Case Study Analysis: Diabetes Management - Assessment Task 2 Report

This document presents an analysis of five distinct case studies related to diabetes, encompassing various aspects of the disease and its management. The first case study focuses on hypoglycemia, its causes, clinical manifestations, and educational needs for patients. The second explores microvascular complications such as diabetic retinopathy and nephropathy, as well as factors contributing to these complications and the management of foot ulcers. The third case study addresses gestational diabetes, its risk factors, physiological mechanisms, and diagnostic methods, along with management strategies. The fourth case study examines community resources available for diabetes patients and the barriers they face, as well as social and environmental factors contributing to the disease. Finally, the fifth case study delves into Type 1 diabetes, its causes, and the factors that facilitate diabetic ketoacidosis. Each case study provides a detailed overview of the respective topics, offering insights into the complexities of diabetes and its multifaceted management.

Assessment task 2 1
DIABETES TASK 2
Students Name
Institutional Affiliation
Due Date

Assessment task 2 2
CASE SCENARIO 1
1. Hypoglycemia is a condition characterized by decreased plasma glucose levels below the
normal 3.2moml/L. It is more common in patients who are diabetic and are receiving
insulin therapy. In early stages of type 2 diabetes, there is reduced insulin production to
produce insulin and when there’s marked treatment, there is a decrease in glucose levels
leading to few episodes of hypoglycemia. In advanced stages, there is total dysfunction of
B-cells there is no change in insulin and glucagon concentration leading to a decrease in
sympathetic responses and hence hypoglycemia. (Cryer,2106)
2. Clinical manifestations of hypoglycemia are both neurological and adrenergic. In
hypoglycemia the secretion of adrenaline is stimulated leading to sweating, increased
heart rate and anxiety. The brain depends on glucose for its normal functioning. A
decrease in blood glucose leading to a reduced glucose supply to the brain through the
extracellular fluid brings about brain dysfunction. Patients present with headache, blurred
vision, dizziness or lethargy which may progress to a coma if there is no medical
intervention leading to coma or even death. Debbie’s friends noticed that she was irritable
and that she lost consciousness.
3. Factors that predispose one to hypoglycemia include excessive insulin levels in the body
caused by excessive intake of insulin. In renal failure there is reduced reabsorption of
glucose from the proximal convolutes tubule leading to glycosuria and reduced blood
glucose. Some endocrine factors such as hypothyroidism, growth hormone deficiency and
glucagon deficiency cause a reduced blood glucose concentration. Non pancreatic tumors
such as mesenchymal tumors, there is an increase in glucose utilization. Other factors
such as exercise, alcohol and drugs also cause hypoglycemia. (Silbert et al,2018)

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4. Educational needs that should be provided to Debbie is that she should avoid taking
excessive alcohol because alcohol consumption without eating blocks the liver from
releasing glucose into the blood and diseases affecting the liver can lead to
hypoglycemia. She should also be advised to avoid doing strenuous exercises without
carbohydrate intake. Other than that she is advised to monitor her blood glucose levels
regularly in order to maintain normal blood glucose, euglycemia. Debbie should be
advised to reduce the amount of insulin she is taking it may be a reason why she
developed hypoglycemia.
CASE SCENARIO 2
1. According to Zaccardi, Webb, Yates and Davies, 2016 diabetes type 2 is a condition in
which there is high concentration of glucose in the blood. This occurs when there is a
decrease in biological response to the normal concentrations of circulating insulin,
insulin resistance. This may be caused by a defect in the insulin receptors. It also occurs
when there is loss of function of B cells of the pancreas that secrete insulin in order to
counteract insulin resistance and reduce the blood glucose. The cells become
unresponsive to glucose and become dysfunctional.
2. Diabetic retinopathy is one of the microvascular complications of diabetes mellitus that
causes loss of vision. Damage to the blood vessels supplying the retina in a long period
of time causes this. The increase in blood glucose causes the retinal blood vessels to
dilate and disruption of normal blood flow leading to increased permeability to the blood
vessels. Increased permeability results in edema of the eye and finally the loss of vision.

