Diabetes Case Study

This document is a case study on type 2 diabetes, discussing the diagnosis, treatment options, and lifestyle changes. It provides information on the symptoms, tests, and medications for managing diabetes. The case study also highlights the importance of physical activity and a healthy diet in controlling blood sugar levels.

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Diabetes case study
Essay
student
9/6/2019

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Table of Contents
Ans. 1 (of Q 1).............................................................................................................................................2
Diagnosis.................................................................................................................................................2
Ans. 2 (of Q2)..............................................................................................................................................4
Metformin................................................................................................................................................4
Contradiction for Dominic.......................................................................................................................5
Ans. 3 (0f Q3)..............................................................................................................................................6
Symptoms after 6 weeks..........................................................................................................................6
Other treatment options...........................................................................................................................6
Medications.........................................................................................................................................6
Lifestyle related changes.....................................................................................................................7
References...................................................................................................................................................8

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Ans. 1 (of Q 1)
Diagnosis
Dominic has been diagnosed with blood glucose levels of 16 mmol/L , he gained 8
kilograms, his waist circumference is 189 cm. although thee some tests must be performed to
confirm the type of diabetes in case of Dominic but the symptoms mentioned below also
indicates that he has type 4 diabetes. It is identified that anyone with the mass index is higher
than 25, and the interpretation of Dominic’s weight and height shows that he has 40.5 body mass
indexes which is very high. Being overweight is the main problem happens in type 2 diabetes in
which the fat is stored mainly around the abdomen. It has been identified that the risk of diabetes
2 increase if an individual has a waist circumference more than 50 inches (101.6 centimetres)
(American Diabetes Association, 2018), and Dominic has 189 cm of waist circumference which
strongly indicates that he has type 2 diabetes. Dominic also has received blood glucose reading
(16 mmol/L), which indicates that he has symptoms of type 2 diabetes. To confirm the type of
diabetes some of the tests can be performed for Dominic are; glycated hemoblobin (A1C) tests,
random blood sugar test, fasting blood sugar tests, and oral glucose tolerance tests.
Glycated hemoglobin (A1C) test:
This blood test, does not need fasting, specifies the average level of sugar in the blood for
the last 2 to 3 months. It calculates the proportion of blood sugar linked to hemoglobin, the O2-
transporting protein in the RBCs. The more the person has levels of blood sugar, the higher
hemoglobin he will have with the sugar linked. If this particular level of BGL is higher than 5.7

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per cent, it demonstrates that there is a constant, abnormally high quantity of glucose in the
patient’s blood (Sherwani et al., 2016).
Fasting plasma glucose (FPG) test
This test requires an individual to consume no food or drink liquid for eight hours before
providing a blood sample. The doctor's office is likely to program it the early morning, and the
examination commonly includes taking blood either from the finger or from a vein in the arm
(Alatrac et al., 2017).
Random blood sugar test
Blood sugar standards are measured in mg/dL or the mmol/L. Irrespective of when the
patient last ate, a sample of blood presenting that the individual’s BGL is 200 mg/dL (11.1
mmol/L) or higher proposes that the person has type two diabetes, particularly if he also
experience complications of diabetes, for example recurrent urination and high thirst (Punthakee,
Goldenberg & Katz, 2018).
Oral glucose tolerance test
This examination is less usually applied than the others, excluding during pregnancy. The
patient will need to avoid food overnight and later drink the sugary fluid at the physician’s
office. BGL are tested occasionally for the next 120 minutes. A BGL less than 140 mg/dL is
common. An interpretation between 140 and 199 mg/dL specifies pre-diabetes and a reading of
200 mg/dL or greater after 120 minutes suggests type 2 diabetes (Hulman et al., 2018).

