Pathophysiology of T2DM and Medications for Emily

This study outlines the pathophysiology of Type 2 Diabetes Mellitus (T2DM) and examines the medications taken by Emily. It also evaluates Emily's renal function test.

Case study

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
PART 1 QUESTIONS.....................................................................................................................1
1.1 Describing the pathophysiology of T2DM associated with the case....................................1
1.2 Differentiating between T2DM and T1DM..........................................................................2
1.3 Examining reasons the BGL is high upon admission of Emily............................................3
PART 2 QUESTIONS.....................................................................................................................4
2.1 Examining three medications taken by Emily......................................................................4
2.2 Discussing the blood results one from prior to surgery and one from the clinic visit of
Emily’s BGL and HbA1c............................................................................................................5
PART 3 QUESTIONS.....................................................................................................................5
3.1 Critically evaluating the renal function test of Emily...........................................................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7

INTRODUCTION
This study is based on case study where complete pathophysiology associated with
T2DM will be outlined with key relevant evaluation of the medication taken by the patient.
Moreover, this study also focuses on critically evaluating the key indications associated with the
Emily’s renal function test.
PART 1 QUESTIONS
1.1 Describing the pathophysiology of T2DM associated with the case.
Type 2 diabetes mellitus is considered to be as a chronic disease which has been
significantly categorized as a high degree of sugar within the blood. The body does not produce
enough degree of insulin. Type 2 diabetes mellitus has been categorized as a peripheral insulin
resistance, decline or failure in β- cell function and reduced regulation of the production of
hepatic glucose (Browne, Nefs, Pouwer, & Speight, (2015)). In the type 2 diabetes mellitus the
tissues of the peripheral resists the key effects associated with the insulin. The pathophysiology
of the type 2 diabetes mellitus is mainly linked with the degree of the insulin within the body and
the capability of the body to effectively utilize the insulin. The pancreatic beta cells helps in
effectively releasing the insulin because of the increased level of blood glucose concentration. In
order to function the brain normally it requires glucose continuously. In this specific case the
Emily has a blood glucose level of 22.9 mmol/L which tends to indicate that she has severe
symptoms related with the high blood sugar. The key relevant symptoms related with the type 2
diabetes mellitus are increased thirst, blurred vision, frequent urination, blurred vision, fatigue
and hunger. The key significant risk factors associated with the T2DM in the Emily is that she
has been overweight with 105kg and her height is 167cm. Emily also has a family history of type
2 diabetes. Her mother and older sister were both diagnosed with T2DM in their early 50. This
increases the risk of Emily to get T2DM. Inactivity among the patient also increases the risk of
type 2 diabetes mellitus. Emily has relevant degree of problem related with the knee problem
which makes it difficult for her to walk. The key significant treatment associated with the type 2
diabetes mellitus mainly comprise of exercise and diet, insulin therapy and medication. Giving
metformin to the patient is considered to be as the first prescribed medication for the treatment of
type 2 diabetes mellitus. It is very useful in lowering the production of the glucose within the
liver and helps in improving the sensitivity of the body towards insulin (Leslie, Taylor, Harris, &
Lean, (2017)). This medication treatment helps the patient in using the insulin more effectively.
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Metformin helps patient in not gaining their body weight. Insulin therapy is considered to be as
one of the most effective treatment for the Emily because she has type 2 diabetes mellitus. The
HbA1c of the Emily is 11% which tends to show key significant result above 6.5% and needs
appropriate level of improvement in order to control the haemoglobin level. Proper level of
exercise and diet is considered to be as the most significant treatment strategy for the Emily.
Appropriate set of diet and exercise helps in improving the glycemic control and is useful in
improving the insulin sensitivity. Effective eating habits helps in decreasing the need associated
with the insulin and oral medication (Diet and Exercise Among Adults With Type 2 Diabetes, 2020).
The person must get indulge in 150min per week to carry out the aerobic exercise, walking,
jogging and swimming. The diet of the type 2 diabetes mellitus mainly comprise of complex set
of carbohydrates like whole wheat, quinoa, brown rice, beans, oatmeal, fruits, vegetables and
lentils.
1.2 Differentiating between T2DM and T1DM.
PARTICULARS T1DM T2DM
1. Meaning It is an effective condition
where the immune system
tends to destroy the insulins
which makes cells in the
pancreas.
Type 2 diabetes mellitus is
considered to be as a chronic
disease which has been
significantly categorized as a
high degree of sugar within
the blood. The body does not
produce enough degree of
insulin.
2. Symptoms Extreme thirst, frequent
urination, dehydration,
frequent infections, etc.
Increased thirst, blurred
vision, frequent urination,
dehydration, blurred vision,
fatigue and hunger (Hamar &
et.al. (2015)).