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It also causes apoptosis of the pericytes which support the capillaries and finally leading
to disruption of the blood retinal barrier (Ahsan, 2015)
3. Microvascular complication diabetic nephropathy occurs in the renal glomerulus. There
is disruption of the glomerular basement membrane and the hyperglycemia causes
production of reactive oxygen species that cause oxidative stress. Oxidative stress causes
activation of genes responsible for activation of transcription factors activating
inflammatory cells increasing vascular permeability leading to protenuria, fibrosis and a
decrease in glomerular filtration rate resulting in renal disease. Microvascular
complications occur in large vessels such as the coronary artery. One of the
complications includes atherosclerosis where hyperglycemia disrupted blood flow by
causing narrowing of lumen due to lipid accumulation and fibrosis hence leading to
myocardial infarction (Pappatheodorou,2016)
4. Factors contributing to diabetes type 2 complications include the duration one has been
diabetic. Long period’s leads to damage of the nerves supplying the eye leading to
retinopathy which eventually leads to loss of vision. Diabetic neuropathy as well as well
due to demyelination. Risk factor for foot ulcer can be vascular disease, reduced
immunity, cigarette smoking and poor blood glucose control. Vascular disease not
enough blood is circulating to reach the foot hence leading to ischemia and poor healing.
Poor immunity in diabetic patients there is delayed healing of the ulcer.
5. Foot ulcer is one of the complications of diabetes. High blood glucose reduces the ability
of the body to fight infection. There is nerve damage and reduced blood flow reducing
the ability for the wound to heal. The preexisting peripheral and diabetic neuropathy
increases the risk for the diabetic ulcer not to heal. In order to manage the ulcer one

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should monitor the blood glucose and avoid applying pressure on the affected area. To
prevent the wound from getting infected, air the ulcer then clean and bandage it. If any
medication is given one should apply on the affected area (Nigam and Knight,2017).
6. According to Lycett, 2015 stopping to smoke reduces fasting blood glucose reducing the
incidence of insulin resistance hence the cells are more responsive to insulin. Smoking
increases the risk of getting serious diabetic complications such as heart and kidney
disease. Smoking also delays formation of healing tissue and encouraged scarring at the
edges of the wound. Losing weight helps control the blood sugar and lowers probability
of getting hypertension and coronary heart disease. There is also a reduced risk for
vascular damage obesity causes inflammation and increases the risk for atherosclerosis.
CASE SCENARIO 3
1. Yes, Zoe is at risk of gestational diabetes. This is because there is a family history in
where her mother has type 2diabetes. According to Shobeiri et al (2015) some of the risk
factors for gestational diabetes include advanced maternal age and the number of
pregnancies a lady has had. Adverse outcomes in previous pregnancies for example still
births and also children born who are overweight. Women who have marked
hypoglycemia during or soon after pregnancy are also at risk. There are also some ethnic
groups that have a higher risk compared to other such as blacks.
2. During pregnancy, there is an increased demand of insulin, this leads to insulin resistance
leading to reduced amount of insulin in beta cells of pancreas leading to a decrease
amount of insulin. Because the amount of glucose that enters the cells is also reduced,
the amount of glucose in the blood is increased, hyperglycemia. Glucose from the mother
is transported to the fetus through the placenta. This increases the blood glucose in the

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fetus stimulating the fetus beta cells to produce insulin increasing growth of the fetus and
fat deposition. (Kampmann et al,2015)
3. Gestational diabetes is diagnosed using Oral Glucose Tolerance Test (OGTT) and
glycosylated hemoglobin. Glycosylated hemoglobin is used in long term control of
glucose and is formed when a bond between N-valine amino acid and the beta chain of
hemoglobin type A is formed. In diabetes the levels are above 7% compared to the
normal 4-6%. The OGTT test is carried out where the patient is given 75g of glucose and
timed samples of blood and urine are taken for 2hours. Diabetes is diagnosed when the
random blood sugar is more than 7.8mmol/L. (Rani & Begum,2016)
4. Poomalar, 2015 was for the opinion that the management of gestational diabetes involves
increased physical diet and modification of the diet to ensure normal fetus growth.
Maintaining of normal glucose concentration in the blood and monitoring of glucose
throughout the pregnancy. If a patient becomes obese she is biguanides such as
metformin to reduce intestinal glucose absorption. Insulin drugs can also be given. Even
during labour normal blood glucose concentration should be maintained. After delivery
don’t require oral agents are given but undergo screening using the 72g glucose OGTT
test in the first few months.
CASE SCENARIO 4
1. Some of the community resources available to Mr.Jedda in regard to his diabetes and foot
care include; The Australian Diabetes Society who’s roles is to carry out research about
diabetes and takes measures ensuring those at risk of getting diabetes don’t get it. It also
takes care of people with diabetes. The second source is The Australian Diabetes
Educators Association which plays a role in educating people about diabetes ensuring

