Diabetes and Kidney Failure: Pathophysiology and Treatment

Running head NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

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1. Diabetes has been found to be one of the leading cause of kidney failure. Poor
hyperglycemia. Landmark trials conducted with patients suffering from diabetes have found
that intensive control of blood sugar level in the early onset of the disease exhibits a long
lasting effect of the risk of chronic kidney disease. The high blood glucose level damages the
blood vessel of the kidneys. When the blood vessels are damaged, they don’t work well, that
can also damage the kidneys.
According to Nasri and Rafieian-Kopaei (2015) the endothelial changes plays an
important role in the pathophysiology of renal disease. Endothelial dysfunction precedes the
changed vascular permeability and causes albuminuria. There are several markers of endothelial
dysfunction. Markers of the endothelial dysfunction like soluble intercellular and the vascular
adhesion of the molecules and the microvascular reactivity can be observed in patients with
diabetes the before any clinical manifestation of diabetes mellitus (Toth-Manikowski and Atta
2015). An accumulation of the uremic toxins and an increased parathyroid levels, increase in
patients with chronic kidney condition (Nasri and Rafieian-Kopaei 2015). Chronic kidney
disease cause insulin resistance in the tissues particularly the skeletal muscle tissues. Insulin
resistance has been found to have been reduced in patients with chronic renal disease (Nasri and
Rafieian-Kopaei 2015).
With the onset of diabetes, there is an increase in the glomerular expression of the
endothelial growth factor A (VEGF-A), parallel to the dysregulation of the other vascular growth
factors like angiopoetins-1/2, which is again accompanied by an increase in the glomerular
capillary length and diameter, increase in the glomerular volume and increased vascular
permeability (Nasri and Rafieian-Kopaei 2015). However, the mechanism under the glomerular
hyper filtration in diabetes in not understood properly. It is evident from the case study, that

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Sharon had been receiving Metformin. It is an antihyperglycemic agent that improves glucose
tolerance in patients suffering from type 2 diabetes and helps in lowering both the postprandial
as well as the basal level. Metformin reduces the production of the hepatic glucose, decreasing
the intestinal glucose absorption and improves the insulin sensitivity by enhancing the peripheral
glucose utilization and uptake (FDA 2017). Unlike sulfonylureas, metformin does not produce
hypoglycemia in individuals suffering from type 2 diabetes (Lalau et al. 2018). Metformin
treatment has been proven to be pharmacologically efficacious for mild to moderate diabetes
related renal disease (Reidy et al. 2016). Hence, as per Sharon’s physical condition, it can be said
that Metformin is an efficient drug to treat her condition.
2. The case study reveals that the BGL value of Sharon is 8-11 mmol/L throughout the day and
7-8mmol/L when she wakes up at the morning, which is quite high in comparison to the
standard blood glucose level,that remains within the range 4-5 mmol/L during fasting and up
to 7.8 mmol/L after the consumption of meals. Greater than these value signifies that the
person was having diabetes. The BGL level of Sharon signifies that she had been suffering
from diabetes, in spite of taking Metformin, since she had been diagnosed with diabetes
(FDA 2017). Metformin is an antidiebetic medicine that is normally used to control the blood
sugar level. This indicates towards the fact that the patient might be missing doses of
medicines.
3. The case study has revealed that glucovance is another oral antihyperglycemic drug. Each of
the drug is available for the oral administration of the tablets. Some of the warning size of the
disease is stomach upset, nausea and weight gain. The stomach symptoms that might occur
during the first day of the treatment can be a sign of lactic acidosis (Rahmah 2013). Serious
effect like bleeding, bruising, signs of infection. Some of the serious effect of the medication