Case Study Analysis: Sharon's Diabetes and Kidney Disease

This essay provides a comprehensive analysis of Sharon's case study, a 58-year-old female diagnosed with type 2 diabetes mellitus, hypertension, obesity, and chronic kidney disease. The essay delves into the risk factors associated with Sharon's condition, including lifestyle factors like poor diet and obesity, along with the physiological mechanisms linking diabetes to kidney failure. The essay examines Sharon's blood glucose levels and evaluates the effectiveness of her current medication, Metformin. Furthermore, it explores the synergistic interaction between Glucovance and Metformin. The essay proposes two potential drugs, 'vasonapril' for hypertension and 'glycolistat' for weight management, along with their mechanisms of action. Finally, the essay discusses the ethical considerations and nursing standards for practice, referencing the Registered nurse standards and the ICN code of ethics, emphasizing the nurse's responsibility in providing compassionate and ethical care. The conclusion reiterates the relationship between diabetes, obesity, and kidney disease, highlighting the role of nursing care in managing the patient's condition.

Sharon’s case study
Introduction.
The essay assignment is a response to Sharon’s case study. Sharon is a 58-year-old female
patient with a height of 1.7 m and she weighs 120 kg. she also has a waist circumference of 110
cm. she has a past, medical history of type II diabetes mellitus which was diagnosed three years
ago. She is currently under metformin to manage her diabetic condition. Sharon states that her
usual blood glucose levels range from 8 mmol/L to 11 mmol/L throughout the whole day. When
she wakes up in the morning her blood glucose levels read 7mmol/L to 8mmol/L. She is
hypertensive with a systolic pressure of 140 mmHg and diastolic blood pressure 95 mmHg. For
now, her consistent chronic kidney disease is evident with an eGFR of 85ml/minute and some
proteinuria. The essay assignment will, therefore, be divided into five parts both of them
responding to the case study described.
Question 1
Sharon was diagnosed with diabetes type II. This type of diabetes is normally associated
with lifestyle risk factors. Or it can be hereditarily inherited from one generation to the next
generation. The risk factors related to the lifestyle include poor diet, physical activities which are
not sufficient for the daily body requirement. Other risk factors are being obese or overweight.
Sharon is obese with a Body Mass Index of 40.6 kg/m2. Her obesity is indicated by a BMI of
above 30 kg/m2 and above (Bae et al 2016, pp 212-220). Her waist circumference of 110 cm
also confirms her obesity since her waist circumference is more than 88 cm for her gender. Her
age being above 40 years is an increased risk factor for her developing the type II diabetes
mellitus (American Diabetes Association, 2017 pp. S11-S24). The diabetes mellitus a condition

characterized by high circulating blood sugar can lead to kidney failure. The kidney failure
caused by diabetes mellitus takes some time for its signs and symptoms to manifest. With time
the high blood glucose levels damage the kidney nephrons leading to kidney nephropathy which
can progress to kidney failure (Reidy et al 2014, pp.2333-2340). The kidneys affected by diabetic
nephropathy cease to work efficiently resulting in water and salt retention that raises the blood
pressure rendering the client hypertensive. The renin-angiotensin system which regulate the
blood pressure is thought to be involved in the development of diabetic nephropathy. People with
diabetes have a high risk of developing hypertension (Hall et al 2014, p 75). In return, the
hypertension is a risk factor for kidney disease development.
Many arteries supply the blood containing the waste products and the fluid to be filtered by
the kidney at the glomerular filtration site. Over time, if the high blood pressure is not managed
it causes narrowing of the arteries supplying the blood to the kidney for filtration. The arteries
become weak too and the excess glucose deposited harden the arteries with time too. They,
therefore, become unable to deliver enough blood to the kidney and that is the onset of the
kidney failure.
Question 2
Sharon reports usual blood glucose levels of 8 to 10 mmol/L throughout the whole day.
These blood glucose levels are higher. The normal glucose levels in a day should be between
3.2mmol/L to 6.5 mmol/L (Nankervis et al 2014). Sharon also states her morning blood glucose
levels ranging from 7 mmol/L to 8 mmol/L. her glucose level should, therefore, be managed to
be maintained at the normal ranges.