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quality health and welfare for those living with diabetes. The State and Territory Diabetes
Organization whose role is to detect, prevent and manage diabetes and providing support
for diabetics and their family.
2. Some of the barriers include lack of education where some people do not have adequate
information that such organizations exist. There is also lack of understanding about the
services the organizations provided and make various assumptions. Not everyone can be
able to access services offered by these organizations due to stereotyping of a particular
group of people. Some organizations set regulations that make it difficult for most people
to receive the services provided. The terminologies and language used cannot be
understood by the regular individuals. Some people are concerned about what people say
and shy away from seeking the services offered.
3. Mr.Jedda can be advised to join a support group of people who are diabetic and are
depressed in order for him to see that he is not alone and motivate each other and how to
cope with the current situation. He also needs to talk to his family in order for them to
support and encourage him. The doctors can also refer Mr.Jedda to a psychiatrist to help
him. Due to the advancement of technology, he can also join online community where he
can connect with people from anywhere in the world. An advantage of this someone can
remain anonymous.
4. Some social factors contributing to diabetes include low level of income. Diabetics with
low earning income won’t be able to access medical services necessary for the screening,
diagnosis and treatment. Low level of education is also a contributing factor. Alcohol
intake as well is a factor which leads to ketoacidosis which predisposes to diabetes.
Environmental factors include lack of physical activity and unhealthy diet. This leads to

Assessment task 2 8
narrowing of vessels and predisposes to cardiovascular disease. Exposure to infection
especially viruses lowers the integrity of the immunity system and predisposes one to
diabetes.
CASE SCENARIO 5
Part A
Part B
1. Diabetes Mellitus type 1 is characterized by autoimmune destruction of the insulin secreting
B-cells of the pancreas. This is mediated by T cells leading to a decrease in the amount of
cells producing insulin and subsequent decrease in insulin. Circulating antibodies which are
markers of B-cell autoimmunity are detected in serum years before the onset of
hypoglycemia. The susceptibility to diabetes type 1 is inherited hence genetic. For example,
in a viral infection, antibodies are secreted against the infection lead to an autoimmune
response that can act on the B-cells destroying them leading to insulin deficiency and finally
causing diabetes (Katsarou et al,2017)
2. According Alourfi and Homsi (2015) some of the factors facilitating diabetic ketoacidosis
include inadequate insulin therapy. This leads to an increase in fat metabolism causing the
liver the produce ketones making the blood acidic. When the concentration becomes too
high, a condition called ketoacidosis develops. Some drugs such as diuretics and
corticosteroids also predispose one to ketoacidosis. Diseases in the body such as stroke and
pancreatitis cause it to produce stress hormones having a counter-effect to insulin. Pregnant
women are also predisposed to getting diabetes ketoacidosis as a complication of gestational

Assessment task 2 9
diabetes. Infections as well can cause disruption of B-cells leading to diabetes and finally
ketoacidosis.
3. The signs and symptoms that Doug is experiencing include confusion brought about by
reduce glucose concentration in the brain. There is a fruity acetone smell caused by the
ketone bodies produced by the liver. Dehydration occurs when the kidney is unable to absorb
glucose and its concentration becomes too high, it causes water not to reabsorbed but passed
in urine. When the liver produces ketones, the body becomes acidic and too much ketone
bodies leads to ketoacidosis. In order for the body to get rid of this it causes deep rapid
breathing as seen with Doug. There is also dry skin.
4. According to Fayfman, Pasquel and Umpierrez (2017) fluid and electrolyte therapy. This is
to replace the water and electrolytes lost in diabetic ketoacidosis given intravenously. There
is also insulin therapy done to reduce the hyperglycemia first given intravenously then later
subcutaneously. Care must be given in order to ensure that too much insulin is not given to
cause hypoglycemia. The acidosis is corrected by acid- base balance using sodium
bicarbonate ensuring the infusion rate is low to avoid hypokalemia. Treatment of infection
using proper medication. In all the methods of management monitoring is required.
5. Humulin R is a short acting insulin whose effects appear after 30minutes and peaks for 2-
3hours having a delayed onset and a prolonged time to peak action. When administered just
before a meal the blood glucose raises faster than insulin hence it is important to administer
it 30-45minutes before a meal. The Humulin NPH is an immediate acting insulin whose
absorption and onset of action is 2-5hours with a duration of action of 4-12hours.Both
Humulin R and Humulin NPH are mixed because NPH takes hours to reach therapeutic
levels hence requires supplementation of the short acting insulin Humulin R before meals

