Pathophysiology of T2DM and Treatment Options

This report discusses the pathophysiology of Type 2 Diabetes Mellitus (T2DM), risk factors, complications, and treatment options. It covers the medications used to manage T2DM, their actions, complications/side effects, and nursing considerations. The report also explains the impact of renal function on T2DM and suggests appropriate treatment options. Find expert study material on Desklib for a comprehensive understanding of T2DM.

Case Scenario
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Contents
INTRODUCTION...........................................................................................................................3
PART 1............................................................................................................................................3
1.1. Pathophysiology of T2DM with links to Emily’s case and risk factors for T2DM, its
pathogenesis, possible complications and 3 levels of treatment options for the disease.............3
1.2. Difference between T2DM and T1DM................................................................................4
1.3. Reasons for high BGL of Emily on admission and the way each reason affects BGLs.......5
PART 2............................................................................................................................................5
2.1. Medications, their action, complications/side effects and nursing considerations linked to
Emily’s situation..........................................................................................................................5
2.2. Discuss the two blood results, one from prior to surgery and one from the clinic visit of
Emily’s BGL and HbA1c. What are they? What do they measure and why have they changed?
.....................................................................................................................................................7
PART 3............................................................................................................................................8
3.1 What does Emily’s renal function test indicate? Explain her renal function test. What
appropriate treatment should be available to Emily? Explain her treatment options with
rationale.......................................................................................................................................8
CONCLUSION................................................................................................................................8
REFERENECS................................................................................................................................9
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INTRODUCTION
Type 2 Diabetes Mellitus (T2DM) is one of the very common disease from which many
people suffer worldwide (Cusi, & et. al., (2016). The major cause behind this is sedentary
lifestyle of people, obesity, high blood pressure etc. This report is based on the case study of
Emily Smith who was diagnosed with Type 2 Diabetes Mellitus and admitted to hospitals due to
increased blood sugar and glycated haemoglobin level. It covers information about the risk
factors, pathophysiology, possible complications, treatment options, medication, actions, side
effects, interventions etc. associated with the disease.
PART 1
1.1. Pathophysiology of T2DM with links to Emily’s case and risk factors for T2DM, its
pathogenesis, possible complications and 3 levels of treatment options for the disease
Type 2 diabetes mellitus is one of the common form of diabetes which is caused due to
environmental and genetic factors that influence beta cell function as well as tissue insulin
sensitivity. It is a heterogeneous disorder whose prevelence is vary among distinct ethnic groups.
In this disease, either the cells ignore the insulin or the body doesn't secrete enough insulin. Type
2 diabetes mellitus begins as resistance of insulin, a disorder when cells do not utilize the insulin
appropriately. As the insulin need increases, the pancreas loses its ability to secrete it. The
pathophysiology of T2DM is characterized through peripheral resistance of insulin, impaired
regulation of production of hepatic glucose, declining function of beta cell and eventually lead to
failure of beta cells (DeFronzo, & et. al., (2015). When glucose not going into cells and builds up
in blood, it causes far reaching implications on health such as kidney damage, heart disease and
nerve damage. It is the leading cause of non-traumatic lower limb amputations, kidney failure,
blindness and other types of diseases. The risk factors associated with type 2 diabetes mellitus
includes overweight, lack of physical activity, family history, age, gestational diabetes,
prediabetes, race or ethnicity, polycystic ovarian syndrome, fat distribution and darkened skin
areas. All these conditions often indicate resistance of insulin in the body which increases the
risk of type 2 diabetes mellitus among people.
In case of Emily Smith, she takes no medication for her diabetes and she can't walk due to
pain in her knee. Her blood glucose level was high, i.e., 22.9 mmol/L and her weight was 105 kg
which was the main risk factor for type 2 diabetes in case of Emily. Due to this, she may face
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several complications like blood vessel disease, heart disease, Kidney disease, neuropathy, eye
damage, slow healing, skin issues, sleep apnea, hearing impairment and Alzheimer’s disease. All
these are the possible complications of type 2 diabetes mellitus from which Emily may suffer
due to increased level of blood glucose level. The pathogenesis of T2DM includes development
of insulin resistance related to compensatory hyperinsulinemia, follow through progressive
impairment of beta cell which outcomes in reduction in secretion of insulin and hyperglycemia.
Increased level of free fatty acid, oxidative factors and inflammatory cytokines from fat have
been implicated in pathogenesis of type 2 diabetes and its complications (Fox, & et. al., (2015).
