleen’s disease mostly falls into two main aetiopathogenetic categories. The first type
(type 1), it causes damage to the islet cells which are located in the pancreas because the cells
developed autoimmunity (Abdul-Ghani et.al, 2017). Genetic markers and serological tests are
often identifying people who are at higher risk of getting (type 1). The second type (type 2)
which is the primary causative agent of Kathleen’s condition is triggered by a grouping of
genetic factors associated with insulin resistance and weakened insulin secretion and
environmental factors, for example, overeating, obesity, stress, lack of sufficient exercise and
aging. The disease is multifactorial, and it is accompanied by environmental factors and multiple
genes (Jayanthi, Srinivasan, Hanifah, & Maran, 2017).
.Genetic factors involved -The development of Kathleen’s disease is mostly related to her
family history of Diabetes.

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The lower concordance rate between dizygotic twins than monozygotic twins indicates
the participation of genetic factors. The pathogenesis is presumed to include the abnormality in
the molecules associated with the regulatory system of the glucose absorption
Roles of environmental Factors- Obesity, aging, inadequate energy consumption,
smoking, alcohol drinking, etc. are independent factors that affect pathogenesis. The reduction in
muscle mass characterizes obesity (specifically visceral fat obesity) caused by lack of adequate
exercise, increase in high- and middle-aged patients, and stimulates insulin resistance. The
changes with the energy associated with dietary, specifically increase in the consumption of pure
sugar, higher intake of fats, high-aged patients and decrease in the absorption of fats, lead to
obesity and stimulate the decline of glucose tolerance.
Pathophysiology
Insulin resistance and impaired insulin secretion contribute to the occurrence of
Pathophysiological conditions.
Impaired insulin secretion- it begins with the reduction in the glucose content. The
impaired insulin secretion is mostly progressive, and its progression includes glucose lipo-
toxicity and toxicity. When untreated, it causes a decrease in B cell mass.

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Insulin resistance- the function of insulin is to enable the body’s cells to convert glucose
into fuel or to be reserved as fats. It means that the concentration of glucose will be high in blood
and this may contribute to the higher sugar level in the blood (Marso et.al, 2016).
If the body becomes resistant to insulin, it will respond by producing more insulin.
Therefore Kathleen will produce more insulin, a process known as Hyperinsulinemia.
Symptoms of insulin resistance include:
High blood pressure, high cholesterol levels, belly Fat, hunger, and brain fog
Insulin resistance occurs mostly when one of the following factors takes place:
Weight gain, high blood pressure, and high cholesterol level
Nursing Management
Postoperative nursing care
Nursing diagnosis- ineffective protection associated with the inability to generate adrenal
gland.
Risk for infection linked to suppressed responses of the inflammatory initiated by high
levels of adrenocorticoid preoperatively and usage of adrenocorticoid replacement
postoperatively.
A risk for damage associated with dramatic blood pressure fluctuations initiated by
abrupt changes in catecholamine or adrenocorticoid levels.
Nursing interventions
The tube of orogastric should be detached at the finishing point of the procedure. The
complete count of blood cell and a chemistry screen are acquired in the PACU. Since the adrenal
glands perform an essential role in the regulation of BP and stress responses, the monitoring of

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BP is critical thru BP cuff or arterial line. The Patients need close checking of electrolytes, such
as Potassium. The PACU RN should also check the patient thoroughly for signs of bleeding.
The nurse of the PACU provides medication for the patients and assesses the level of
pain for the patients. Usually, the patient will not need the PCA as would be required in the open
adrenalectomy. Because of the minor laparoscopic incisions, patients are given medications.
Patients are advised to ambulate immediately after the surgery (Chatterjee, Khunti & Davies,
2017).
The removal of urinary drainage catheter on the initial postoperative day and on that first
postoperative day, a clear liquid diet should be offered. Then the levels of Serum cortisol should
be evaluated to ensure that no insufficiency of adrenal elements needs supplementation.
A patient undergoing adrenalectomy unilateral may need short-term replacement of
glucocorticoids and there should be the administration of intravenous fluids. The patient should
be encouraged to deep breathing and coughing in order to avoid respiratory infection.
Impaired would healing raise the infection risk in clients with the disorders of the
adrenal. Apply aseptic technique to reduce this offer routine post-op care. Then evaluate the
body temperature, wound drainage, and WBC levels. The dressing should also be changed by
use of the sterile technique. The final intervention is the recording of critical vital signs, measure
output and intake, and monitor electrolytes on a regular schedule, mainly during the initial 48
hours after surgery.
The following intervention should also be taken into consideration: There should be self-
administration of replacement hormones, there should provision of discharge planning and client
teaching, unilateral adrenalectomy, deliver general treatment for the patient with abdominal
surgery and observation for shock and hemorrhage. The patient should also use vasopressors and