3. Risk factors Genes, viruses, environmental
factors, geography, family
history, genetics, etc. diabetes
are the key risk factors related
Age, family history, inactivity,
weight gain, prediabetes and
gestational diabetes are the
key risk factors related with
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with the T1DM. the T2DM.
4. Management Taking insulin, counting fat,
protein and carbohydrates,
exercising, eating healthy,
monitoring blood sugar are
effective management of the
T1DM.
Losing body weight, eating
healthy, regular exercising,
insulin therapy, medication,
monitoring blood sugar are
effective management of the
T2DM.
5. Prevention In order to prevent
complications associated with
T1DM it is necessary to keep
blood pressure, blood sugar
and the cholesterol level
normal.
In order to prevent
complications associated with
T2DM it is necessary to
maintain balanced diet and eat
processed food, exercise
regularly, manage weight and
control blood pressure.
1.3 Examining reasons the BGL is high upon admission of Emily.
1. Being inactive and stress: In this case scenario, Emily has not been indulged in the
proper exercise because of the pain in the knee. Irregular movement within the body and
lack of exercise is one of the key reason for increase in the blood glucose level within
Emily at the time of admission. Stress is also one of the key relevant factor which results
in the increase in the blood glucose level within Emily at the time of admission (Chiang
& et.al. (2019)). The patient has Bakers Cyst which results in restricted movement of the
body. When the body is under stress then the adrenal glands tends to release the glucose
which has been stored in different organs and results in increase in the level of glucose
within the bloodstream.
2. Not following proper diet plan and no specific medication: This is the relevant reason
which has led to increase in the blood glucose level in Emily. She has not been taking any
proper diet which eventually affects the glucose level in the body. No appropriate
medication leads to increase in the blood glucose level within Emily at the time of
admission.
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PART 2 QUESTIONS
2.1 Examining three medications taken by Emily.
1. Metformin: Metformin is effectively used in order to control the blood glucose level in
people who has Type 2 diabetes mellitus and especially among those people who are
overweight.
Action: Metformin i.e., apo-metformin tablets has been used to effectively control the blood
glucose level in people who has Type 2 diabetes mellitus. It is useful in decreasing the
production of the hepatic glucose and helps in improving the insulin sensitivity by significantly
increasing the utilization of the peripheral glucose (Harding & et.al. (2016)). It helps in reducing
the level of sugar which has been released by the liver into the body.
Complications/side effects: The key side effects associated with the Emily upon intake of
Metformin results in heartburn, bloating, nausea, vomiting, stomach pain, gas, constipation, etc.
Nursing considerations: The health care practitioner or the nurse must effectively monitor the
serum or urine glucose levels on a frequent basis to determine the effectiveness of medication.
Emily has the problem of taking stress and arranging the insulin therapy at the time of high stress
is an effective nursing consideration.
2. Glipizide: It is an oral medication for type 2 diabetes which is useful in the control of the
blood sugar levels and helps pancreas in producing insulin.
Action: It has to be used with proper exercise and diet program which helps in controlling high
blood sugar.
Complications/side effects: Vomiting, nausea, loss of appetite, upset stomach, weight gain,
headache, upset stomach, diarrhoea and constipation are the key side effects associated with this
medication (Healy & et.al. (2015)).
Nursing considerations: This drug must be given 30 minutes before the breakfast. The nurses
must also monitor the serum or urine glucose levels on a frequent basis to determine the
effectiveness of medication.
3. Cortisone injections: It is considered to be as an anti- inflammatory medications which helps
in relieving the pain within the specific area of the body.
Action: Corticosteroid injections tends to increase the blood glucose levels within diabetic
patients. It is useful in the prevention of the production of collagen. This injection helps in
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shutting down the production of collagen-producing cells. The action of the Corticosteroid
injections helps in reducing pain by calming the nerves.
Complications/side effects: It tends to weaken the immune system of the person. It also leads to
low bone density, swelling of the limbs, mood alterations and high blood pressure.
Nursing considerations: The doctors must monitor the blood sugar level of the patient before
giving Cortisone injections (Toyama & et.al. (2019)). The injection must be limited to once in 3
months. The nurses must also monitor the serum or urine glucose levels on a frequent basis to
determine the effectiveness of medication.
2.2 Discussing the blood results one from prior to surgery and one from the clinic visit of
Emily’s BGL and HbA1c.
Blood glucose level is referred to as the amount of glucose within the blood (Deed & et.al.
(2016)). However, glucose is considered to be as a sugar which tends to come from the food we
eat and is stored within the body. The blood sugar level which is less than 7.8 mmol/L or 140
mg/dl is considered to be normal.
HbA1c is considered to be as a glycated haemoglobin (Hays & et.al. (2015)). It tends to
develop when the haemoglobin which is a protein within the red blood cell tends to carry out
oxygen and joins glucose in blood. The normal HbA1c is <6.5% among the T2DM.
