Type 2 Diabetes Case Study: Causes, Complications, and Treatment Options

This case study explores the story of Melanie Johnson, a 63-year-old woman diagnosed with type 2 diabetes. It discusses the causes and risk factors of the condition, as well as the complications that can arise if left untreated. The study also covers treatment options, including lifestyle changes and medication. The article concludes with a discussion of Melanie's blood glucose levels and the medications prescribed to manage her diabetes.

TYPE 2 DIABETES CASE STUDY 1
Type 2 diabetes case study
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TYPE 2 DIABETES CASE STUDY 2
Assessment Task 2: Case Scenario
Melanie Johnson is a 63 years old woman who has been admitted to your surgical ward for
the drainage of a BakersCyst.ShewasdiagnosedwithType2DiabetesMellitus (T2DM) 6months
ago, during a routine workup for surgery. She takes no specific medication for her diabetes
and has been told by her GP to ‘watch what she eats’. She was devastated to discover her
diagnosis of T2DM, as she was aware of the risks due to her family history. She has not
returned to her GP since her initial diagnosis. She has no other past medical history of note.
Melanie says tearfully “I have been trying to eat right and exercise, but I can’t walk because
of the pain in my knee and I was feeling down and eating ice cream. I have hardly eaten
anything in the last week because I am trying to lose weight and get my blood sugar down”.
Her mother and older sister were both diagnosed with T2DM in their early 50’s.
Melanie tells you she has had the Bakers Cyst for about 2 years. It has been increasing in size
over the last 8 months, restricting her movements. The planned surgery is drainage followed
by two follow up cortisone injections.

TYPE 2 DIABETES CASE STUDY 3
On Admission at 0800 - her blood glucose level (BGL) was 22.9 mmol/L; HbA1c: 11%. She
has been fasting since midnight. She notes that she is feeling quite “stressed” about the
surgery. On admission the following were recorded:
Height: 167cm
Weight: 105kg
Blood Pressure: 140/80 mmHg Pulse rate: 95 beats/min Respiratory Rate: 22 breaths/minute
Temperature: 36.7 oC
SpO2: 97%
Page 1 of 2
NURBN2016 2018 Assignment
Part 1 Questions (1000 words)
Melanie is distressed that her blood glucose level is elevated and asks you for help in
understanding her diabetes. She tells you that she has a friend who is very overweight, eats
lots of cake and hardly ever exercises, and he does not have diabetes.

TYPE 2 DIABETES CASE STUDY 4
1. Type 2 diabetes is a condition in which the body is resistant to insulin which is
produced by the B cells in the pancreas. The pathophysiology of T2DM is quite
complex and it involves the red blood cells ,muscle cells, fat and liver cells that take
glucose from blood and convert it to energy (Areosa Sastre, Vernooij, González-
Colaço Harmand, & Martínez, 2017). For them to achieve their functions, they need
insulin which is attached to the insulin receptors and the GLUT4 transporters. Type 2
diabetes occur when the cells lose their sensitivity to insulin and therefore fail to bind
glucose leading to accumulation of glucose in blood. Different risk factors are
responsible in making the cells insensitive to the insulin .One of the risk factor is
genetics(Besseling, Kastelein, Defesche, Hutten, & Hovingh, 2015) .If at any point
one of the family members had this condition, it is likely to affect another family
member. This is the case for Melanie in the case study since she said that she was
aware of the risk due to family history. She said that her mother and sister were
diagnosed with type 2 diabetes in the 50s. Another risk factor for type 2 diabetes is
overweight. This is in fact the primary risk factor in the case study since Melanie
weighs 105 kg (Christine et al., 2015). Studies have established that the more the fatty
tissue an individual has, the higher the risk of resistance to insulin. Another important
risk factor for type 2 diabetes is inactivity. According to Melanie, she has pain in her
knee and it is therefore difficult for her to exercise. This is because scientists have
established that exercise consumes the excess glucose and also assists an individual to
control his or her weight. Age is another risk factor (Chrvala, Sherr, & Lipman,
2016). Studies have revealed that individuals who are above 45 years old are likely to
suffer from type 2 diabetes. In the case study, Melanie was 63 years old. This is
because old people are more likely to exercise less. They also have the tendency of
losing muscle mass than gain weight. This places them at the risk of type 2 diabetes.

