Australian Catholic University BIOL122 Assignment 2: Diabetes Solution

This assignment solution addresses the pathophysiology and management of type 2 diabetes mellitus, focusing on a specific 'person/client' scenario. It begins by explaining how beta cells in the pancreas fail to produce sufficient insulin in response to hyperglycemia and how insulin resistance develops, leading to difficulties in blood glucose control. The solution then details the complications of hyperglycemia, including neuropathy and myocardial infarction, elaborating on the mechanisms by which high glucose levels damage nerves and affect heart function. The primary pharmacological intervention, metformin, is discussed, emphasizing its mechanism of action through the activation of AMP-activated protein kinase to stimulate cellular metabolism. The solution also explores the relationship between adiposity and type 2 diabetes, citing studies that highlight the role of visceral fat in increasing insulin resistance. Finally, it underscores the importance of HbA1c measurement in monitoring and managing the disease, explaining how this metric reflects average blood glucose levels and helps assess treatment effectiveness. The assignment concludes with a bibliography of relevant articles used to support the findings.

Question 1
In a normal individual, beta cells found in islets of Langerhans in the pancreas upon sensing
hyperglycemia, synthesize insulin a hormone that breaks down the excess glucose into harmless
glucagon. Furthermore, the insulin binds on tissue receptors and sends signals to stimulate
cellular uptake of glucose. In an individual with type 2 diabetes like McRoberts, the beta cells do
not synthesize insulin upon hyperglycemia due to insensitivity brought about by the initial
overproduction of insulin. The available insulin on the other hand binds on receptors but doesn’t
transmit the signal to increase cellular uptake of glucose. This two conditions makes it difficult
to control glucose in blood.
Question 2
Accumulation of glucose in blood to toxic levels is referred to as hyperglycemia. This condition
is associated with diverse complications. Neuropathy and myocardial infarction are just the
notable complications. When glucose builds up to toxic levels, it destroys nerves in the body
such that there is impaired relay of signals within the body. This condition is defined as
neuropathy. Similarly, damage of nerves that coordinate contraction and relaxation of muscles of
the heart leads to irregular or abnormalities in contraction thus leading to myocardial infarction.
Question 3
The drug of choice for type 2 diabetes is metformin. It works by stimulating cellular metabolism
through the action of AMP-activated protein kinase. Metformin normally inhibit production of
mitochondrial ATP. This leads to an elevated cytoplasmic ADP: ATP and the AMP: ATP ratios
that in return activate the enzyme that increase cellular metabolism.

Question 4
a)
In different studies examining the relationship between adiposity and the risk of type 2 diabetes,
results indicate that obesity increases the risk of type 2 diabetes. The studies found out that
accumulation of adipose tissue under the viscera leads to production of retinol binding protein 4
that increases insulin resistance within the cells of the body.
b)
HbA1c is a combination of glucose and hemoglobin. Measuring or estimating the level of
HbA1c is the best approach during management of type 2 diabetes. HbA1c provides an average
amount of glucose in the body for a period of around 10 weeks. This measure can therefore be
used to evaluate how the patient responds to medication. If for example the level of glucose
remains high, then that means the therapy hasn’t worked while low levels indicate the therapy is
effective.

Bibliography
Kim, E. J., Jeong, M. H., Kim, J. H., Ahn, T. H., Seung, K. B., Oh, D. J., … Chae, J. K.
(2017). Clinical impact of admission hyperglycemia on in-hospital mortality in acute
myocardial infarction patients. International Journal of Cardiology, 236, 9-15.
doi:10.1016/j.ijcard.2017.01.095
In this article, I obtained relevant information about complications of hyperglycemia particularly
myocardial infarction. The article explains how hyperglycemia contributes to myocardial
infarction through damage to the nerves.
An, H., & He, L. (2016). Current understanding of metformin effect on the control of
hyperglycemia in diabetes. Journal of Endocrinology, 228(3), R97-R106. doi:10.1530/joe-15-
0447
In this journal, I obtained important information about Metformin, which is the drug of choice
for type 2 diabetes. I got information on how metformin stimulates cellular metabolism to lower
the level of glucose in blood.
Grisold, A., Callaghan, B. C., & Feldman, E. L. (2017). Mediators of diabetic neuropathy.
Current Opinion in Endocrinology & Diabetes and Obesity, 24(2), 103-111.
doi:10.1097/med.0000000000000320
This article was used to provide information on the link or association between high blood
glucose and neuropathy. The article explains how damage to nerves contributes to impaired
coordination within the body.

Duggan, E. W., Carlson, K., & Umpierrez, G. E. (2017). Perioperative Hyperglycemia
Management. Anesthesiology, 126(3), 547-560. doi:10.1097/aln.0000000000001515
I used to article to obtain information on the importance of HbA1c and long term management of
type 2 diabetes.
Defronzo,R. A., Ferrannini, E., Groop, L., Henry, R. R., Herman, W. H., Holst, J. J., …
Weiss, R. (2015). Type 2 diabetes mellitus. Nature Reviews Disease Primers, 15019.
doi:10.1038/nrdp.2015.19
This is the article that provides an overview of type 2 diabetes mellitus.It descrines the
mechanism of pathophysiology of the disease.