By adopting a healthy lifestyle like increasing physical activity level, changing diet,
maintaining healthy weight etc., a person can prevent diabetes or delay its onset, reduce its risk
and live healthier longer. The three levels of treatment options available for type 2 diabetes
mellitus includes medications, insulin therapy and weight loss. In case of Emily Smith, her
weight is too high so, losing weight can reduce her blood sugar levels. Apart from this, by
controlling food portions and eating healthy diet can help in reducing her weight. Losing weight
can lower blood glucose levels of Emily and the risk of cardiovascular disease. It also assists in
maintaining blood pressure level and cholesterol level which is beneficial in reducing blood
glucose level. Moreover, physical exercise also helps in reducing the blood glucose level. Some
medications like DPP-4 inhibitors, Alpha-glucosidase inhibitors, SGLT2 inhibitors, dopamine
receptor agonist etc. are also used in treatment of diabetes type 2 mellitus. In addition to this,
insulin therapy also helps in treating type 2 diabetes (Hackett, & Steptoe, (2017).
1.2. Difference between T2DM and T1DM
There are some key differences between type 1 diabetes mellitus and type 2 diabetes
mellitus which are as follows:
Basis of difference Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus
What is occurring The body attacks cells in pancreas
which restricts the secretion of
insulin.
In it, the body is not able to secrete
enough insulin or insulin that body
do make does not work properly.
Symptoms Its symptoms appears more quickly. The symptoms can be easier to
miss due to which they appear
slowly.
Risk factors The risk factors of type 1 diabetes The risk factors associated type 2
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are not known currently (Palomer, &
et. al., (2018).
diabetes are known such as weight
and ethnicity.
Management It can be managed through taking
insulin to control blood sugar.
It can be managed through
exercise, medication, insulin and
diet.
Cure and
Prevention
There is no cure available for it
currently.
It cannot be cured, but it can be
prevented.
1.3. Reasons for high BGL of Emily on admission and the way each reason affects BGLs
The reasons due to which the blood glucose level of Emily Smith is high at the time of
admission are high stress level because of surgery and her weight. When a person takes stress,
adrenal glands trigger glucose release which is stored in various organs, and it leads to high level
of glucose in bloodstream. Stress creates an issue for the diabetic patients as it can cause serious
alterations in levels of blood sugar and make it harder for diabetic patients to manage this
situation and maximize the risk (Portillo-Sanchez, & et. al., (2015). Constant stress will cause
adrenal fatigue and leads to failure of adrenal gland. Apart from this, being overweight also
increases the risk of type 2 diabetes as it makes even more harder for a person to control blood
sugar levels. When a person has much weight, the body cells become less sensitive to insulin
which is released from pancreas which in turn end up causing resistance to insulin. This leads to
increase in blood glucose levels and creates several issues for Emily Smith. So, stress and
overweight are the two main reasons due to which the blood glucose level of Emily is high on
admission.
PART 2
2.1. Medications, their action, complications/side effects and nursing considerations linked to
Emily’s situation
Medications Action Complications/ Side effects
Cortisone injections
(Kenacort-A 40)
This injection can help in
relieving the inflammation and
pain in her knee so that Emily
Continuous or long term use
of cortisone injection may
damage cartilage within
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Smith can able to move. It is a
powerful anti-inflammatory
medication (Tahrani, Barnett,
& Bailey, (2016).
joint. It may damage the
nerve, thinning of nearby
bone, tendon weakening, joint
infection etc.
Metformin (APO-Metformin
Tablets)
This medication production of
decreases hepatic glucose,
reduce intestinal glucose
absorption, and recovers
insulin sensitivity through
rising peripheral glucose
uptake and use. It helps in
controlling high blood sugar
levels, assist in preventing
kidney damage, loss of limbs,
nerve problems, blindness,
and other issues.
The most common side effects
of this medication includes
stomach pain, bloating,
diarrhea, weight loss,
headache, constipation, nausea
or vomiting, heartburn,
unpleasant metallic taste in
mouth, extreme tiredness,
dizziness etc.
Glipizide (Minidiab Tablets) This medication helps in
treating type 2 diabetes by
reducing blood sugar level of
Emily Smith. By causing
release of natural insulin of
body, it lowers the blood sugar
level. It acts through to
partially blocking channels of
potassium among beta cells of
Langerhans in pancreatic
islets. By blocking the
channels of potassium, the cell
depolarize which resulted into
opening of voltage gated
channels of calcium. The
The side effects of this
medication includes upset
stomach, constipation, weight
gain, loss of appetite,
headache, nausea, vomiting
and diarrhea (Zaccardi, & et.
al., (2016).
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resulting influx of calcium
encourages release of insulin
from beta cells which controls
blood sugar levels.
Nursing interventions for type 2 diabetes:
The nursing interventions related to type 2 diabetes includes educating regarding home
glucose monitoring, review on the factors in glucose instability, encourage Emily to read the
labels, check viability of insulin, review insulin type used, discuss about the way antidiabetic
medications work and check the sites of injection periodically. The nurse need to discuss home
glucose monitoring with patient as per the individual parameters in order to determine as well as
manage the variations in glucose level. Apart from this, the nurse must encourage Emily Smith
to read label and to choose the food which have high fibre, low fat content and low glycaemic
index. Moreover, review of factors in glucose instability as proper review of common
situations of patient which contribute to instability of glucose is needed by nurse as there are
many factors which play significant role in increasing blood glucose level like infection, missing
meals or other illness (Nursing Interventions, (2020).
