Essay 2: Diabetes Type 2 Pathophysiology and Management Approaches

This essay delves into the intricacies of Type 2 Diabetes, beginning with an overview of its pathophysiology, which includes insulin resistance, impaired glucose control, and the potential for complications like hyperosmolar syndrome. The essay then explores various management approaches, including the use of insulin, antihypertensive medications, and the importance of lifestyle modifications such as diet, exercise, and the cessation of harmful habits like smoking and excessive alcohol consumption. The essay also highlights the significance of a coordinated healthcare team and patient self-management education. The case study of a 75-year-old male patient, Bill, diagnosed with Type 2 Diabetes and hypertension, is used to illustrate the practical application of these management strategies, emphasizing the need for individualized treatment plans and the importance of addressing both glycemic and blood pressure control to prevent micro and macrovascular complications. Furthermore, the essay references several studies and clinical trials that support the efficacy of different treatment options and the cost-effectiveness of intensive management of diabetes and hypertension, underscoring the multifaceted nature of diabetes care.

Running Head: ESSAY 0
Diabetes
3-26-2020

ESSAY 1
Contents
Pathophysiology.........................................................................................................................2
Management approaches............................................................................................................4
References..................................................................................................................................8

ESSAY 2
Type-2 diabetes is the most common and widespread disease not in selected countries
but globally. It is a disorder which is genetically inherited or acquired through disturbed
lifestyle. It happens when blood glucose, commonly known as blood sugar, becomes
relatively high. Blood glucose is primarily obtained from the food. Insulin is a pancreatic
hormone which helps to carry glucose further to the cells for the energy use. However, in
case of diabetes the patient’s body does not produce adequate insulin or use the available
insulin in a significant manner. Extremely high levels of blood sugar will also cause a serious
condition called the hyperosmolar syndrome. This is a type of dehydration which is life
threatening. Hyperosmolar syndrome is the first symptom, in some cases, of a person having
type 2 diabetes. It induces distracted thought, fatigue, nausea, even coma and seizure
(American Diabetes Association, 2017).
In the case study that is being provided in which a 75-year-old man named Bill who is
diagnosed with Diabetes type 2. In reference to this case, this discussion focusses on the
pathophysiology of diabetes specifically type 2, parallel with the management intervention by
medical and nursing staff in handling the hypertensive diabetes case.
Pathophysiology
Diabetes of type 2 is considered as a heterogeneous disease. Its pathophysiology is
characterized by the indication of the peripheral insulin resistance parallel with impaired
control of the production of hepatic glucose and decreasing size of the β-cell, which
eventually leads to gradual failure in cells. The main events include deficit secretion of in
insulin and in many patients, it is accompanied by a resistance in the exterior insulin.
Impaired level in insulin production and secretion and significant reduction in glucose
tolerance that is detected prior to the onset of illness. More precisely, a reduction in glucose
responsive insulin secretion is caused by impaired glucose tolerance (IGT), and significant

ESSAY 3
decline in the additional insulin after meals which results in triggering of post prandial
hyperglycemia (Bullard, et al., 2018).
The decline in early stage secretion is an integral part of diabetic type 2 disease, and is
extremely significant as a fundamental pathophysiological shift found in all ethnic groups
during the onset of disease. Impaired secretion of insulin is typically gradual, and glucose and
lipid toxicity are involved in its development. If left untreated, then it leads to decline in
pancreatic mass. The development of pancreatic irregular cell function dysfunction
significantly influences blood glucose regulation for a longer period. Although patients in
early stages after the onset of disease primarily exhibit a rise in postprandial blood glucose as
a result of increased insulin resistance (Goldstein & Dirk, 2016). Whereas reduced secretion
at early stage accompanied by progression of deterioration in the functioning of the
pancreatic cell subsequently induces elevation in permanent blood glucose level. Insulin
resistance is termed as a disorder in which insulin does not exercise acceptable and suitable
action in respect to its blood concentration in the body. A common characteristic of
pathophysiologic of type 2 diabetes is the failure of insulin function in major organs such as
liver and muscles. Until the development of the disease insulin tolerance grows and increases
(Zaccardi, Webb, & Yates, 2018).
Prior to the beginning of type 2 diabetes, potential studies were conducted which
showed either deficiency or resistance towards insulin. Two studies have been documented in
respect to the insulin resistance in diabetic patients and non-diabetic relatives, when their
tolerance for glucose was normal (Tesauro & Francesco , 2020). Apart from that many
studies showed that high risk population have already failed to establish tolerance against
insulin, and in the similar community they have identified impairment in the secretion or loss
of normal insulin. Moreover, even on these divergent findings, the pathogenesis of diabetes

