NR 507 Week 6 Case Study

Sample Answer

Pathophysiology and Clinical Findings of the Disease

The symptoms the 48-year-old male patient reports relates to type 2 diabetes. The diagnosis has been derived from the patient’s description of his symptoms and past medical history. Besides, the condition entails the lack of adequate insulin being produced in the pancreas, leading to deficiency. The muscle and fat cells’ malfunction can prevent them from responding appropriately to insulin, causing them to absorb less sugar.

The pathophysiology of diabetes mellitus type 2 entails the failure of the B-cells to function correctly. B-cells produce insulin that helps maintain normal blood sugar levels (Galicia-Garcia et al., 2020; Mann et al., 2020). The insulin is synthesized as pre-proinsulin. Upon maturation, the pre-proinsulin undergoes modification with the help of specific proteins in the endoplasmic reticulum to become proinsulin (Galicia-Garcia et al., 2020). The proinsulin gets transported to the Golgi bodies from the endoplasmic reticulum and undergoes further modification to become insulin and C-peptide.

Besides, the insulin is stored until it is ready to be released. Response to high glucose concentrations triggers the release of insulin (Galicia-Garcia et al., 2020). The B-cells take in the glucose and release it to the plasma membrane following a series of electrolyte actions in the B-cells. However, the B-cells could be impaired and fail to function as required. This patient’s case could be due to extreme nutritional conditions, including obesity and hyperlipidemia. These conditions lead to insulin resistance and chronic inflammation. Hence, the B-cells experience significant pressure, leading to their death.

The diagnosis of type 2 diabetes in this patient results from subjective and objective findings. The subjective findings from this client include fatigue, extreme thirst, frequent urination at night, increased appetite, and unintended weight loss (Trikkalinou et al., 2017). The patient reports that these symptoms began around three weeks ago. He had been living normally until this period. Conversely, the objective findings leading to this diagnosis include a high fasting glucose level of 132 mg/dL, a high blood pressure of 136/80, and a BMI of 36.5 (Malone & Hansen, 2019).

The objective and subjective patient information confirms that this patient has type 2 diabetes. The patient’s medical history, including obesity, hyperlipidemia, and hypertension, further support the diagnosis. Besides, the patient’s brother has the condition, indicating that genetics could have played a role in the patient developing diabetes.

Management of the Disease

Management of type 2 diabetes entails ensuring that the glucose level in the blood remains within the normal range. Medications and non-pharmacological treatments apply in this scenario. The two common medication classes for this condition are biguanides and sodium-glucose transporter (SGLT) 2 inhibitors. According to Grytsai et al. (2020), biguanides function by decreasing the amount of glucose produced by the liver.

The medications also regulate the glucose absorbed in the intestines, causing the body to be more sensitive to insulin. Metformin is a common drug in this class. It is always the first drug patients are prescribed to manage the condition. The physician may combine the medication with others depending on the severity of the patient’s symptoms. The patient should take 500 mg to 2250 mg daily, depending on the physician’s observation of his symptoms. The patient can take the medication alongside or after meals.

The physician starts the dosage at low levels and increases it gradually. The patient can take the drug once to three times a day, depending on the form. The drug is suitable for this patient because it controls blood glucose levels throughout the day. By increasing the body’s sensitivity to insulin, the medication helps in weight management. However, the physician must evaluate the patient’s kidney function before administering the medication since people with advanced kidney disease may develop complications when they take this drug. Other side effects of the drug include nausea, stomach upsets, and diarrhea.

The patient should also share with the physician whether he takes other drugs to avoid adverse drug interaction issues. The other drug class for treating type 2 diabetes is sodium-glucose transporter (SGLT) 2 inhibitors. Joshi et al. (2021) indicate that the medications prevent the kidneys from holding onto glucose. Instead of maintaining glucose, the liver eliminates it through urine (Xu et al., 2022). Hence, these drugs are suitable for this patient’s condition because of his other underlying issues like obesity. The drugs also reduce the chances of cardiovascular problems, chronic kidney disease, and heart failure, possibly due to the patient’s underlying conditions.

