Case Study of a Patient with Diabetes Type 2

This case study explores the condition of a patient suffering from Diabetes Type 2, including their medication, the standards of practice for nurses, and the role of critical analysis in nursing. It also discusses the risks and complications associated with the disease.

“Case study of a patient suffering from Diabetes Type2”
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Contents
Introduction.................................................................................................................................................3
New Medication..........................................................................................................................................4
Standards of practice for nurse....................................................................................................................4
References...................................................................................................................................................5
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Introduction
Diabetic kidney disease has been found to be very prevalent among adults who are suffering
from diabetes type 2. It has been recommended that assessment of albumin excreted through
urine and estimated glomerular filtration rate that is eGFR should be done annually in order to
detect any kind of damage in the individuals suffering from diabetes type 2 (Sun et al., 2017).
A case study
Sharon is a 58 year old female, who is 170cm tall, weighs 120kg, and has a waist circumference
of 110cm. She was diagnosed with type 2 diabetes three years ago, and takes metformin
(Metformin Sandoz 1000mg, twice per day). She states that her usual blood glucose levels
(BGLs) are 8 to 11mmol/L throughout the day, and 7 to 8mmol/L when she wakens in the
morning. Her BP is 140/95mmHg. She now has consistent evidence of chronic kidney disease,
with an eGFR of 85ml/minute and some proteinuria. The patient is a 52 year old female who is
suffering from Diabetes Type 2. Medicine prescribed to her is metformin which does not leads to
hypoglycemic condition in the patient (Kulvinder Kaur, 2017). But as she is suffering from a
chronic kidney disease this would lead to the excess usage of glucose trough gluconeogenesis
and glycogenolysis resulting in hypoglycemia. If glucovance would also be given along with the
metmorfin then it could lead to the decrement of glucose in the bloodstream. The patient is also
having chronic kidney disease and metformin is excreted out of the body through renal pathway
only, which adds on to the risk of getting adverse effects on kidneys of the patient. It can only be
used with those patients who have their kidneys functioning normally. Also the dosage
Glucovance which is mentioned is too high for a patient aged 52 as the renal functions get much
more deteriorated by age. Considering the age of the patient the dosage should be titrated first
and then given in an amount that does not cause any harm. Using both the drugs in combination
can lead to various serious complications or a condition called lactic acidosis. It is a condition in
which pH of blood goes extremely down due to the depositions of lactate in the body which is
due to the malfunctioning caused with the body’s oxidative metabolism which results in the
excess of acid in the blood stream (Connelly et al., 2017). Lactic acidosis can cause the
following symptoms in the patient like low levels of sugar in the blood including chills,
headache, nausea, dizziness, having problem in breathing, tingling sensations on feet as well as
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hands, feeling uneasy, weakness, pain in the muscles, irregular heartbeats, cold sweats, fainting,
drowsiness, stomach discomfort, etc. (Lee et al., 2017).
New Medication
The patient is having two conditions, one is the hypoglycemic condition that is the level of sugar
in the blood stream is very low and the second is the chronic kidney disease. Both the conditions
should be kept in mind while devising new drug for the treatment of diabetes type 2 condition.
Drug X: This drug acts by initiating the mechanism of gluconeogenesis, the process of making
of glucose through certain non-carbohydrate substances, regulating the uptake of glucose by
muscle tissue, and increased apoptosis of beta cells. It would reduce HbA1c and fasting glucose,
with a low incidence of side effects, especially hypoglycemia.
Drug Y: This drug does not cause any further harm to the condition of the patients’ kidneys as it
gets flushed out of the system easily without taking longer time or without its deposition in the
system that could lead to further any complication. The further addition to its efficacy is that it
does not uses renal route for its excretion, instead it gets excreted out trough biliary route posing
less harm to the kidneys which are already at risk. The drug does not causes further weight gain
in the patient since the patient is already at an extreme obese condition with a body mass index
of 41.
Standards of practice for nurse
Nurses have a very crucial role to play along with great responsibilities while providing care to
the diabetes patient. There are certain standard of practice for registered nurse such as
 She should be able to critically analyse the condition and provide appropriate solutions to
it.
 She should be able to maintain a balance between therapeutic and personal relationship
 She should be able to maintain nursing practices on point.
 She should be able to conduct the assessments comprehensively,
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 She should be able to provide such nursing practices that are safe, responsible and
comprehensive.
 She should be able to devise certain plans to develop the nursing practices
 She should be able to perform critical evaluation to add u to the nursing services.
(Nursingmidwiferyboard.gov.au, 2019)
The statement which most appropriately justifies the nursing practice for the current case is
Standard 1: Thinks critically and analyses nursing practice. Being a registered nurse I should
take the following points into consideration.
 I should critically analyse what type of care a patient needs.
 The patient is in an extreme obese condition, so I should make the diet plan critically.
 The amount of daily energy required and the amount of exercise to be done should also
be monitored by me.
 The patient is hypoglycaemic so I should monitor the blood sugar level periodically
because introduction of Glucovance can add up to the hypoglycaemic condition.
 I should look forward to advising a patient to wear a medical alert band and carry some
sources of glucose handy so that whenever the symptoms of hypoglycaemia they can
have those sources ready with them.
 While deciding the food, I should keep in mind that the patient is suffering from
proteinuria so the meals should be designed accordingly.
 I should motivate the patient for self-care as it would also add seed to the recovery
process or at least not worsen the current condition.
 I should keep proper record of each and every medication and diet plans of the patient
because these are the basic elements that should be always kept up to the mark.
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References
Connelly, P., Lonergan, M., Soto-Pedre, E., Donnelly, L., Zhou, K. and Pearson, E. (2017).
Acute kidney injury, plasma lactate concentrations and lactic acidosis in metformin users: A
GoDarts study. Diabetes, Obesity and Metabolism, 19(11), pp.1579-1586.
Kulvinder Kaur, K. (2017). An Update on Etiopathogenesis and Management of Type 1 Diabetes
Mellitus. Open Access Journal of Endocrinology, 1(2).
Lee, E., Hwang, S., Lee, Y., Lee, S., Lee, Y., Kang, H., Han, E., Lee, W., Lee, B., Kang, E., Cha,
B. and Lee, H. (2017). Association between Metformin Use and Risk of Lactic Acidosis or
Elevated Lactate Concentration in Type 2 Diabetes. Yonsei Medical Journal, 58(2), p.312.
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia -
Professional standards. [online] Available at:
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx [Accessed 25 Apr. 2019].
Sun, X., He, J., Ji, X., Zhao, Y., Lou, H., Song, X., Shan, L., Kang, Y., Zeng, W., Pang, X.,
Zhang, S., Ding, Y., Ren, Y. and Shan, P. (2017). Association of Chronic Kidney Disease
with Coronary Heart Disease and Stroke Risks in Patients with Type 2 Diabetes
Mellitus. Chinese Medical Journal, 130(1), pp.57-63.
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