ESSAY 4
of type 2 makes it quite difficult to separate insulin resistance and deficiency while it is in
the body (Nauck & Meier, 2016).
Insulin's ability to inhibit the production of hepatic glucose in both fasting and
postprandial conditions is common in diabetic patients with type 2 symptoms. It is the rise in
glucose production specifically postprandial glucose rate that heralds IGT's evolution.
Ultimately the development of both fasting and postprandial glucose increases with the
progression of diabetes. Additionally, in the occurrence of insulin, the insulin which secreted
from liver possess resistance which shows marked reduction in the activity of glucokinase
and an enhanced alteration of substrates into the glucose in the well availability and presence
of catalyst (McCance & Sue , 2018). The liver in diabetic condition is made habitual for both
overproduction & underusing of glucose. The raised levels of fatty acid present in diabetes of
type 2, can also play a crucial role in the amplified development of hepatic glucose. However,
recent research indicates a significant function of the kidney in the development of glucose
via the process of gluconeogenesis or synthesis of new glucose molecules which is
uncontrolled in the presence of diabetes of type 2 (Chen, Bruce , & Wuwei , 2016).
Management approaches
Since type 2 diabetes occurs when the functioning of pancreas imbalances and results
in decline in production of enough insulin to resolve insulin resistance, there is some sort of
insulin injection in around one in three people with this disorder. Insulin is required more
than once or twice a day and in form of higher doses to meet the shortcomings in severe
diabetic patients or people who precisely regulate the glucose levels in the body. Treatment
plans which include both long time acting insulin and short time acting insulin are often the
most effective for blood sugar controls. When a person does not eat on a daily schedule,
rather short time acting insulin is of particular benefit (Jutterström, Åsa, & Herbert , 2016).

ESSAY 5
Reducing blood pressure in people with hypertension and diabetes decreases risks at
both the macrovascular and microvascular stages. Clinical studies using a variety of
antihypertensive agents have shown that small blood pressure decreases in 9 to 11 mmHg of
systolic pressure while 3 to 9 mmHg of diastolic pressure decrease which accounts for around
35 to 70 percent of decrease and microvascular complications by 25 to 45 percent in only 2 to
5 years. In most cases of diabetic hypertensive patients with normal renal functioning, still
need a combination of two to more antihypertensive agents to reduce the blood pressure level
to less than 130/80 mmHg, which in Bill’s case it is 170/100 mm Hg and has led to
complications. While patients with associated severe kidney disease can need few more
agents. Bill also possess high urinary albumin secretion which indicates problem in kidney
functioning (Zhao, Riitta , Koskinen, & Leino‐Kilpi, 2017).
An economic modeling analysis based on evidence from clinical trials indicated that
intense management of diabetes hypertension is in fact saving the cost as it improves patient
outcomes and decreases overall health care costs. By comparison, intense management of
glycemic and dyslipidemia is only cost effective however they boost health outcomes but
contribute to some rise in health care costs. With diabetes, hypertension happens twice as
often as in equivalent to non-diabetics. Patients of these conditions are at a substantially
higher risk for micro & macrovascular complications (Li, Sit, Choi, & Chair, 2017).
Active blood pressure regulation eliminates risks at both the microvascular as well as
macrovascular stages. The enzyme inhibitor named as Angiotensin-converting are the first
step in diabetic hypertensive therapy which can be later combined with blockers named as
angiotensin II receptor blockers, in case if patients become intolerant to them. Recent studies
show that in reducing both macro-micro vascular issues, ARBs are on similar base with
ACEI. The combination of these agents may have a beneficial effect on proteinuria, but no
significant reduction in macrovascular risk (Bucher, et al., 2016). Thiazides are also used as