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Ans. 2 (of Q2)
Metformin
Mechanisms of action of Metformin are distinctive from other type of oral
antihyperglycemic medicines. Metformin reduces BGL by lessening hepatic glucose creation
(gluconeogenesis), declining the glucose absorption in the patient’s intestine, and increasing
insulin sensitivity by improving uptake of peripheral glucose and use. It is well recognized that
metformin prevents activity of mitochondrial complex I, and it has meanwhile been usually
assumed that its strong anti-diabetic effects take place through this mechanism only (Song,
2016). The above procedures causes reduction in blood glucose, management of type II diabetes
and utilizing positive impacts on glycemic regulation. After taking, the organic cation
transporter-1 (OCT1) is accountable for the uptake of this drug into the hepatocytes (liver cells).
Since this medicine is positively charged, it stores in cells and inside the mitochondria because of
the membrane capacities across the cell membrane along with the mitochondrial internal
membrane. Metformin prevents mitochondrial complex I, stopping the creation of mitochondrial
ATP results in augmented cytoplasmic ADP: ATP and the AMP: ATP proportions. These
alterations trigger AMP-triggered protein kinase (AMPK), which is an enzyme plays a major role
in the control of glucose breakdown. Apart from this process, AMPK can be triggered by the
lysosomal mechanism including other activators. Subsequent this procedure, upsurges in AMP:
ATP proportion also prevent fructose-1, 6-bisphosphatase enzyme, leading to the
gluconeogenesis inhibition, whereas also hindering adenylate cyclase and reducing the creation
of cyclic adenosine monophosphate (cAMP), a derived from the ATP used during cell signaling.
Triggered AMPK phosphorylates 2 isoforms of the acetyl-CoA carboxylase enzyme, thus

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hindering synthesis of at and results in fat oxidation, decreasing hepatic lipid supplies and
increasing sensitivity of liver to insulin (Rena, Hardie & Pearson, 2017).
Contradiction for Dominic
The efficacy and advantages of metformin management in diabetes type 2 have been
established by large-scale readings and accepted by numerous consensus declarations. Still, a
huge list of contraindications might increase the occurrence of severe adverse effects, which
prevents numerous patients from taking metformin. Contradiction of may include Hyperactivity
to the metformin hydrochloride, pre-coma related to diabetes, acute situations with the possibility
to change function of kidneys like dehydrations, serious infection, shock, and intravascular
administration of the iodinated contrast agents. The Acute or long-lasting type of illnesses which
might causes tissues hypoxia, for example failure of respiratory functioning, the decompensated
heart failure, contemporary myocardial infarction, and shock (Salber et al. 2017). It has been
identified that this drug works effectively when the patient perform daily exercise and consume
healthy diet, which is the main issues in case of Dominic as he do not eat healthy food and
perform no exercise. The contraindications of this drug also include the hepatic insufficiency,
any kind of acute metabolic acidosis (for example lactic acidosis, and diabetic ketoacidosis),
renal failure, and acute type of alcohol intoxication and alcoholism. Renal damage signifies a
contraindication to the metformin treatment because of the augmented threat of lactic acidosis (a
kind of metabolic acidosis because of the insufficient elimination of lactic acid from the blood).
Though lactic acidosis related to metformin is an exceptional condition. As discussed in the case
study that Dominic enjoys gout out with the friends, and drinks eight to ten beers per night, this
might be the contraindication for him related to metformin 500 mg (Bailey, 2017).

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Ans. 3 (0f Q3)
Symptoms after 6 weeks
After six week Dominic reported to have symptoms like abdominal cramps, nausea, and
diarrhoea which occur occasionally. These symptoms might be associated with the lactic acidosis
which is the most severe adverse effect of lactic acidosis associated with Metformin, it is rare but
severe problem that can takes place due to the development of metformin in the patient’s body. It
is the medical emergency that requires immediate treatment. Some of the symptoms that an
individual might experiences due to lactic acidosis are muscle pain, trouble breathing, nausea,
vomiting, and stomach pain (DeFronzo, Fleming, Chen & Bicsak, 2016).
Other treatment options
Medications
Sulfonylureas are the drugs that can help Dominic’s body top secrete more insulin, for
example glyburide, glipizide, and glimepiride. Madlitinides like repaglinie, and nataglinide can
work like sulfonylureas by triggering the pancreas to discharge more insulin in the body. These
drugs are fast acting, and the effect duration in the body is comparatively lower.
Thiazolidinediones includes rosiglitazone and pioglitazone increase the tissue sensitivity of to
the insulin (Müller-Stich et al., 2015). DPP-4 inhibitor medications like sitagliptin, saxagliptin,
and linagliptin help in reducing levels of blood sugar; however tend to have a very modest
impact (Deacon, 2018). GLP-1 receptor agonists are the injectable medicines slow digestion and
support in reducing blood sugar levels. Using these drugs frequently causes weight loss.
Potential side effects comprise nausea and an augmented risk of the pancreatitis. Some of the
individuals who have type 2 diabetes require insulin treatment. Previously, insulin therapy was

