Type 2 Diabetes Case Study: Metformin, Lifestyle, and Blood Glucose

This case study focuses on John Smith, a 68-year-old male with Type 2 Diabetes Mellitus, examining the physiological aspects of blood glucose control, consequences of hyperglycemia, and the use of Metformin for diabetes management. It compares John's condition to a non-diabetic individual, highlighting insulin production and resistance. The study further explores the impact of high blood glucose levels, such as retinopathy and angina pectoris, and explains how Metformin aids in increasing insulin sensitivity and reducing glucose production in the liver. Additionally, it delves into the pathophysiology of insulin resistance due to increased abdominal adiposity and discusses the role of HbA1c in long-term blood glucose management. The analysis is supported by relevant references and an annotated bibliography.

Vodcast -Type 2
Diabetes

Client Information
Name – John Smith
Gender – Male
Age – 68
Sufferer condition – Type 2 Diabetes mellitus
Is he within a healthy weight range – Overweight
Do he exercise – take small morning walk
Occupation – Retired bank manager
Living status – Lives with his son and daughter in law.
Family Medical History – John's mother was also patient of
diabetes type 2.
Is he a smoker - No

Contd......
Alcohol intake – One beer on alternate days.
Medicines he is prescribed with - Metformin

Question 1: Physiology for blood glucose control in
John Smith
 In type 2 diabetes John's body produce less amount of insulin
from beta cells of pancreatic islets.
 It also leads to impaired insulin action in the tissues of liver,
muscles and fat and create a condition known as insulin
resistance.
 In this condition various cells of muscles, liver and fat cells are
not able to respond for the insulin even if they are present in large
amount.
 The main reason for inadequate insulin production is insulin
resistance and this occurs due to condition of overweight and lack
of physical activities.

Comparison with a non- diabetic person
• In a non- diabetic or healthy person, insulin is being
synthesized in specific quantities and the whole process takes
place in beta cells present in the pancreas.
• It is being released in two ways. The first phase maximizes
the blood sugar levels.
• The second phase is quite sustained in which there is a slow
response.
• The interaction of the molecules of insulin with the structure
of the cell membranes improves the intracellular metabolism.

Question 2: Consequences of hyperglycaemia in
John Smith
 High level of blood glucose level leads to several consequences.
 In John's case he was dealing with retinopathy. Due to increase in
blood glucose level the blood vessels tends to get damaged.
 The vessels surrounding John's eyes got highly damaged and start
leaking protein and fat that form a layer around eyes which interfere
with normal vision.

Angina Pectoris
• Insulin resistance is
considered as a process in
which the body is unable to
appropriately use the
insulin it makes. It acts as a
reason for type 2 diabetes.
• Due to diabetes mellitus
type 2, John might be
having higher amount of
those substances in his
blood which are responsible
for causing clots.

Continued…
Further, presence of diabetes may have also caused damage to
the nerves of his heart and the blood vessels. Due to high
levels of glucose in the blood, the walls of the arteries become
susceptible to development of atheroma. This may have led to
insufficient flow of blood to heart muscle leading to angina.

Question 3: Use of Metformin by John Smith for
management of type 2 diabetes mellitus
 It is known that in John, the sensitivity of cells for insulin is
low.
 Metformin is administered by John in order to increase the
sensitivity of various body tissue for insulin.
 It also help in lowering down the production of glucose in
liver.

Continued…
It can also help John by decreasing the absorption of
glucose in the small intestine.
And it is the best available medicine for the
management of diabetes among overweight people.

Action of Metformin

Question 4: (A)Pathophysiology for insulin
resistance due to increased abdominal adiposity
 There is a core relation between the insulin resistance
and increase in abdominal adiposity.
 This mainly occur because of the change in the
functions that are performed by adipose tissue.

Continued…
 This malfunctioning in the adipose result in the increased
release of fatty acids and results in abnormalities in adipokine
secretion.
 The main reason for this improper functioning is dysfunction
of visceral adipose tissue which become magnified for the
release of free fatty acids.

Question 4: (B)Use of HbA1c for the long term
control and management of blood glucose level
 The term HbA1c is also known as glycated haemoglobin.
 This occurs when haemoglobin combines with glucose present in
the blood.
 Through this test clinicians and doctors are able to get information
regarding average blood sugar level in body for a period of time.

Continued…
 When sugar is processed in body then glucose present in blood
stream attached to haemoglobin i.e. the amount of glucose that
combines with this protein refers to the total amount of sugar
that is present in our blood stream.
 And due to the reason RBC's survive for 8-12 weeks in human
body thus measuring HbA1c gives result for that particular
duration.

References
Hardy, O. T., Czech, M. P. and Corveraa, S., 2012. What causes the
insulin resistance underlying obesity?. U.S. National Library of
Medicines. 19(2). Pp. 81-87.
Khardori, R., 2017. Type 2 Diabetes Mellitus. Med scape
Rojas, L. B. A. and Gomes, M. B., 2013. Metformin: an old but still
the best treatment for type 2 diabetes. Diabetology & Metabolic
Syndrome.
Nentwich, M. M. and Ulbig, M. W., 2015. Diabetic retinopathy -
ocular complications of diabetes mellitus. World Journal of Diabetes.
6(3). Pp. 489–499.
Florkowski, C. 2013. HbA1c as a Diagnostic Test for Diabetes
Mellitus – Reviewing the Evidence. The clinical Biochemist Reviews.

Annotated Bibliography
1. Hardy, O. T., Czech, M. P. and Corveraa, S., 2012. What causes
the insulin resistance underlying obesity?. U.S. National Library of
Medicines. 19(2). Pp. 81-87.
I used this journal to learn about pathophysiology of insulin resistance
due to increase in abdominal adiposity.
2. Khardori, R., 2017. Type 2 Diabetes Mellitus. Med scape.
I used this article to gain knowledge regarding insulin synthesis and
its resistance in human body.
3. Rojas, L. B. A. and Gomes, M. B., 2013. Metformin: an old but
still the best treatment for type 2 diabetes. Diabetology & Metabolic
Syndrome.
I have been through this article in order to examine the use and effects
of Metformin in diabetes type 2.

Contd......
4. Nentwich, M. M. and Ulbig, M. W., 2015. Diabetic retinopathy -
ocular complications of diabetes mellitus. World Journal of
Diabetes. 6(3). Pp. 489–499.
I have gone through this article to get proper understanding
regarding effect of retinopathy on the person having high level
of Type 2 diabetes mellitus.
5. Florkowski, C. 2013. HbA1c as a Diagnostic Test for Diabetes
Mellitus – Reviewing the Evidence. The clinical Biochemist
Reviews.
I used this article for gathering appropriate information regarding
use of HbA1c test for the proper management of type 2 diabetes
mellitus.