A typical drug under this medication category is dapagliflozin. The patient can take this drug with others, like metformin, based on the physician’s instructions. For instance, a physician may prescribe a dosage of 5 mg daily, which could increase to 10 mg based on the physician’s observation of the patient. The physician must monitor the patient’s kidney function before and during treatment to determine the drug’s effect on the organ.

Apart from the medications used to address type 2 diabetes mellitus, the patient can also undergo non-pharmacological treatment. The patient should strictly observe a healthy diet (Magkos et al., 2020). For example, this entails eating the healthiest foods in moderate amounts and having regular meal times. The diet should be rich in nutrients and low in calories and fats. Healthy food allows the client to control the glucose levels in the body. Foods with too much fat and calories often increase blood glucose levels. Failure to keep this level in check could lead to adverse outcomes like hyperglycemia and kidney and heart problems.

Since this patient is already obese, he needs to see a dietician who would help him develop a healthy diet plan. Another non-pharmacological treatment for type 2 diabetes entails regular physical activity. Physical activities help manage a person’s weight (Magkos et al., 2020). They help burn calories that would otherwise accumulate and increase blood sugar levels, increasing the risk of adverse effects. Being physically active improves the body’s sensitivity to insulin, helping to manage the client’s condition. Two common exercise categories suitable for this client are aerobic and resistance exercises.

Aerobic exercise allows the patient to manage his blood pressure and triglyceride levels, lowering the chances of cardiovascular problems. Conversely, resistance exercise enables the client to build muscle strength and mass. Often, exercise allows the patient to manage his weight, considering that excess calories get burned up, preventing the chances of uncontrolled weight gain. Therefore, the patient must work with an exercise expert to develop a regular exercise plan.

Conclusion

The patient has type 2 diabetes mellitus. The diagnosis results from the patient’s symptoms, including fatigue, extreme thirst, frequent urination, weight loss, and increased appetite. The patient’s medical history also confirms that he is at risk of this condition, considering he has obesity and hyperlipidemia. Besides, the patient’s brother has type 2 diabetes. The most appropriate treatment for this client entails a combination of medication and non-pharmacotherapy. He can take metformin alongside dapagliflozin. He should also create a healthy diet plan and a regular exercise schedule with the assistance of relevant experts.

References

• Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., … & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal of Molecular Sciences, 21(17), 6275.
• Grytsai, O., Myrgorodska, I., Rocchi, S., Ronco, C., & Benhida, R. (2021). Biguanides drugs Past success stories and promising future for drug discovery. European Journal of Medicinal Chemistry, 224, 113726.
• Joshi, S. S., Singh, T., Newby, D. E., & Singh, J. (2021). Sodium-glucose co-transporter 2 inhibitor therapy Mechanisms of action in heart failure. Heart, 107(13), 1032–1038.
• Magkos, F., Hjorth, M. F., & Astrup, A. (2020). Diet and exercise in the prevention and treatment of type 2 diabetes mellitus. Nature Reviews Endocrinology, 16(10), 545-555.
• Malone, J. I., & Hansen, B. C. (2019). Does obesity cause type 2 diabetes mellitus (T2DM)? Or is it the opposite? Pediatric diabetes, 20(1), 5–9.
• Mann, E., Sunni, M., & Bellin, M. D. (2020). Secretion of insulin in response to diet and hormones. Pancreapedia The Exocrine Pancreas Knowledge Base.
• Trikkalinou, A., Papazafiropoulou, A. K., & Melidonis, A. (2017). Type 2 diabetes and quality of life. World Journal of Diabetes, 8(4), 120.
• Xu, B., Li, S., Kang, B., & Zhou, J. (2022). The current role of sodium-glucose cotransporter 2 inhibitors in type 2 diabetes mellitus management. Cardiovascular Diabetology, 21(1), 83.