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IV therapy as ordered. Hydrocortisone or Administer cortisone as ordered to sustain cortisol
level.
Physiotherapist
They assist people who are affected by disability or illness through exercise and
movement, injury, manual therapy, advice, and education. Physiotherapist maintains the
excellent health of the individuals of all ages, assisting patients to prevent disease and manage
pain. The professional help in facilitating recovery and encouraging development, and this allow
different individuals to remain in work while helping them to stay independent for a longer
duration of time (Pfeffer et.al, 2015). Physiotherapy profession uses a whole person approach to
wellbeing and health, which involves the patient’s overall lifestyle. The essential part is the
patient’s involvement in their care, through awareness, empowerment, education, and
participation in their treatment. Physiotherapy applies their skills and knowledge to improve the
patient’s body conditions, such as multiple sclerosis, stokes chronic heart disease, etc.
Social workers
They offer spiritual care and counseling to assist the families of the patients to manage
their psychosocial, economic, and emotional requirements. The social workers have the required
skills in evaluating the patient’s and family’s requirements and the necessary care needed for the
treatment of the patients (Holman et.al, 2017). They then assist in the establishment of a social
work plan. Social workers help patients attain a sense of control by offering guidance and
counseling. They also support in alleviating the difficulties which the patient’s families are
experiencing by assessing the family’s and patient’s spiritual needs, economic, and psychosocial,
and then assist in obtaining resources to satisfy those needs (Inzucchi et.al, 2015).

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After the procedure in adrenalectomy, patients enquire hypertension because of primary
aldosteronism which developed due to the elimination of the adrenal gland. Rennin angiotensin,
mechanism of the aldosterone that helps in maintaining blood pressure back to normal get
affected which result in high blood pressure (Goldberg, 2016).
Specific renal actions associated with aldosterone decide the clinical features.
Aldosterone raises the amount channels of sodium of the luminal membrane of the primary
principal cells that are found in the collecting tubule hence, which increases the reabsorption of
sodium. The successive cationic sodium loss creates the Lumen electronegative, creating an
electrical gradient that enables the discharge of cellular potassium into the lumen.
Adrenalectomy also contributes to the damage of renal structural leading to the decline in
approximated glomerular filtration rate (Ehtisham, 2014).
Dietitian
They are the health professionals that diagnose, assess and treat nutritional problems and
dietary at general public health and an individual level (Zinman et.al, 2015). They mostly
perform their duties with both sick and healthy people. Dietitians apply the most recent scientific
research and public health on food, disease, and health which they turn into practical guidance to
allow people to come up with suitable food and lifestyle choices. Dietitians assist in designing
food plans and counsel and educate patients to help them in managing the states of the disease
such as high cholesterol, obesity, or heart disease. Dietitians perform in different areas for
example geriatrics, pediatrics, diabetes education or renal disease (Wanner et.al, 2016).
Conclusion
The healthcare team is made up of different Health professionals that work as a team with
the aim of solving the needs and the requirements of the patients and their families. Different

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Nursing interventions should be put in place to help in solving the problems of the patients which
are seeking treatment to the healthcare.

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Reference
Abdul-Ghani, M., DeFronzo, R. A., Del Prato, S., Chilton, R., Singh, R., & Ryder, R. E. (2017).
Erratum. Cardiovascular Disease and Type 2 Diabetes: Has the Dawn of a New Era
Arrived? Diabetes Care 2017; 40: 813–820. Diabetes care, 40(11), 1606.
Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085),
2239-2251.
Ehtisham, S. (2014). Type 2 diabetes.
Goldberg, R. (2016). Type 2 diabetes. In Comprehensive Management of High Risk
Cardiovascular Patients (pp. 213-280). CRC Press.
Holman, R. R., Bethel, M. A., Mentz, R. J., Thompson, V. P., Lokhnygina, Y., Buse, J. B., ... &
Maggioni, A. P. (2017). Effects of once-weekly exenatide on cardiovascular outcomes in
type 2 diabetes. New England Journal of Medicine, 377(13), 1228-1239.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ... &
Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a
patient-centered approach: update to a position statement of the American Diabetes
Association and the European Association for the Study of Diabetes. Diabetes
care, 38(1), 140-149.
Jayanthi, R., Srinivasan, A. R., Hanifah, M., & Maran, A. L. (2017). Associations among Insulin
Resistance, Triacylglycerol/High Density Lipoprotein (TAG/HDL ratio) and Thyroid

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hormone levels—A study on Type 2 diabetes mellitus in obese and overweight
subjects. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11, S121-S126.
Marso, S. P., Daniels, G. H., Brown-Frandsen, K., Kristensen, P., Mann, J. F., Nauck, M. A., ...
& Steinberg, W. M. (2016). Liraglutide and cardiovascular outcomes in type 2
diabetes. New England Journal of Medicine, 375(4), 311-322.
Pfeffer, M. A., Claggett, B., Diaz, R., Dickstein, K., Gerstein, H. C., Køber, L. V., ... &
Maggioni, A. P. (2015). Lixisenatide in patients with type 2 diabetes and acute coronary
syndrome. New England Journal of Medicine, 373(23), 2247-2257.
Wanner, C., Inzucchi, S. E., Lachin, J. M., Fitchett, D., von Eynatten, M., Mattheus, M., ... &
Zinman, B. (2016). Empagliflozin and progression of kidney disease in type 2
diabetes. New England Journal of Medicine, 375(4), 323-334.
Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., ... & Broedl, U. C.
(2015). Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. New
England Journal of Medicine, 373(22), 2117-2128.