TYPE 2 DIABETES CASE STUDY 5
Polycystic ovarian syndrome is another risk factor for diabetes (DeFronzo,
Ferranninin, Groop, Henry, Herman, Holst and Weiss, 2015) .This is however
experienced in women alone. This condition is characterized by excess growth of hair
as well as obesity .In the case study, Melanie once had a cyst and therefore places her
at risk of type 2 diabetes.
Complications associated with type diabetes.
Diabetes affects different organs of the body if left untreated. The complications
usually develop with time and eventually become disabling or life threatening. Some
of the notable complications of type 2 diabetes include the heart and blood vessel
disease. Studies have linked type 2 diabetes to different cardiovascular diseases such
as stroke and angina. Another complication is nerve damage which is also called
neuropathy since excess glucose harm capillaries that supply blood to nerves. This
therefore leads to lose of sense ("Diagnosis and Classification of Diabetes Mellitus,"
2013).Type diabetes also leads to damage of the kidney by the excess glucose
destroying the small filtering systems. Eye damage is also a complication of T2DM
where the glucose destroy blood vessels in the retina and this leads to blindness. Other
complications include foot damage by destroying nerves that supply the foot, hearing
impairments, skin conditions and finally the Alzheimer’s disease.
Treatment options for type 2 diabetes.
The three treatment options for type 2 diabetes include eating well as this will assist in
managing of the body glucose as well as the weight of the body .Another option is
regular exercise so as to reduce the fatty tissue from the body (Inzucchi et al., 2014).
Finally, monitoring the blood glucose level assists in management of blood glucose.

TYPE 2 DIABETES CASE STUDY 6
2. Causes: Type 1 diabetes is an autoimmune system where the immune system attack
and destroy cells that produce insulin in the pancreas. Type 2 diabetes is a metabolic
disorder where the body either does not produce insulin or it is resistant to it.
Insulin production: In type 1 diabetes, the body does not produce insulin hormone
while in type 2 diabetes, insulin is produced.
Prevention: There is no means for preventing type 1 diabetes while in type 2 diabetes,
staying active and healthy diet reduce the risk of type 2 diabetes.
Treatment: In type 2 diabetes, insulin injections and monitoring glucose is a treatment
option while in type 2 diabetes, the treatment options include changes in lifestyle.
The risk factors: The risk factors for type 1 diabetes include family history, genetics
and environmental factors while for type 2diabetes, the risk factors are genetics,
lifestyle choices and overweight.
Common physical attributes: In type 1 diabetes, the BMI is usually within the normal
range or lower while in type 2 diabetes, the BMI is either overweight or the obese
range.
3. In the case study, the BGL for Melanie was at 22 mmol/L even after fasting from
midnight. There are two reasons however as to why the blood glucose was still high.
The two factors include the secretion of growth hormone and then the secretion of
stress hormones (Macaluso et al., 2002). According to the case study, Melanie was
very stressed about the surgery. Studies have established that emotional stress as well
as physiological stress stimulate the body to release stress hormones into the blood

TYPE 2 DIABETES CASE STUDY 7
stream. The common stress hormones include adrenaline and cortisol. The liver is the
organ that stores glucose in the form of glycogen (Portillo Sanchez et al., 2014) .The
liver only breaks little amount of glycogen to form glucose which is then released into
the blood stream so as to provide nourishment to the brain, the nerves, the heart and
other important organs. According to studies however, it is only possible for the liver
to release the glucose into blood under the influence of certain hormones. Out of all
the hormones in the body, it is only insulin that stimulates the liver to take glucose
from the blood stream and then store it in form of glycogen. On the contrary, all the
remaining hormones stimulate the liver to release glucose into the blood stream
(Reynolds, Mann, Williams, & Venn, 2016) .The reason why Melanin experienced
high glucose level on admission was therefore due to stress that stimulated the release
of adrenaline which in return stimulated the liver to release glucose into the
bloodstream.
Another reason for the elevated blood glucose on admission was growth hormones.
Scientists established that growth hormones are produced after a cycle of every 24
hours (Scheen, 2014). Scientists’ link an increase in blood glucose to this growth
hormones and the elevated blood glucose is usually experienced either during the
night or early in the morning .In this case study, it was early morning.
Part 2 Questions (700 words)
The surgery is successful and Melanie comes to see you in the outpatient clinic for cortisone
injections (Kenacort-A 40). She has been commenced on metformin (APO-Metformin
Tablets) and glipizide (Minidiab Tablets) to help control her diabetes. Her blood test on this
visit were BGL 8.8 mmol/L; HbA1c: 8%.

TYPE 2 DIABETES CASE STUDY 8
1. Metformin is a prescription drug that comes either in oral tablet or the oral
solution. This drug has been prescribed to Melanie in the form of APO-Metformin
Tablets and it is used to treat type 2 diabetes. This drugs belong to the class of
biguanides and all the drugs in this class have a similar mechanism of actions. The
metformin usually work by reducing the quantity of glucose made by the liver .It
also reduce the amount of glucose that the body absorbs (Semenkovich, Brown,
Svrakic, & Lustman, 2015) .Finally, the drug work by increasing the activity of
insulin in the body. There are different side effects that are associated with
metformin and they include diarrhoea, nausea, stomach pain, heartburns. These
are mild side effects. Serious side effects include lactic acidosis that is shown by
fatigue, unusual muscle pains, slow and irregular heart rate and then dizziness or
light-headedness. The drug is also associated with low blood sugar and this can be
seen by headaches, confusion, and irritability and sweating. The nursing
interventions in this case involves the nurse educating the patient to avoid
vitamins or herbs since they interact with metformin.
Another drug that has been prescribed for Melanie is cortisone which has been
prescribed in the form of Kenacort A40.This drug is only available in the generic
form. This drug is used to treat different conditions in the body but basically it is used
as a replacement therapy for certain hormones like adrenaline and prevents
inflammation in the body. It is also used to treat arthritis, asthma, ulcerative colitis,
lupus and anaemia .For the case of this case study however, and it is used as a
replacement therapy for hormones(Zaccardi, Webb, Yates, & Davies, 2015). Since
this drug belong to steroids, they work by releasing certain molecules in the body
which prevent inflammation. They also prevent the body experiencing immune
responses. The most common side effects of cortisone include confusion, excitement,

