Diabetes Case Study Nursing Assignment

Running head: BACHELOR OF NURSING
Case Study- Type 2 Diabetes
Name of the Student
Name of the University
Author Note

1BACHELOR OF NURSING
Question 1
Insulin is a peptide hormone, produced by β-cells of the islets of langerhans, and
regulates the carbohydrates, proteins and fats metabolism by promoting the glucose absorption
from blood. Its effects are initiated by binding to a receptor containing α- and β subunits. This
binding triggers tyrosine kinase activity that promotes β subunits autophosphorylation. This
activates a signal transduction cascade that aids in glucose absorption. In the patient with type 2
diabetes, there is insufficient insulin production from the β-cells (American Diabetes
Association, 2014). This leads to insulin resistance. There occurs inappropriate release of
glucose from the liver cells into the bloodstream. The signal pathway gets inactivated which
leads to this resistance. Thus, the cells are unable to use insulin effectively, leading to increased
blood sugar.
Question 2
There is a high risk for angina pectoris in the patient because high blood glucose affects
the artery walls and increase the likelihood to degenerate the walls. Moreover, type 2 diabetes
increases risk of hypertension, high triglyceride levels and low levels of HDL cholesterol. Thus,
the risk of atheroma will increase (Shah et al., 2015). The heart muscles will become less
efficient to pump blood. Family history of diabetes, smoking and obesity will also make the
patient vulnerable to angina pectoris.
The patient is also at a risk of diabetic retinopathy due to chronically high blood glucose
levels. Light rays are detected by the retina and converted to signals, which are sent to the CNS
through the optic nerve. Type 2 diabetes will damage the blood vessels in the retina, and may

2BACHELOR OF NURSING
lead to diabetic retinopathy. The blood vessels may bleed (hemorrhage) or leak fluid, thereby
distorting the vision (Ruta et al., 2013). In advanced stage, there may be abnormal proliferation
of the blood vessels on the retina surface, which in turn can lead to cell loss and scarring.
Question 3
Metformin can be considered as an effective drug for the patient. It works principally by
reducing or lowering the amount of glucose production from the liver. Metformin plays a role in
influencing peripheral glucose uptake and insulin sensitivity in the cells. It decreases elevated
blood sugar by the process of hepatic gluconeogenesis. Gluconeogenesis occurs three times the
normal rate in an average patient suffering from type 2 diabetes. Administration of metformin
reduces this amount by more than one-third. The potential action mechanisms include: AMP-
activated protein kinase (AMPK) activation, inhibition or suppression of mitochondrial
respiratory chain complex I and elevated cyclic adenosine monophosphate (cAMP) induced by
glucose, reduction of protein kinase A (PKA) and on gut microbiota effects (Pernicova &
Korbonits, 2014). Inhibition of liver glucose production primarily depends on AMPK activation.
The enzyme plays an essential role in maintaining energy balance, glucose metabolism and
insulin signaling. The drug also increases peripheral glucose uptake by GLUT4 phosphorylation
and enhances insulin sensitivity. However, it can lead to some gastrointestinal side effects in the
patient.
Question 4 (a)
Insulin resistance often is among patients with visceral adiposity. These people have an
increased amount of fatty tissue within their abdomen. This is distinct from any subcutaneous
adiposity. There are several evidences that suggest correlation between insulin resistance and