Analysis of Diabetes Type 2: Pathophysiology and Management Approaches

This report focuses on type 2 diabetes, exploring its pathophysiology, which includes insulin resistance and insufficient insulin secretion. It discusses the case of Bill MacDonald, a 75-year-old diagnosed with type 2 diabetes and hypertension, highlighting the impact of fluctuating glucose levels and eye tiredness. The report details the importance of lifestyle modifications such as exercise and diet, alongside pharmacological interventions. It examines various drug classes including ACE inhibitors, ARBs, diuretics, and sulphonylureas, considering their roles in managing hypertension and the progression of diabetic complications like kidney failure. The report emphasizes the need for a stepwise approach to pharmacological management, tailored to the patient's condition and potential side effects, supporting nurses in making informed decisions for hypertensive diabetic patients.

Running head: MEDICAL AND SURGICAL NURSING 1
Medical and Surgical Nursing
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Introduction
Diabetes type 2 is a chronic infection caused when the pancreases are not able to provide
the sufficient insulin or when the human body lacks the ability to utilize the produced insulin.
According to WHO (World Health Organization), the global explosion of obesity has led to the
development of a higher prevalence of diabetes type 2 (Zaccardi, Webb, Yates & Davies, 2016).
Diabetes type 2 is a non-communicable infection that has infected over 370 million individuals
worldwide and is one of the economic implications in Australia (Li et al., 2019). The main
objective of this paper is to examine the pathophysiology of diabetes type 2 and the analyze the
possible management strategies.
The pathophysiology of type 2 diabetes
The pathophysiology of type 2 diabetes is as the result insufficient or lack of insulin
secretions and insulin resistance (Gurung et al., 2010). Diabetes type 2 pathophysiology can as
well be described using an analogy of key and the lock. In this case, the key is the insulin and
lock the body cells especially when they do not function properly. Insulin resistance happens
when insulin fails to produce its impact on the body. Insulin is secreted by the pancreatic beta
cells located Langerhans islets (Rehman & Akash, 2017). In order to overcome the insulin
resistance, the pancreas must produce insulin in a considerable quantity. Impaired insulin
secretions and insulin resistance is as the result of the dysfunction of the beta cells.
These aspects result in the ineffectiveness of beta cells in responding to the level of
glucose within the bloodstream. Excess glucose in the bloodstream is due to the release of
glycogen by the liver, the suppression of insulin by glycogen, and the unresponsiveness of
insulin receptors in the liver, adipose tissues and skeletal muscles.

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In the Bill case, there is a significant potential that his body overweight causes insulin
resistance. Resistance of insulin can happen to any obese person by the diabetes type 2 is as the
result of decreased production of insulin by the beta cells in the pancreas. Individuals like Bill
with obesity have impaired peripheral insulin secretion due to the production of fatty acids by the
adipose cells. Retnakaran & Shah (2017) states that fatty acids are able to access the liver where
they cause fasting hyperglycemia. Secondly, the free fatty acids cause the gluconeogenesis,
hepatic and muscle insulin resistance.
Diabetes type 2 cause the effects of Bill eye’s tiredness due to an abrupt change in blood
glucose transforms the eye’s osmotic pressure. Such effect can continue in the future even after
one has taken a step in monitoring the level of glucose in the blood negatively impacts the eye’s
osmotic pressure. That why there is need for Bill to seek medical attention to correct the level of
glucose in his blood. Eye’s tiredness is a situation that can last for a short period until the when
the pressure is corrected (Dandel, Wallukat & Hetzer, 2018.
Insulin Resistance
Insulin resistance is a circumstance within the body in which the insulin cannot perform
the adequate functions in the blood concentration. Insulin resistance develops and expands
before the initial stages of diabetes infection (Moore, 2018). Various studies regarding the
molecular mechanism for the insulin actions have categorized the link the insulin resistance to
the environmental and genetic aspects. Some of the genetic aspects linked to diabetes type 2 are
the insulin receptors, Insulin Receptor substrate-1 and polymorphisms constituted by thirty
genes. Inflammatory and Glucolipotoxicity mediators are as well vital in the mechanisms for
impaired secretion of the insulin. According to Khan, et al (2019), several medical practitioners
focus on adipocyte bioactive substances in the insulin resistance. The fatty acids, resistin, and

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leptin play a key role in increasing the resistance while adiponectin helps in improving the
resistance.
Potential management approaches for the hypertensive diabetic patients
Nursing management
A nurse must first diagnose Bill MacDonald for hypertension by first confirming if his
blood pressure measures equal or greater to 130/80 mmHg. If the BP is equal or above 140/ 90
mmHg, there is need to initiate lifestyle modifications and pharmacological. Regarding the Bill’s
scenario, his blood pressure is 170/ 100 mmHg and has also reported eye’s tiredness.
Managing Bill's case will start with changes in his lifestyle which include, regular
excises, and weight reduction since his glucose has been fluctuating and remained unstable in the
past 3 months. At the initial stages of diabetes type 2, it’s possible for the nurse managers to
monitor the situation through exercises and observing proper diet (Salvo et al., 2016).
The monitoring of blood pressure by the nurse will also help in decreasing the macro-
and microvascular complications while controlling the blood glucose reduces the health risks of
micro- and macrovascular complications. In such case, the nurse is required to select a ARB or
ACE inhibitor as initial pharmacological therapy. The monotherapy will help in reaching the
Bill’s blood pressure of 130/80 mmHg or below.
Pharmacological approaches
In order to manage Bill's case, the pharmacological management will follow a stepwise
concept. According to Pluchart, Khouri, Blaise, Roustit & Cracowski, (2017), individuals with
BP below 130 mm Hg are suitable for lifestyle modifications. Looking at the above
recommendation, Bill's blood pressure stands at 170/ 100 which leaves the option of