Upon admission the blood glucose level was recorded to be 22.9 mmol/L [3.9-6.1 mmol/L]
and the HbA1c is recorded to be 11%. On the contrary, the Emily’s blood glucose level was
recorded to be 8.8 mmol/L [3.9-6.1 mmol/L] after the surgery was successful and the HbA1c is
recorded to be 8%. The surgery of the Bakers Cyst helps in better functioning of the organs and
leads to lower blood glucose level and HbA1c. Appropriate medications like Metformin and
Glipizid are useful in controlling the blood sugar levels and helps pancreas in producing insulin.
PART 3 QUESTIONS
3.1 Critically evaluating the renal function test of Emily.
The blood test result of the Emily mainly indicates glomerular filtration rate of
10ml/min/1.73m2. The Haemoglobin was 95g/L and the Serum Potassium was 5.7 mmol/L.
Moreover, the Serum Urea is indicated to be 17 mmol/L and Serum Creatinine is indicated to be
150 μmol/L. The GFR is considered to be as an appropriate measure of kidney function and has
been performed with the proper blood test (Zheng, Ley, & Hu, (2018)). Taking medications like
Ibuprofen and naproxen for the osteo-arthritis helps in relieving the key symptoms associated
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with pain. Dialysis is considered to be as one of the key prominent treatment for the better renal
function. It is useful in removing the waste products and also tends to remove extra fluid from
the body. She has increased degree of tiredness, general pruritus and nausea. The blood pressure
of the Emily is indicated to be BP to be 190/110mm Hg. This states a condition of the high blood
pressure and can eventually damage the blood vessels. This is a situation of hypertensive crisis
and can also result in stroke (Patterson & et.al. (2018)). Exercising on a regular basis, eating
healthy, reducing stress, monitoring of the blood pressure and family centred intervention are
referred to as the key relevant treatment for the Emily. Maintaining optimum body weight is also
effective treatment for the Emily to maintain blood pressure levels.
CONCLUSION
From the conducted study it has been summarized that, Type 2 diabetes mellitus is
considered to be as a chronic disease which has been significantly categorized as a high degree
of sugar within the blood. Giving metformin, Insulin therapy and proper diet and exercise are
key significant treatment for Type 2 diabetes mellitus.
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REFERENCES
Books and Journals
Browne, J. L., Nefs, G., Pouwer, F., & Speight, J. (2015). Depression, anxiety and self‐care
behaviours of young adults with Type 2 diabetes: results from the International Diabetes
Management and Impact for Long‐term Empowerment and Success (MILES) Study. Diabetic
Medicine, 32(1), 133-140.
Chiang, J. I & et.al. (2019). 217-LB: Associations between Multimorbidity and HbA1c in People
with Type 2 Diabetes in Australian Family Practice.
Deed, G & et.al. (2016). Peer-to-Peer, Interactive GP education can reduce barriers to best
practice in diabetes management. Diabetes Therapy, 7(1), 153-161.
Hamar, G. B & et.al. (2015). Long-term impact of a chronic disease management program on
hospital utilization and cost in an Australian population with heart disease or diabetes. BMC
health services research, 15(1), 174.
Harding, J. L & et.al. (2016). Age-specific trends from 2000–2011 in all-cause and cause-
specific mortality in type 1 and type 2 diabetes: a cohort study of more than one million
people. Diabetes Care, 39(6), 1018-1026.
Hays, R & et.al. (2015). Does Strongyloides stercoralis infection protect against type 2 diabetes
in humans? Evidence from Australian Aboriginal adults. Diabetes research and clinical
practice, 107(3), 355-361.
Healy, G. N & et.al. (2015). Accelerometer-derived sedentary and physical activity time in
overweight/obese adults with type 2 diabetes: cross-sectional associations with cardiometabolic
biomarkers. PloS one, 10(3), e0119140.
Leslie, W. S., Taylor, R., Harris, L., & Lean, M. E. J. (2017). Weight losses with low-energy
formula diets in obese patients with and without type 2 diabetes: systematic review and meta-
analysis. International Journal of Obesity, 41(1), 96-101.
Patterson, R & et.al. (2018). Sedentary behaviour and risk of all-cause, cardiovascular and cancer
mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis.
Toyama, T & et.al. (2019). Effect of SGLT2 inhibitors on cardiovascular, renal and safety
outcomes in patients with type 2 diabetes mellitus and chronic kidney disease: a systematic
review and meta‐analysis. Diabetes, Obesity and Metabolism, 21(5), 1237-1250.
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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
Diet and Exercise Among Adults With Type 2 Diabetes. 2020. [ONLINE]. Available through<
https://care.diabetesjournals.org/content/25/10/1722#:~:text=Diet%20and%20exercise%20are
%20considered,insulin%20(1%2C2).>
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