2.2. Discuss the two blood results, one from prior to surgery and one from the clinic visit of
Emily’s BGL and HbA1c. What are they? What do they measure and why have they
changed?
Prior to the surgery of Emily Smith, her blood glucose level was 22.9 mmol/L [3.9 - 6.1
mmol/L] and HbA1c was 11% [normal <6.5%]. This depicts that her blood glucose level was
high. The main reason of this was stress which she takes before the surgery. However, after the
surgery, her blood glucose level was 8.8 mmol/L [3.9 - 6.1 mmol/L] and HbA1c was 8% [normal
<6.5%], which was low then before. The reason of this significant decrease in blood glucose
level and HbA1c was successful completion of her surgery (Zheng, Ley, & Hu, (2018). Because
of undertaking surgery, she takes a lot of stress which ultimately impacts on her blood glucose
level but, post successful surgery, her stress level decreases which results into low blood sugar
levels than before. Apart from this, the another reason is that Emily did not take any specific
medication for diabetes before the surgery. But, after the surgery she take proper medications
which is also the cause behind her comparatively low glucose level post-surgery.
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PART 3
3.1 What does Emily’s renal function test indicate? Explain her renal function test. What
appropriate treatment should be available to Emily? Explain her treatment options with
rationale
The renal function test of Emily indicates that her glomerular filtration rate
10ml/min/1.73m2, which was lower than the normal range. Apart from this, her haemoglobin
was also lower (95g/L), serum potassium was high (5.7 mmol/L), serum urea level was high (17
mmol/L) and serum creatinine (150 μmol/L) was also found high than normal levels. The results
of this test clearly depicts that Emily was suffering from chronic kidney disease (Thomas,
Cooper, & Zimmet, (2016). The possible treatment available for Emily to reduce the
complications and slow down the progression of disease includes medications related to high
blood pressure, low cholesterol level, to treat anaemia and low protein diet in order to minimise
the waste products from blood. Apart from this, bringing changes in lifestyle also help in lower
down the progression of disease. Besides this, dialysis can also be done if required to prevent it.
CONCLUSION
As per the above discussion, it can be concluded that type 2 diabetes mellitus leads to create
several other complications for an individual if it is not monitored and controlled timely. The
medications like Metformin and Glipizide helps in reducing the blood sugar level in body and
managing the disease.
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REFERENECS
Books and Journals
Cusi, K., & et. al., (2016). Long-term pioglitazone treatment for patients with nonalcoholic
steatohepatitis and prediabetes or type 2 diabetes mellitus: a randomized trial. Annals of
internal medicine, 165(5), 305-315.
DeFronzo, R. A., & et. al., (2015). Type 2 diabetes mellitus. Nature reviews Disease
primers, 1(1), 1-22.
Fox, C. S., & et. al., (2015). Update on prevention of cardiovascular disease in adults with type 2
diabetes mellitus in light of recent evidence: a scientific statement from the American
Heart Association and the American Diabetes Association. Circulation, 132(8), 691-718.
Hackett, R. A., & Steptoe, A. (2017). Type 2 diabetes mellitus and psychological stress—a
modifiable risk factor. Nature Reviews Endocrinology, 13(9), 547.
Palomer, X., & et. al., (2018). Palmitic and oleic acid: the yin and yang of fatty acids in type 2
diabetes mellitus. Trends in Endocrinology & Metabolism, 29(3), 178-190.
Portillo-Sanchez, P., & et. al., (2015). High prevalence of nonalcoholic fatty liver disease in
patients with type 2 diabetes mellitus and normal plasma aminotransferase levels. The
Journal of Clinical Endocrinology & Metabolism, 100(6), 2231-2238.
Tahrani, A. A., Barnett, A. H., & Bailey, C. J. (2016). Pharmacology and therapeutic
implications of current drugs for type 2 diabetes mellitus. Nature Reviews
Endocrinology, 12(10), 566.
Thomas, M. C., Cooper, M. E., & Zimmet, P. (2016). Changing epidemiology of type 2 diabetes
mellitus and associated chronic kidney disease. Nature Reviews Nephrology, 12(2), 73.
Zaccardi, F., & et. al., (2016). Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year
perspective. Postgraduate medical journal, 92(1084), 63-69.
Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes
mellitus and its complications. Nature Reviews Endocrinology, 14(2), 88.
Online
Nursing Interventions, (2020). [Online]. Available through: <https://nurseslabs.com/diabetes-
mellitus/>
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