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applied as the last resort, however nowadays it is frequently recommended sooner due to its
benefits (Müller-Stich et al., 2015).
Lifestyle related changes
Physical activity: Dominic has lack of physical activity issues that also contributed to his
diabetes. Individuals with this health issues must perform some exercise that can be doable such
as walking, swimming, and biking according to the recommendations of physicians. This will
also help Dominic to maintain his weights (Barrès & Zierath, 2016).
Healthy diet: As john reported that he is not consuming a healthy diet and consumes alcohol
when at home. He must consume a healthy diet rich in more vegetables, and fibres. He must also
limit the consumption calories, carbohydrates, and saturated fats (Barrès & Zierath, 2016).

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References
Alatrach, M., Agyin, C., Adams, J., DeFronzo, R. A., & Abdul-Ghani, M. A. (2017). Decreased
basal hepatic glucose uptake in impaired fasting glucose. Diabetologia, 60(7), 1325-1332.
American Diabetes Association. (2018). 2. Classification and diagnosis of diabetes: standards of
medical care in diabetes—2018. Diabetes care, 41(Supplement 1), S13-S27.
Bailey, C. J. (2017). Metformin: historical overview. Diabetologia, 60(9), 1566-1576.
Barrès, R., & Zierath, J. R. (2016). The role of diet and exercise in the transgenerational
epigenetic landscape of T2DM. Nature Reviews Endocrinology, 12(8), 441.
Deacon, C. F. (2018). Peptide degradation and the role of DPP-4 inhibitors in the treatment of
type 2 diabetes. Peptides, 100, 150-157.
DeFronzo, R., Fleming, G. A., Chen, K., & Bicsak, T. A. (2016). Metformin-associated lactic
acidosis: Current perspectives on causes and risk. Metabolism, 65(2), 20-29.
Hulman, A., Vistisen, D., Glümer, C., Bergman, M., Witte, D. R., & Færch, K. (2018). Glucose
patterns during an oral glucose tolerance test and associations with future diabetes,
cardiovascular disease and all-cause mortality rate. Diabetologia, 61(1), 101-107.
Müller-Stich, B. P., Senft, J. D., Warschkow, R., Kenngott, H. G., Billeter, A. T., Vit, G., &
Nawroth, P. P. (2015). Surgical versus medical treatment of type 2 diabetes mellitus in
nonseverely obese patients: a systematic review and meta-analysis. Annals of
surgery, 261(3), 421-429.

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Punthakee, Z., Goldenberg, R., & Katz, P. (2018). Definition, classification and diagnosis of
diabetes, prediabetes and metabolic syndrome. Canadian journal of diabetes, 42, S10-
S15.
Rena, G., Hardie, D. G., & Pearson, E. R. (2017). The mechanisms of action of
metformin. Diabetologia, 60(9), 1577-1585.
Salber, G. J., Wang, Y. B., Lynch, J. T., Pasquale, K. M., Rajan, T. V., Stevens, R. G., & Kenny,
A. M. (2017). Metformin Use in Practice: Compliance With Guidelines for Patients With
Diabetes and Preserved Renal Function. Clinical Diabetes, 35(3), 154-161.
Sherwani, S. I., Khan, H. A., Ekhzaimy, A., Masood, A., & Sakharkar, M. K. (2016).
Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomarker
insights, 11, BMI-S38440.
Song, R. (2016). Mechanism of metformin: a tale of two sites. Diabetes care, 39(2), 187-189.