The rate of other chronic health issue

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

1NURSING
Type 2 diabetes (T2D) is a chronic health condition, whose prevalence is increasing
globally. According to the data by Australian Bureau of Health Statistics (2018), one in twenty
Australians had diabetes in 2017-2018. With the increase in risk of diabetes, the rate of other
chronic health issue such as hypertension and heart disease has increased too. Research literature
has established correlation between diabetes and hypertension as both the condition exists
together and worsens clinical outcomes in patients. Hypertension in diabetes patient can further
increase the risk of cardiovascular disease and nephropathy (Khangura et al., 2018). Thus,
paying attention to hypertensive diabetic patient is important to reduce the burden of
cardiovascular disease. This essay will look into the case scenario of a patient who has similar
issue of hypertension and diabetes. The case study is about Bill McDonald, a 75 year old male
patient diagnosed with T2D. The essay will examine the symptoms and diagnostic test results of
the patient and link it to the pathophysiology of T2D. The essay will also examine the potential
management approaches for a hypertensive diabetic patient.
Bill McDonald is a patient with diagnosis of diabetes. He has a history of smoking
cigarettes for 35 years and a history of alcohol consumption. His blood glucose level had been
fluctuating over the past 3 months. His risk of diabetes was linked to family history as his mother
had diabetes and diet of heart failure at the age of 65 years. Recently, Mr. Bill was found to have
high blood pressure, when he presented for a regular GP visit. His blood pressure was found to
be 170/100 mmHg. To understand the events that lead to his diabetes and his current chronic
symptoms, looking at the pathophysiology behind the condition is important.
The pathophysiology of T2D involves peripheral insulin resistance and declining of beta
cell function leading to beta cell failure. The primary event for all patients with diabetes is the
initial deficit in insulin secretion and initiation of insulin resistance. Insulin resistance is an

2NURSING
important factor for the development of T2D. According to Tesauro and Mazzotta (2020), all
patients with T2D suffer from varying degree of insulin resistance and insulin deficiency. Insulin
resistance is a phenomenon that occurs due to presence of excess glucose in the blood and the
reduction in the ability of the blood to use glucose for energy. This is manifested in the form of
high blood glucose level in the blood. Similar issue was found for Mr. Bill as his fasting blood
glucose level ranged from 4.5 to 7 mmol/L. The blood glucose of 7mmol/L or higher is seen in
patient with diabetes and blood glucose between 5.6 to 6.9mmol/L is seen in prediabetes patient.
Hence, Mr. Bill’s FPG value shows that he is suffering from moderate blood glucose control
issues as his FPG test is fluctuating.
There are many driving forces behind insulin resistance in any individual. This is
influenced by various factors such as obesity, smoking, genetics and ageing. Obesity can be
linked to Mr. Bill’s diagnosis as his weight was 123 kg. Obesity is a condition that is highly
associated with developing insulin resistance and T2D. This is because obese individuals have
adipose tissues which release large amount of non-esterified fatty acids and pro-inflammatory
cytokines. These cytokines can cause insulin resistance in adipose tissue and liver. The initiation
of the inflammation occurs in obese individuals, when adipose tissues lead to adipocyte
hypertrophy and local oxygen supply is disrupted by the adipocytes leading to activation of
cellular stress pathways. This mechanism results in autonomous inflammation and release of
cytokines and other pro-inflammatory signals (Kang et al., 2016). Thus, localized insulin
resistance takes place leading to abnormal metabolic state. Mr. Bill is an active smoker and his
smoking habit can be one of the reasons behind his T2D.
In addition to obesity, Mr. Bill’s high blood pressure is because of the effect of diabetes.
The main pathophysiology behind hypertension in diabetic patient involves the interaction