ESSAY 6
medicines at initial stage. Use of Beta-blockers in the further stage works as an add-on in
case of patient with coronary artery disease. In diabetic hypertensive case combination of
drugs and medicines are regularly required. The target is to obtain a blood pressure level of
lesser than130/80 which is the priority treatment rather than the drug combination to avoid
development of vascular complications in case of diabetic hypertension (Hamilton, Grace ,
Vaina, Smith, & Paul, 2016).
People with diabetes will seek medical treatment from a coordinated team of
physicians. It is important that people with diabetes take an active part in their treatment in
this collaborative and coordinated team approach. The management strategy will be designed
as an individualized therapeutic partnership between the patient and family, the doctor and
other health care team members. Any plan will consider self-management education
regarding diabetes as an important component of treatment. Consideration should be given to
the patient's age, physical activity, dietary habits, social status and temperament, cultural
factors and the occurrence of diabetes complications or other medical conditions in designing
the program (Hockenberry & Wilson, 2018). Treatment should be done according to the
standards and practices while keeping patient, family, and health care team opinianated .
Self-management for patients should be stressed, and the program will emphasize the
patient's participation as much as possible in problem solving. Different approaches and
should be used in the different aspects of diabetes management to provide appropriate
knowledge and enhancement of problem-solving skills. Implementing the management plan
requires that the patient and care providers understand and agree on each level, and that the
expectations and treatment plan are realistic (Murphy, et al., 2017).
Hence, it is important for the Bill to look for his health, as he is a clear case of
hypertension Diabetes. The measure provided can work at their indicative way. Parallel with
that at the individual level, maintaining the healthy life style at the age of 75 is crucial for

ESSAY 7
Bill. He must indulge in mindful eating habits as well a must cut down the consumption of
alcohol and the eat of smoking completely form the daily routine. A moderate level of
exercise and physical activity will work as an added advantage in making his condition
controllable and manageable.

ESSAY 8
References
American Diabetes Association. (2017). Classification and diagnosis of diabetes. Diabetes
care, 40(1), S11-S24.
Bucher, L., Lewis, S. L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D.
(2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical
Problems, Single Volume. Elsevier Health Sciences.
Bullard, K. M., Cowie, C. C., Lessem, S. E., Saydah, S. H., Menke, A., Geiss, L. S., . . .
Imperatore, G. (2018). Prevalence of diagnosed diabetes in adults by diabetes type—
United States. Morbidity and Mortality Weekly Report, 67(12), 359.
Chen, R., Bruce , O., & Wuwei , F. (2016). Diabetes and stroke: epidemiology,
pathophysiology, pharmaceuticals and outcomes. The American journal of the
medical sciences, 351(4), 380-386.
Goldstein, B. J., & Dirk, M. W. (2016). Type 2 diabetes: principles and practice. CRC Press.
Hamilton, H., Grace , K., Vaina, C. L., Smith, M., & Paul, S. P. (2016). Children and young
people with diabetes: recognition and management. British journal of nursing, 26(6),
340-347.
Hockenberry, M. J., & Wilson, D. (2018). Wong's nursing care of infants and children-E-
book. Elsevier Health Sciences.
Jutterström, L., Åsa, H., & Herbert , S. (2016). Nurse-led patient-centered self-management
support improves HbA1c in patients with type 2 diabetes—A randomized study.
Patient education and counseling, 99(11), 1821-1829.
Li, C., Sit, J. W., Choi, K.-c., & Chair, S.-Y. (2017). Effectiveness of interactive self‐
management interventions in individuals with poorly controlled type 2 diabetes: A
meta‐analysis of randomized controlled trials. Worldviews on Evidence‐Based
Nursing, 14(1), 65-73.

ESSAY 9
McCance, K. L., & Sue , E. H. (2018). Pathophysiology-E-book: the biologic basis for
disease in adults and children. Elsevier Health Sciences,.
Murphy, M. E., Molly, B., Galvin, R., Bolan, F., Fahey, T., & Smith, S. M. (2017).
Improving risk factor management for patients with poorly controlled type 2 diabetes:
a systematic review of healthcare interventions in primary care and community
settings. BMJ Open, 7(8).
Nauck , M. A., & Meier, J. A. (2016). The incretin effect in healthy individuals and those
with type 2 diabetes: physiology, pathophysiology, and response to therapeutic
interventions. The lancet Diabetes & endocrinology, 4(6), 526-536.
Tesauro, M., & Francesco , A. M. (2020). Pathophysiology of diabetes. In In
Transplantation, Bioengineering, and Regeneration of the Endocrine Pancreas (pp.
37-47). Academic Press.
Zaccardi, F., Webb, D. R., & Yates, T. (2018). Pathophysiology of type 1 and type 2 diabetes
mellitus: a 90-year perspective. Postgraduate medical journal, 92(1084), 63-69.
Zhao, F.‐F., Riitta , S., Koskinen, S., & Leino‐Kilpi, H. (2017). Theory‐based self‐
management educational interventions on patients with type 2 diabetes: a systematic
review and meta‐analysis of randomized controlled trials. ournal of advanced
nursing, 73(4), 812-853.