Diabetes and Chronic Kidney Disease: Case Study

This case study explores the relationship between diabetes and chronic kidney disease, focusing on a patient with type 2 diabetes. It discusses the patient's symptoms, medication, blood glucose levels, and potential treatment options.

NAME: KOMAL KAMBOJ
STUDENT I.D: 1118428
COURSE CODE: NUR231
TASK2: CASE STUDY
Question1.
Sharon has type 2 diabetes, which is usually diagnosed in adulthood. Insulin resistance, beta-
cell destruction, and high blood sugar levels characterize this condition. Sharon’s weight in
relation to her height indicates that she is overweight. Her Body Mass Index (BMI) shows
that she is obese. Obesity triggers change in a body metabolic processes where adipose tissue
releases fat molecules into the blood affecting the responsiveness of insulin cells resulting in
reduced insulin sensitivity (DeFronzo et al. 2015). Besides, her waist circumference is 110
cm, which is more than the recommended: 88 cm. Sharon’s waist circumference is an
indicator of the amount of health risk, in this case diabetes type 2. (Reidy et al. (2014)
suggests that obesity, metabolic disorders, and diabetes types 2 are critical in elevating blood
pressure levels; hence, the pathogenesis of diabetic nephropathy. Sharon’s blood pressure is
140/95 mmHg, which is higher than the average level: 120/80 mmHg. Hypertension has
deleterious effects on a patient’s renal system as it increases sodium reabsorption and other
metabolic disorder that accelerate renal injury (Reidy et al. 2014). The high pressure in the
efferent arteriole of the glomerulus and the dilation of the afferent arteriole increases the rate
of glomerular filtration, which further exacerbates the ailment’s progression to proteinuria.
As evident in Sharon’s diagnosis, she has an eGFR of 85ml/min and some proteinuria: it is an
indicator of chronic kidney disease.Sharon uses Metformin Sandoz 1000mg twice each day.
Metformin is a type of medication that falls under the class of biguanides. It helps control the
high glucose levels in patients with diabetes type 2. The drug increases the sensitivity of cells
to insulin, which promotes the uptake and use of glucose from the blood (Rena, Hardie &
Pearson 2017). As a result, Metformin helps the muscle and fat cells to remove excess
glucose from the bloodstream adequately. Besides, the biguanide suppresses the production
of insulin from the liver; therefore, lowering Sharon’s blood glucose levels. Moreover,
Metformin delays gastrointestinal absorption of glucose after meals (Rena, Hardie & Pearson
2017). The drugs help Sharon control her blood glucose levels between and after meals
throughout the day.

Question2.
Blood glucose levels define the amount of glucose, a simple sugar, that is present in a human
or animal’s blood (Hippisley-Cox & Coupland 2016). During fasting, an average person’s
blood glucose levels ought to be between 3 to 5.4 mmol/L. Likewise, the levels are expected
to rise to 7.7 mmol/L. Hypoglycemia is a condition characterized by low blood sugar levels.
On the other hand, elevated blood glucose levels characterize hyperglycemia, a state often
caused by diabetes type 2. Diabetic patients ought to monitor their glucose levels, and align
their medication doses and strive to maintain their blood sugar levels within the normal range
(Plis et al. 2014). Sharon states that her blood glucose levels are at 8 to 11 mmol/L during the
day and within 7 to 8 mmol/L when she wakes up. Her situation dictates hyperglycemia.
Typically, for non-diabetic patients, their blood glucose levels ought to be between 3.0 to 5.4
mmol/L. However, Sharon’s glucose levels should be lower. According to Plis et al (2014),
the target levels for type 2 diabetes patients should be 4.0 to 7.0 mmol/L before mealtimes
and 8.5 mmol/L after taking meals.
Question3.
It has been suggested that Sharon ought to add Glucovance 500mg/2.5mg to her current
medication list. Glucovance is an antidiabetic drug that contains glyburide and metformin. It
is used in combination with other antidiabetics to help regulate the elevated blood sugar in
patients with diabetes mellitus. Glucovance stimulates the release of the hormone, insulin,
which regulates blood sugar levels. Notably, Glucovance 500mg/2.5 mg is more active when
compared to metformin: it improves fasting plasma glucose; postprandial blood sugar; and
the levels of HbA1c. The common side effects that patients may experience when taking
Glucovance 500mg/2.5mg include nausea, headaches, weight gain, diarrhea, and abdominal
discomfort.
However, some drugs when taken in combination with Glucovance interferes with a healthy
metabolism (Prabhakar, Kumar, Doble 2014). The addition can elevate blood glucose levels
instead of lowering it. In this case, Sharon’s medication might include antihypertensives and
diuretics to help reduce her blood pressure that is 140/95mmHg. The commonly administered
diuretics include osmotic, loop, thiazide, and potassium-sparing diuretics (Kim & Park 2017).
When taken with Glucovance, diuretics are likely to cause hyperglycemia. This condition is
likely to hasten Sharon’s current chronic renal condition into an end-stage renal disease.
According to( Kim & Park 2017)most of the chronic disease patients end up with end-stage
renal disease. Besides, such patients are prone to mortality, cognitive impairment, and
comorbidities. At this advanced stage of renal disease, Sharon’s kidneys will have lost their

