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Diabetes - Case studyIntroductionThe patient is 69 years old. He is having type-2 diabetes since 5 years. He is retired from the profession. He is diabetic since the year 2000 i.e. 16 years. Currently, he is having heavy meals for dinner. He was diagnosed with diabetes type -2 when he was 53 years old. Since then he is having a routine life. He retired from his job of Chattered Accountant at the age of 60 years. Post retirement his life has become. During his working days, he used to go joggingfor one hour in the morning. That helped him keeping his diabetes in check. Also, he used to have regular and balance diet. Since retirement, he has discontinued his jogging regime. Also since many days he is having heavy dinner meals such as large pasta meals along with the sweet dish. Though he is under regular medication but after few days he will again deviate from the healthy dietary habits and adopt unhealthy habits. This has been causing him some discomfort which has been ignored by the patient. The level of discomfort gradually decreases as he returns to his normal dietary habits.Presentation of caseWhat are the chief complaints of the patient?Patient profileThe patient is a 69 year’s old retired man. He is having a history of type-2 Diabetes since 16 years. Currently presents with recent weight gain, foot pain and the suboptimal control on diabetes. The patient is having one tablet glyburide 2.5mg every morning. The patient is trying to lose weight since 6 months but there is no success. The medication which he started is causing him dizziness. Hence he has stopped the medicine. The dizziness is also followed
by sweating by the afternoon. Along with diabetes, he is having high cholesterol for which heis taking atorvastatin 10 mg daily. As the patient is not able to lose his weight he is also taking chromium picolinate and gymnema sylvestre and improves pancreas function and enhance diabetic control. But eventually, he stopped them as there was no improvement .Patients both mother and father had type II Diabetes. Patient has a limited knowledge of Diabetes and diabetic self-care. He often says that why he is having diabetes since he never eats sugar.Since retirement, he has not been much physically active. Earlier he used to go for exercise for 1 hour in every morning. But now he has a sedentary life. He consumes heavy dinner and also not much active. He has been suggested by his wife to visit a dietician. But he finds it unnecessary. He also does not self-monitor his glucose levels. As per him, glucose tests are reliable by labs only and self-test at home is not reliable. The patient told that he is fond of pasta. Recently he is having an excessive intake of carbohydrate in the form of pasta and bread. But as per the patient, he is not eating anything wrong because he is not consuming sugar. The patient’s wife gathers a lot of knowledge from the internet. She has been telling him to get the self-test done at home but the patient is reluctant for it. We can see here that as patient never visited dietician he does not really understand what healthy diet is. Moreover for him not consuming sugar is the only control measure of diabetes. Perhaps he is not able tounderstand that his increased intake of carbohydrates has also contributed to rising sugar level. Also as he does not monitor his diabetic levels at home, he is unaware of the day to daychanges due to his food habits. His exercise levels are also low. Diabetic patients need to keep their weight in check (American Diabetes Association, 2014). But as he is not able to dothat it further worsens the condition for him making him prone to the complications of Diabetes. The patient is not able to understand that by ignoring his condition he is inviting
serious consequence in future (Evert et al, 2014). Patient’s wife has found some of the recipesof healthy food from the internet. But the patient does not eat them. He found them tasteless.What is the pathophysiology of present signs and symptoms?Diabetes type II is a combination of genetic factors as well as the lifestyle changes (AmericanDiabetes, 2014). Our lifestyle has changed really very quickly in past few decades (AmericanDiabetes Association, 2012). The consumption of fast food has increased many folds. There are many factors which are in our control like our habits. But there are few factors which are not in our control like age and genetics. Diabetes type II is closely related to obesity, lack of activity, poor diet and stress (American Diabetes Association, 2013). Diet also influences diabetes. Nowadays all processed food is made up of high carbohydrate, salt and sugar levels.Saturated fats which are present in processed food are abundance and are also responsible for diabetes. Genetics are also a huge contributor. If any of the one parent is suffering from diabetes, the chances of the offspring suffering from the same increases by 20 percent (Johnson et al, 2013).Type 2 diabetes is inadequate insulin production from the beta cells of the pancreas. Another factor is insulin resistance in which the cells do not respond to the secretion of insulin. Liver cells do not recognise insulin released in the blood (Crume et al, 2013). Hence lever abnormally increases the glucose levels. Another factor has increased the breakdown of fat cells and high glucose levels due to diet. This increases the water retention and inappropriate metabolism. After we eat the liver stores glucose but in some people’s case this does not happen and sugar keeps on passing out through urine.
From this, we can understand that patient is having water retention in the body. This is causing weight gain (Spaleniak et al, 2014). Also as the patient is consuming high carbohydrate diet this is not required by the body. It has high amounts of sugar and saturated fat. Due to the patient, body failure to consume this amount of glucose the blood sugar level rises. Also patient is taking medication which is causing a reverse mechanism in which the blood sugar levels fall rapidly (Sarwar et al, 2015). This causes dizziness. As there is weight gain and also the patient food habits are bad it is very evident that his diabetes is not under control and may be slowly progressing towards complication. The patient is complaining of foot pain. Diabetic neuropathy is one of the many complications of diabetes. In this, the nerves are directly affected. This shows blood sugar is high since several weeks. Patient’s negligence towards his self-care can be one of the reasons. Another reason could be circulatory problems. This is due to the effect of raised sugar on capillaries. In diabetes due tooverweight fat may get deposited on capillaries causing their walls thicken. Blood which flows to the feet gets blocked there. As tissue suffers from a lack of oxygen it becomes an extremely painful (Kitos and Nilsson, 2014). The patient might be suffering from the circulatory disorder. He has put on weight and not exercising adequately. The patient is also having high cholesterol which is indicative of circulatory problems. There are also many problems arising due to lack of knowledge of the patient.What should be the pharmacological approach towards Diabetes?There are many types of pharmacological approaches for diabetes. In this patient also have microvasculature involved. When only lifestyle changes are not enough for control of diabetes than the pharmacological approach is taken (Zechner et al, 2015). In this, the first and foremost thing to do is administer the antiglycemic drug. Our target is to attain the A1C
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