Diabetes - Case study

Added on - 25 Sep 2019

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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 theprofession. He is diabetic since the year 2000 i.e. 16 years. Currently, he is having heavymeals for dinner. He was diagnosed with diabetes type -2 when he was 53 years old. Sincethen he is having a routine life. He retired from his job of Chattered Accountant at the age of60 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 tohave regular and balance diet. Since retirement, he has discontinued his jogging regime. Alsosince many days he is having heavy dinner meals such as large pasta meals along with thesweet dish. Though he is under regular medication but after few days he will again deviatefrom the healthy dietary habits and adopt unhealthy habits. This has been causing him somediscomfort which has been ignored by the patient. The level of discomfort graduallydecreases 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 16years. Currently presents with recent weight gain, foot pain and the suboptimal control ondiabetes. The patient is having one tablet glyburide 2.5mg every morning. The patient istrying to lose weight since 6 months but there is no success. The medication which he startedis 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 alsotaking chromium picolinate and gymnema sylvestre and improves pancreas function andenhance diabetic control. But eventually, he stopped them as there was noimprovement .Patients both mother and father had type II Diabetes. Patient has a limitedknowledge of Diabetes and diabetic self-care. He often says that why he is having diabetessince he never eats sugar.Since retirement, he has not been much physically active. Earlier he used to go for exercisefor 1 hour in every morning. But now he has a sedentary life. He consumes heavy dinner andalso not much active. He has been suggested by his wife to visit a dietician. But he finds itunnecessary. He also does not self-monitor his glucose levels. As per him, glucose tests arereliable by labs only and self-test at home is not reliable. The patient told that he is fond ofpasta. Recently he is having an excessive intake of carbohydrate in the form of pasta andbread. But as per the patient, he is not eating anything wrong because he is not consumingsugar. The patient’s wife gathers a lot of knowledge from the internet. She has been tellinghim to get the self-test done at home but the patient is reluctant for it. We can see here that aspatient never visited dietician he does not really understand what healthy diet is. Moreoverfor 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 sugarlevel. 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 tokeep 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 ofDiabetes. 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. Thereare many factors which are in our control like our habits. But there are few factors which arenot in our control like age and genetics. Diabetes type II is closely related to obesity, lack ofactivity, poor diet and stress (American Diabetes Association, 2013). Diet also influencesdiabetes. 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 fordiabetes. Genetics are also a huge contributor. If any of the one parent is suffering fromdiabetes, 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. Anotherfactor is insulin resistance in which the cells do not respond to the secretion of insulin. Livercells do not recognise insulin released in the blood (Crume et al, 2013). Hence leverabnormally increases the glucose levels. Another factor has increased the breakdown of fatcells and high glucose levels due to diet. This increases the water retention and inappropriatemetabolism. After we eat the liver stores glucose but in some people’s case this does nothappen and sugar keeps on passing out through urine.
From this, we can understand that patient is having water retention in the body. This iscausing weight gain (Spaleniak et al, 2014). Also as the patient is consuming highcarbohydrate diet this is not required by the body. It has high amounts of sugar and saturatedfat. Due to the patient, body failure to consume this amount of glucose the blood sugar levelrises. Also patient is taking medication which is causing a reverse mechanism in which theblood sugar levels fall rapidly (Sarwar et al, 2015). This causes dizziness. As there is weightgain and also the patient food habits are bad it is very evident that his diabetes is not undercontrol and may be slowly progressing towards complication. The patient is complaining offoot pain. Diabetic neuropathy is one of the many complications of diabetes. In this, thenerves are directly affected. This shows blood sugar is high since several weeks. Patient’snegligence towards his self-care can be one of the reasons. Another reason could becirculatory 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 whichflows to the feet gets blocked there. As tissue suffers from a lack of oxygen it becomes anextremely painful (Kitos and Nilsson, 2014). The patient might be suffering from thecirculatory disorder. He has put on weight and not exercising adequately. The patient is alsohaving high cholesterol which is indicative of circulatory problems. There are also manyproblems 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 havemicrovasculature involved. When only lifestyle changes are not enough for control ofdiabetes than the pharmacological approach is taken (Zechner et al, 2015). In this, the firstand foremost thing to do is administer the antiglycemic drug. Our target is to attain the A1C
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