Question 3
Glucovance is a drug used to control high blood sugar levels in patients with type II diabetes
mellitus (Prabhakar, Kumar & Doble 2014, pp 123-130). Glyburide as a component of
Glucovance, it lowers blood sugar levels by allowing the release of the natural insulin into
circulation and at the same time decreasing the amount of sugar made by the liver. By doing so it
decreases the levels of the circulating blood glucose. On the other hand, metformin’s mechanism
of action is decreasing the amount of sugar made by the liver and decreasing the amount of
glucose absorbed by the stomach and the intestines. The interaction between the two drugs is
synergistic. The therapeutic outcome of the two drugs used together is greater compared to the
therapeutic outcome of each drug used individually (Foucquier & Guedj, 2015)
Question 4
Currently, Sharon can be diagnosed with two medical conditions. Kidney failure which
started as diabetic nephropathy. Kidneys filter blood from the arteries. When diabetes damages
the arteries by depositing the excess sugar in them lead to damaging the kidneys as well. The
second medical condition that can be diagnosed is the type II diabetes mellitus caused by the
excess circulating glucose in the blood. Sharon is hypertensive, hypertension is related to
diabetes mellitus and related to kidney failure as well. two drugs that can be invented should
manage hypertension and the kidney nephropathy for them to be effective.
The first drug should be clinically indicated for hypertension. This drug named as
"vasonapril" should work aiming at blocking Angiotensin II. Angiotensin II promotes the
secretion of aldosterone. Angiotensin II produced by the body tightens the blood vessels causing

vasoconstriction increasing the blood pressure inside the vessels rising (Majumder & Wu, 2015,
pp 256-283). When the Angiotensin II is blocked it will, therefore, cause relaxation of the blood
vessels thus decreasing the pressure of the circulating blood inside the blood vessels.
The second drug that can be administered should aim at managing the overweight and
decreasing the waist circumference of Sharon. From the assessment data, it is evident that Sharon
is overweight with a waist circumference of 110 cm this is above the normal waist circumference
which is supposed to be 80 to 88 cm (Ashwell, M. and Gibson, S., 2016). Sharon also has a Body
Mass Index of 40.6 which is higher than the normal BMI which is supposed to be less than 30.
These are the suggested factors increasing the risk of Sharon becoming obese and diabetic. The
second drug named "glycolistat" should work aiming at increasing the body's rate of metabolism
and an increased rate of use of the ATP energy. This will ensure any excess glucose molecules
are metabolized and the energy in form of ATP used. Its second mode of action should be
interfering the body's ability in absorbing some nutrients in the daily diet. Most of the foods
consumed by human beings contain some fats which increase the body weight and raising the
Body Mass Index, therefore, when the drug’s mechanism of action is preventing absorption of
the fats in the different kinds of foods, it will be therapeutically effective in decreasing Sharon’s
weight and waist circumference (Fako, Zhang & Liu, 2014, pp 3444-3453). The last mechanism
of this drug should be altering the patient’s appetite. When Sharon’s appetite is altered, she will
tend to eat less than normal thus decreasing the number of calories she is consuming per day.
Question 5
The Registered nurse standards for practice and the ICN code of ethics provides the nursing
standards for practice. They clearly state that the registered nurse is accountable for his/ her
decisions and actions such that when there is need to meet the client’s needs and the nurse