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6. Insulin is sensitive to light and extremes of both hot and cold temperatures. Insulin that has
not been used, they are placed in the refrigerator and when someone wants to use it, they can
place it in room temperature up to a certain period of time. But the longer its kept outside,
the lower the percentage for its maximal effect reduces. Hot temperatures cause degradation
of insulin and hence won’t be useful in maintaining euglycemia. At the same time, cold
temperatures that are too low it can freeze too much that it can’t be injectable and most
importantly it will break down and won’t be effective (Patil et al, 2017)
7. Doug’s wife can play an important role by accompanying her husband to hospital during his
appointments. She can also assist him inject the insulin but in order for this to happen has to
be present to hear the doctor’s instructions or her husband can guide her through it. Because
the diet of her husband would change significantly, Doug’s wife can support him by begin
the diet changes in the family and ensure that it is maintained together with exercising
routinely. She can also provide social support which is seen to improve self-care in the long
run help manage diabetes.
8. Other problems for other disciplines include retinopathy in which the nerves supplying the
retina are destroyed the patient is required to see an ophthalmologist before the condition
gets worse as it may lead to loss of vision. There is also a cardiovascular risk because of the
risk of arthrosclerosis due to accumulation of fat and narrowing of blood vessels hence
required to see a cardiologist. Due to the risk of kidney failure caused by diabetic
nephropathy, the need for nephrologists is important. Diabetes also causes demyelination of
nerves in the central nervous system causing neuropathy necessitating the need to see a
neurologist.

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References.
Ahmad, S. I. (2016). Reactive oxygen species in biology and human health. CRC Press.
Alourfi, Z., & Homsi, H. (2015). Precipitating factors, outcomes, and recurrence of diabetic
ketoacidosis at a university hospital in Damascus. Avicenna journal of
medicine, 5(1), 11.
Chawla, A., Chawla, R., & Jaggi, S. (2016). Microvasular and macrovascular complications
in diabetes mellitus: distinct or continuum? Indian journal of endocrinology and
metabolism, 20(4), 546.
Cryer, P. (2016). Hypoglycemia in diabetes: pathophysiology, prevalence, and prevention.
American Diabetes Association.
Fayfman, M., Pasquel, F. J., & Umpierrez, G. E. (2017). Management of hyperglycemic
crises: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Medical
Clinics, 101(3), 587-606.
Katsarou, A., Gudbjörnsdottir, S., Rawshani, A., Dabelea, D., Bonifacio, E., Anderson, B. J.,
... & Lernmark, Å. (2017). Type 1 diabetes mellitus. Nature reviews Disease
primers, 3, 17016.
Nigam, Y., & Knight, J. (2017). Diabetes management 3: the pathogenesis and management
of diabetic foot ulcers. Nursing Times, 113(5), 51-54.
Patil, M., Sahoo, J., Kamalanathan, S., Selviambigapathy, J., Balachandran, K., Kumar,
R., ... & Ajmal, K. (2017). Assessment of insulin injection techniques among
diabetes patients in a tertiary care centre. Diabetes & Metabolic Syndrome: Clinical
Research & Reviews, 11, S53-S56.

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Poomalar, G. K. (2015). Changing trends in management of gestational diabetes
mellitus. World journal of diabetes, 6(2), 284.
Rani, P. R., & Begum, J. (2016). Screening and diagnosis of gestational diabetes mellitus,
where do we stand. Journal of clinical and diagnostic research: JCDR, 10(4), QE01.
Silbert, R., Salcido-Montenegro, A., Rodriguez-Gutierrez, R., Katabi, A., & McCoy, R. G.
(2018). Hypoglycemia among patients with type 2 diabetes: epidemiology, risk
factors, and prevention strategies. Current diabetes reports, 18(8), 53.
Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2016). Pathophysiology of type 1 and
type 2 diabetes mellitus: a 90-year perspective. Postgraduate medical
journal, 92(1084), 63-69.