Management of Hypertensive Diabetic Patients: A Case Study of Bill McDonald

Running head: ACUTE CARE
Acute care
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Diabetes and hypertension are two heath conditions that are often found together in many
person and sharing common etiology and disease mechanism is the main reason that explains
why the two conditions co-exists in many person. This essay focussed on examining a patient
with diabetes who has hypertension as the main health issue too. The patient under study is Bill
McDonald, a 58 year old male patient who has a history of type 2 diabetes and he came to the
GP to the emergency department with symptoms of fatigue, painful feet and nausea. The main
purpose of this essay is to further examine Mr. Bill’s chronic symptoms and discuss the
pathophysiology associated with the condition. The essay discusses about the potential
management approach need for caring for a hypertensive diabetic patient. A comprehensive
education plan will also be developed to ensure that his treatment needs associated with
progression of the disease is met.
Bill is a patient with type 2 diabetes and on visit to the GP one week ago, he was found to
have a blood pressure of 170/100 mmHg. However, he had not other symptom of type 2 diabetes
at that time apart from the complaint that his eyes get tired easily. After the 4 day business trip to
Sydney, he is experiencing symptom of fatigue, nausea and pain in the feet. The current
symptom after the business trip suggests that his condition is deteriorating and many
pathophysiological changes is the reason behind his current symptoms. The common
pathophysiological mechanism associated with type 2 diabetes includes impaired insulin
secretion and insulin resistance. It is a condition that leads to inadequate insulin secretion from
the pancreatic beta cell and increase in glucagon secretion (Zaccardi et al., 2016). Insulin
resistance is mainly caused by obesity and physical inactivity. Insulin resistance is a condition
that leads to decrease in glucose responsiveness. The deposition of fat in the liver and muscles
results in the development of insulin resistance. As the fats deposits in the pancreas, it lead to

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impaired beta cell function, islet inflammation and eventually beta cell death. It results in
hypergylcemia and increase in risk of many microvascular and microvascular complication
(Kahn, Cooper & Del Prato, 2013).
One of the chronic symptoms that have been observed in Mr. Bill includes fatigue.
Fatigue in diabetes may be linked to the physiological phenomena of hyperglycemia and it may
also be linked to lifestyle issues such as being overweight and lack of physical activity. Mr.
Bill’s weight is 120 kg and he has a sedentary lifestyle. These lifestyle factors might also leading
to fatigue for the patient (Fritschi & Quinn, 2010). Chronic hyperglycemia is often linked to
fatigue. Patients with well controlled HbA1c level are less likely to suffer from fatigue. Fatigue
is the common presenting symptom of many diabetes patient (Park et al., 2015). The
pathophysiological changes associated with fatigue in diabetic patients include biochemical and
ionic changes in muscles and its impact on contractile properties of organ. High level of
hydrogen ions and presence of phosphate and potassium is also a mechanism associated with
fatigue. In people with diabetes, shift in energy substrate occurs because of lack of insulin as per
body’s need. Due to this process, the ADP phophorylation rate falls and the ATP resynthesis rate
decreases. This process leads to the occurrence of fatigue in diabetes patients (Kalra & Sahay,
2018). Similar process might be the reason for Mr. Bill to experience such symptoms.
Another chronic symptom that has been observed in Mr. Bill includes pain in the feet. On
going to a 4-day business trip, Mr. Bill complained about painful feet during the trip. On
physical examination of the patient, open ulcer has been found too. Foot pain is a nerve problem
that occurs due to the physiological mechanism of peripheral neuropathy. Peripheral neuropathy
is a type of nerve damage that occurs in diabetes patients because of high blood sugar level for a
long time. This can damage nerves throughout the body and result in pain in the feet and ulcers

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too. Neuropathy in diabetes mellitus can result in damage to the innervations of the leg muscles
causing imbalance between flexion and leg extension. This results in deformity and change of
pressure points. It leads to gradual skin damage and development of ulcer. These
pathophysiological mechanisms explain how Mr. Bill developed feet ulcer in the feet.
The review of Mr. Bill’s case also shows that hypertension is a major issue for him. His
blood pressure is 170/100 mmHg depicting that he is hypertensive. Research evidence shows
that diabetes and hypertension is often seen in same individual and the two conditions co-exist
because physiological process like inflammation and oxidative stress occurs both in diabetes and
hypertension (Cheung & Li, 2012). There are many potential management approaches that are
used to treat and manage health conditions of hypertensive diabetic patients. The first is
related to medical management of hypertensive diabetic patient and the second includes nursing
management of diabetic patient. Pharmacological intervention like the use of angiotensin
converting enzyme (ACE) inhibitor is the cornerstone treatment in the management of diabetes
patients with hypertension. ACE inhibitors like Ramipril and Vasotec is most often prescribed to
patients with hypertension. As hypertension is a common comorbidity in patients with diabetes,
the main aim of pharmacologic management is to achieve a target blood pressure of less than
130/80 mmHg. Remonti et al., (2016) explains that ACE inhibitor is effective in preventing
progression of complications in patients as it works to delay microvascular or macrovascular
complications in patients. The study revealed that treatment with ACE inhibitors in diabetic
patients results in decrease in risk of all cause mortality. Hence, ACE inhibitor is a vital regimen
in the treatment of patients with diabetes and hypertension.
In case of pharmacological management of hypertensive diabetes patients, drugs like
angiotensin receptor blockers (ARB) and diuretics are also combined in treatment. The critical