decides to delegate her duties to be undertaken by either, a nursing student or her fellow
registered nurse, the nurse delegating retains accountability for the decision to delegate. The ICN
code of ethics for Nurses has four elements that describe the standards of ethical conduct. From
the first element which is the nurse and the people, we find that it describes the primary
professional responsibility of a registered nurse to people is providing the nursing care to the
people. In providing care the nurse will promote an environment in which Sharon's rights, her
values, her spiritual beliefs, and cultural beliefs are respected. And therefore, any nursing actions
that are against Sharon's beliefs will be avoided to preserve the boundary. The registered nurse
will ensure that any medical or nursing information received by Sharon concerning her care is
timely, accurate and is received in an appropriate manner culturally. The registered nurse will
observe confidentiality when handling Sharon's information and medical records. And lastly, the
nurse will be compassionate, respectful, responsive, and trustworthy while caring for Sharon.
She should be in a position to demonstrate her professional values.
Conclusion
Type II diabetes mellitus is related to obesity and overweight. (Al-Goblan, Al-Alfi, &Khan
2014, p 587). Obesity is confirmed by measuring the waist circumference and calculating the
Body Mass Index when given the Height and Weight of a person. A circumference of more than
88 cm indicates the client as obese and a BMI of over 30 is also a confirmation for obesity.
When type II diabetes progresses with time it leads to kidney failure whereby it starts with
kidney nephropathy that develops into kidney failure altering the kidney function (Alicic,
Rooney, & Tuttle 2017, pp.2032-2045). Impaired kidney function can lead to hypertension. The
registered nurse is therefore required to observe the code of ethics while providing care for the
client. The ICN code of ethics has four elements. In the essay, the first element was discussed

which described what Sharon as the client should expect from a registered nurse caring for her
condition.

References.
Al-Goblan, A.S., Al-Alfi, M.A. and Khan, M.Z., 2014. Mechanism linking diabetes mellitus and
obesity. Diabetes, metabolic syndrome and obesity: targets and therapy, 7, p.587.
Alicic, R.Z., Rooney, M.T. and Tuttle, K.R., 2017. Diabetic kidney disease: challenges, progress,
and possibilities. Clinical Journal of the American Society of Nephrology, 12(12), pp.2032-2045.
American Diabetes Association, 2017. 2. Classification and diagnosis of diabetes. Diabetes
care, 40(Supplement 1), pp. S11-S24
Ashwell, M. and Gibson, S., 2016. Waist-to-height ratio as an indicator of ‘early health risk’:
simpler and more predictive than using a ‘matrix’based on BMI and waist circumference. BMJ
open, 6(3), p.e010159
Bae, J.P., Lage, M.J., Mo, D., Nelson, D.R. and Hoogwerf, B.J., 2016. Obesity and glycemic
control in patients with diabetes mellitus: analysis of physician electronic health records in the
US from 2009–2011. Journal of Diabetes and its Complications, 30(2), pp.212-220
Fako, V.E., Zhang, J.T. and Liu, J.Y., 2014. Mechanism of orlistat hydrolysis by the thioesterase
of human fatty acid synthase. ACS catalysis, 4(10), pp.3444-3453.
Foucquier, J. and Guedj, M., 2015. Analysis of drug combinations: current methodological
landscape. Pharmacology research & perspectives, 3(3), p.e00149.
Hall, M.E., do Carmo, J.M., da Silva, A.A., Juncos, L.A., Wang, Z. and Hall, J.E., 2014. Obesity,
hypertension, and chronic kidney disease. International journal of nephrology and renovascular
disease, 7, p.75.

Majumder, K. and Wu, J., 2015. Molecular targets of antihypertensive peptides: understanding
the mechanisms of action based on the pathophysiology of hypertension. International Journal
of Molecular Sciences, 16(1), pp.256-283.
Nankervis, A., McIntyre, H.D., Moses, R., Ross, G.P., Callaway, L., Porter, C. and Jeffries, W.,
2014. ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus
in Australia. Modified June
Prabhakar, P.K., Kumar, A. and Doble, M., 2014. Combination therapy: a new strategy to
manage diabetes and its complications. Phytomedicine, 21(2), pp.123-130.
Reidy, K., Kang, H.M., Hostetter, T. and Susztak, K., 2014. Molecular mechanisms of diabetic
kidney disease. The Journal of clinical investigation, 124(6), pp.2333-2340