TYPE 2 DIABETES CASE STUDY 9
restlessness, headache, nausea, vomiting as skin problems. The drug is also associated
with insomnia and weight gain. Serious side effects include allergic reactions, fluid
and electrolyte problems and muscle problems. The nursing interventions in this case
involves the nurse teaching the patient not to introduce vitamins and herbs since they
interact affecting its efficacy in return.
Glipizide is another drug that has been prescribed for Melanie. This drug is used to
reduce blood glucose in people with type 2 diabetes. This drug belongs to the
sulfonylureas class and they work in a similar manner. This drug works by stimulating
the release of insulin from the pancreas .Insulin the assists in removing the glucose
from the blood stream to the cells where they belong. This generally reduces the level
of glucose in the blood. The common side effects for glipizide include headache as
well as irritability .It also causes seating, faster heart rate, dizziness,
nausea ,hunger ,anxiousness, diarrhoea, constipation, skin rash, redness or itching.
Just like the other drugs, the nursing intervention is similar since they also react with
vitamins and herbs .However, they further react with antifungals and the non-steroidal
anti-inflammatory drugs and therefore it is important for the nurse to provide such
education to the patient.
1. There were two blood tests conducted on Melanie, one was done prior to surgery
and the results were 22.9 mmol/L. The HbA1c values in this case was 11%.After
the surgery, the same blood glucose level test was done and the results were 8.8
mmol/L and HbA1c was 8%.The first test is used to measure the level of glucose
in the blood and the second test is used to measure the HbA1c in blood.HbA1c is
a component that carries oxygen within the haemoglobin and the test is therefore
used to estimate the quantity of the HbA1c that is in blood (Zaccardi et al., 2016).

TYPE 2 DIABETES CASE STUDY 10
All this tests are carried out differently but they have the same objective. They are
used to monitor the blood glucose level of patients with type 2 diabetes. However,
the values for both the tests have reduced. The reason why the two values have
reduced is because the patient is no longer stressed about the surgery since it has
been successful. As a result, the adrenaline hormone that stimulates the liver to
breakdown glycogen to glucose is not stimulated and therefore the blood glucose
level reduce. Once the blood glucose level reduce, the HbA1c also reduces.
Part 3 Questions (300 words)
While Melanie is waiting to see the doctor, she starts talking to you about her condition. She
asks if she has insulin dependent diabetes or early onset diabetes. She is also unsure of how to
use her BGL machine and BGL strips.
1. There are incidences where the terms insulin dependent diabetes mellitus/non-insulin
dependent diabetes mellitus and the mature/early onset are used. This terms are
always misleading. This is because in all the types of diabetes, there is a defect in
insulin. This therefore makes it hard to differentiate between the two. In all the cases,
both can begin early or on maturity depending on the exposure to the risk factors .A
good example is referring to type 2 diabetes as insulin independent. This could
literally mean that the T2DM does not rely on insulin yet in real sense occurs due to
the insensitivity of the body to insulin.
2. Teach Back method of patient education can basically be defined as a method
whereby a patient is taught a new aspect then the healthcare provider asks the patient
to explain or demonstrate what she or he was taught (Callaway et al., 2018). This
method ensures that the patient has grasped the concept effectively by demonstrating
or teaching back. According to studies, this is the best method of patient education.

TYPE 2 DIABETES CASE STUDY 11
Since in this case study Melanie does not know how to use the BGL machine, I will
use this method to teach her (Dinh, Bonner, Clark, Ramsbotham, & Hines, 2016). I
will ensure that explain things clearly using plain language. I would avoid using
medical jargons as well as vague language so that the patient can understand me well.
During teaching I would also speak slowly while maintaining eye contact with the
patient.
If the patient does not understand, I will have to repeat the procedure frequently. This
method needs a good environment and I will provide this by giving the patient time
and the opportunity so that she can talk to me. When using this method, it is
recommended to use decision aids. In this I will therefore use different decision aids
such as videos, written material as well as interactive tools.

TYPE 2 DIABETES CASE STUDY 12
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TYPE 2 DIABETES CASE STUDY 13
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TYPE 2 DIABETES CASE STUDY 14
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