complete function of waste removal and retention of beneficial substances in the blood. As a
result, Sharon will need regular dialysis or a kidney transplant. It is critical that such patients
be monitored for hypoglycemia when the diuretics are withdrawn.
Question4.
It is crucial to invent novel drugs based on the knowledge of diabetes and chronic kidney
disease pathogenesis to reduce the incidences of diabetes and ultimately the end-stage renal
disease. The current pharmacological treatment and therapies aim to improve the sensitivity
of cells and muscles to insulin; increase the availability of insulin; and, increase the excretion
of glucose through urination. The new medications that could be invented to treat particular
aspect relating to Sharon’s diabetes and chronic kidney disease are dipeptidyl peptidase 4
inhibitors and angiotensin receptor blockers. Dipeptidyl peptidase 4 inhibitors that could be
administered as oral hypoglycemic drugs would help lower Sharon’s blood glucose levels.
Endothelial cells secrete dipeptidyl peptidase 4 in response to immunity and inflammation
(Mulvihill & Drucker 2014). Dipeptidyl peptidase 4 inhibitors utilize the incretin system that
inhibits the enzymes responsible for degrading Glucagon-like peptide-I (GLP-1).
Postprandial glucose levels can be decreased by decreasing the clearance of glucagon-like
peptide-1. Deacon and Lebovitz (2016) contend that dipeptidyl peptidase 4 inhibitiors elevate
the concentrations of GLP-1 and glucose-dependent insulinotropic polypeptide, which brings
about an enhanced beta-cell responsiveness to the available glucose concentrations. Besides,
it will suppress the secretion of glucose. Diabetic patients have markedly increased levels of
this enzyme. Drugs that inhibit dipeptidyl peptidase 4 will help elevate incretin levels that
will inhibit the enzyme, glucagon; therefore, increasing the levels of insulin (Mulvihill &
Drucker 2014). Besides, the drugs will decrease both gastric emptying and blood sugar levels
(Deacon & Lebovitz 2016).
Drugs that could block angiotensin receptors would prevent the advancement of Sharon’s
chronic kidney disease. Angiotensin receptor blockers lower blood pressure. Angotensin
receptor blockers inhibit the effect of angiotensin II (Bangalore et al. 2016). Typically,
angiotensin II in blood narrows the blood vessels, which gives little space for proper
circulation; hence, elevating blood pressure. Moreover, angiotensin II triggers more water
retention, and the presence of large volumes of fluid in limited space increase blood
pressure. A drug that would block Sharon’s angiotensin II receptors would lower her current
high blood pressure levels, which is 140/95 mmHg. According to Bangalore et al. (2016),
angiotensin receptor blockers prevent angiotensin II from expressing vasoconstrictive and

aldosterone effects. As a result, these receptor blockers help reduce proteinuria and ultimately
the rate at which renal functions exacerbates in diabetic patients due to complete inhibition of
the renin-angiotensin system (Bangalore et al. 2016).
Question5.
Since its inception in 1953, the International Council of Nurses (ICN) Code of Ethics for
Nurses continues to serve as standards for nurses globally. The Code clarifies that the respect
of human rights is an integral part of nursing practice, that is, the right to life; the right to
dignity; and right to be treated respectful (International Council of Nurses 2012). Under the
ICN Code of Ethics, nursing is universal: the nurses are responsible for promoting health,
preventing diseases, restoring health, and alleviating human suffering (International Council
of Nurses 2012). The ICN Code of Ethics for Nurses outlines four elements that define the
standards of nurses’ ethical conducts: nurses versus people, practice, profession, and co-
workers (International Council of Nurses 2012). The Code’s element of nurses and practice is
relevant in guiding the nursing care for Sharon within a clinical setting. Nurses carry personal
responsibility and accountability in their practice in maintaining competency. However, it is
imperative that nurses include their patients in the decision making processes regarding their
healthcare.
The Code of Ethics of Nurses states that educator nurses ought to promote the importance of
personal health and a healthy lifestyle. According to Wilding (2014), health promotion plays
a critical role in managing diabetes and chronic kidney diseases. Besides, the creation of
positive relationships and support of social contexts promote a healthy lifestyle (Wilding
2014). Aging is the leading cause of diabetes, which often results in chronic kidney disease.
Therefore, it is imperative that nurses promote physical activity as one of the ways of
improving health as it is beneficial to diabetic patients of all ages (Wilding 2014). Physical
inactivity increases morbidity to patients such as Sharon, who has type 2 diabetes.
Regular exercise can improve Sharon’s quality of life. Exercises will help control Sharon’s
glycemic levels by increasing the skeletal’s need for glucose. Also, regular exercises done
through nurses’ supervision will help Sharon stay in energy balance. More also, it will make
Sharon’s heart stronger making her heart pump blood with less effort; hence reduced blood
pressure. Concomitantly, the exercises ought to help Sharon reduce the fat around her help; as
a result, she will achieve a waist circumference of less than 88 cm. Physical exercise helps
control type 2 diabetes and ultimately slowing the progression of chronic kidney disease. In

conclusion, the Code’s element of nurses and practice helps the standards of personal conduct
that reflect on a nurse’s profession while enhancing public confidence in nursing practices.

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