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pharmacologic interventions. That a gradual approach is appropriate since it's vital for diabetic
patients with higher BP. Decreasing the blood pressure for diabetic patients is very vital
especially for Bill's case since he has a coexisting cardiovascular disease (hypertension).
The hypertensive diabetic cases in Australia are becoming common in different
populations. These cases are profound in diabetic patients when compared to non-diabetic
individuals. Hypertension is associated with blood pressure greater or equal to 140/90 mmHg
and affects 60% of the patients with obesity and diabetes status. In the case scenario, the blood
pressure of Bill is 170/100 mmHg which is high, a patient with diabetes should at all times attain
a target blood pressure of not more than 130/80 mmHg. Hence the need to initiate some of the
approaches that can support in the management of such conditions (Dandel, Wallukat & Hetzer,
2018).
The HOT (Hypertension Optimum Trial) and the UKPDS indicated that the immediate
interventions of the blood pressure lead to a decreased in the microvascular and macrovascular
complications. Maqbool, Cooper & Jandeleit, (2018), indicated that a prolonged tight BP
monitoring for the hypertensive diabetic patients has a significant result in all diabetes-associated
endpoints.
ACE inhibitors
ACE inhibitors are the first major class of diabetic to consider in the case of Bill.
Angiotensin-converting enzyme (ACE) inhibitors support in delaying or preventing
macrovascular and microvascular complications linked to diabetes and are in most instances are
recommended as first-line antihypertensive agents in patients with diabetes. ACE inhibitors are
most significant in delaying the progression of diabetic kidney disease. The results from the
urine analysis conducted shows that Bill has a kidney failure. ACE inhibitors are appropriate in

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delaying the initiation of kidney infections. For instance, the GFR (the rate of glomerular
filtration) of less than 1.72 m2 the need for dialysis for patients like Bill who has hypertension
and type 2 diabetes. A study conducted in the USA on the application of ACE inhibitors showed
that a patient with diabetes and a cardiovascular disease experienced a significant decrease in all-
cause mortality risks. The reduction of all-cause mortality is due to the ability of ACE inhibitors
in reducing diabetes complications, for hypertensive patients. Thus, in the case of Bill, a regimen
that incorporates ACE inhibitors or receptor blockers.
Carnagarin, Matthews, Gregory & Schlaich, (2018) recommend that the ARBs or ACE
inhibitors when treating patients with high blood pressure and diabetes and chronic kidney
infection. Nevertheless, initiating the ARBs or ACE inhibitors can result in transient reduction
hence increasing the serum creatinine level. Thus, the need for Bill's nurse in administering the
drugs continuously considering his underlying kidney failure. Raising the level of ARBs or ACE
inhibitors by 30% is linked to subsequent preservations of renal functions. However, this
subsequent preservation of renal functions is not suitable when considering the ground for the
therapy cessation. A nurse should as well consider an increase of the serum creatinine levels with
more than 30% or in case of hyperkalemia development in reducing or discontinuing the ACE
inhibitor dosage.
Angiotensin receptor blocker
The review of Bill's urine tests showed an increase in protein levels. The blood tests also
indicate an increase of urea by 25 mg/dl, serum albumin by 6.1 mg/dl and a considerable
reduction of glomerular filtrate rates. An additional test of 24 hours indicated abnormal urine
with an albumin excretion. Thus, the need in incorporating the ARBs with the ACE inhibitors in
managing his diabetic and kidney failure status. The ARB helps in reducing diabetes

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complications like kidney failure progression and they are more effective when managing
hypertensive diabetic patients. In one of the randomized controlled trials, a patient with diabetes
type 2 and hypertension demonstrated non-inferiority when compared with Vasotec in GFR
interventions. No individual had end-stage renal infection within the five years of research and
the mortality rate linked to cardiovascular issues was significantly low across the groups.
Diuretics
Bill McDonald was diagnosed with type diabetes at the age of 75 years and that prompts
the need in incorporating the Thiazide diuretics. According to Hædersdal, Lund, Knop &
Vilsbøll (2018), either as a combination of monotherapy are beneficial for the hypertensive
diabetic patient intervention. For the elderly people living with hypertension and diabetes type 2,
Thalitone help in reducing cerebrovascular and cardiovascular events.
Use of sulphonylureas
Even after increasing the metformin from 500 mg to 100mg twice in a day, his glucose
has been fluctuating and remained unstable in the past 3 months. Hence, the need to initiate
sulphonylureas in the case of Bill MacDonald. The metformin and changes of the lifestyle seem
insufficient in controlling his level of blood glucose.
Sulphonylureas is one of the most classes of anti-diabetic drugs considered by several
nurses when managing the hypertensive diabetic patients (Hidayat, Du, Wu & Shi, 2019). Its also
one of the classes that is vital when dealing with Bill MacDonald diabetic case. Sulphonylureas
plays a vital role in increasing the insulin secretion level through the stimulation of beta cells.
This is because the Sulphonylureas have a higher absorption rate and higher protein-bound that
helps greatly in the distribution and metabolization. The Sulphonylureas should be administered

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thirty minutes prior to the meals especially in the morning and evening in case they are
prescribed twice in a day. This will help Bill's blood glucose to respond effectively than when
taken along with the meals because they have a low absorption rate.
Conclusion
The development of type 2 diabetes can be avoided by living a proper lifestyle and
managed through various pharmacological approaches. Pharmacological approaches are suitable
in allowing the condition of progress. However, these pharmacological approaches are
appropriate depending on the condition presented by the patient. This paper has therefore, outline
the pathophysiology of Diabetes type 2 and some of the pharmacological approaches appropriate
in managing Bill MacDonald conditions.

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