1.Pathophysiology
Type 2 diabetes mellitus (T2DM) is usually caused by the increasing development of insulin resistance such as in muscles and liver cells, and the ensuing dysfunction of pancreatic beta cells (Kahn, Cooper, & Del Prato, 2014). Abdominal fat, not like subcutaneous fat is not responsive to the antilipolytic impacts of insulin- which leads to the secretion of too much amount of free fatty acids. Excessive amounts of free fatty acids result in insulin resistance in the muscle and liver cells. Such a condition develops glucogenesis in the liver and the hindrance of the uptake of glucose by muscle cells, leading to elevated levels of circulating glucose.
Moreover, adipocytes extend so much until they cannot store any additional fat, leading to the storage of fat in muscle, pancreatic cells, and liver, which further increases insulin resistance. The continued deterioration of the role of the pancreatic beta cell leads to a permanent increase in blood glucose (Ozougwu, Obimba, Belonwu, & Unakalamba, 2013). Based on the weight and height of Melanie, here BMI is 37.6, which is far above the recommended healthy weight with BMI of 18.5 to 24.9. This implies that she is obese. Her condition, therefore, leads to impaired insulin secretion and insulin resistance. Her eating lifestyle has contributed to her obese state which further increases the risk of T2DM.
Furthermore, studies have shown that T2DM is hereditary. The Study by Lyssenko and Laakso (2013) indicated that high concordance rates were in monozygotic were much higher than in dizygotic twins some specific twin research (Ali, 2013). This explains why Melanie is at a higher risk of having diabetes because her mother and elder sister had the same illness. Another risk factor is age; research has shown that individuals over 45 years of age are prone to developing T2DM more so if they are overweight, just like Melanie who is 65 years old and obese (Martín-Timón, Sevillano-Collantes, Segura-Galindo, & del Cañizo-Gómez, 2014). Schellenberg, Dryden, Vandermeer, Ha, & Korownyk (2013) observed that lifestyle such as physical inactivity and an unhealthy diet also triggers the development of T2DM. Melanie doesn’t exercise, consumes unhealthy food, and has a family history of T2DM hence the reasons for her T2DM.
T2DM patients are more vulnerable to multiple types of both short-term and long-term complications such as macro-vascular illnesses and microvascular disorders. Short-term complications include hypoglycemia, hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Hypoglycemia is low blood sugar level and is likely to be caused by fasting and at the same under medication like insulin drug, causing blood glucose level to get too low. HHNS is when the blood glucose level raises to uncontrollable levels and is not treated (Marso et al., 2016). This condition is common in people who are sick and thus cannot always rehydrate the body. Microvascular complications are long-term complications affecting the kidney and eyes. It is likely that uncontrolled blood sugar levels for a long time will lead to cataracts which may end up in the loss of vision. Kidney disease may also result in T2DM if left untreated for a long time.
Three common treatment options for T2DM include diet and lifestyle changes, oral medications, and insulin therapy. Lifestyle changes occur in diet, behavioral therapy, and exercise. The objective of lifestyle changes is gradual and maintained weight loss. Dietary recommendations comprise reducing the intake of excessive fat, salt, and sugar (Courcoulas et al., 2015). Physical activity increases the uptake of muscles and lowers the need for insulin therapy (Balk, Earley, Raman, Avendano, Pittas, & Remington, 2015). If lifestyle changes fail to regulate blood sugar levels, then metformin is prescribed to the T2DM patient. Metformin works by reducing the production of plasma glucose level in the liver and enhancing insulin sensitivity in the muscles (Inzucchi, Lipska, Mayo, H., Bailey, & McGuire, 2014). Other additional medications may be prescribed based on the patients’ response to metformin. The third level of medication is insulin therapy. Insulin ensures that the plasma glucose is used in the body and maintains it within a standard range. Advanced levels of T2DM will require that patients be treated with insulin only if other measures have failed (Kahn et al., 2014).
2.Type 1 diabetes mellitus (T1DM) is common in children whereas T2DM is common in adults of 30 years and above. T2DM is mostly associated with excess body weight while T1DM is not. T1DM is usually linked to excessive ketone levels at diagnosis whereas T2DM is mainly linked to high blood pressure or levels of cholesterol at diagnosis. T1DM is treated with insulin injections, but T2DM is not medically treated at the beginning. It is possible to come off the disorder in T2DM whereas it is impossible to control T1DM without insulin intake. Incidences of hypoglycemia are prevalent in T1DM while in T2DM they are absent except when someone is under medication of diabetes drugs (Ozougwu et al., 2013).
3.The blood glucose level (BCL) of Melanie is high on admission because of two main reasons namely stress and time (morning). Researchers have found a direct relationship between stress levels and blood glucose levels. Mergenthaler, Lindauer, Dienel, and Meisel (2013) indicates that adrenaline, growth hormone, glucagon, and cortisol to regulate the plasma glucose levels. Under stressful situations, the body prepares itself by producing sufficient sugar. The levels of insulin decrease, adrenaline and glucagon levels are increased, and additional sugar is released to the liver. The growth hormone and cortisol levels are increased simultaneously reducing the sensitivity of body tissues, thus increasing the sugar levels in the bloodstream. According to Asmat, Abad, and Ismail (2016) stress can be due to infections or emotional stress. Melanie is stressed up because of her diabetic state and of the upcoming surgery, hence the reason for the high BCL.
Hormonal changes in the body take place in the morning causing the natural increase in blood sugar level. This state is counterbalanced by the increased secretion of insulin in people without diabetes. But for those with T2DM, it’s a challenge. At night the liver produces extra glucose required in the bloodstream, and at the same time hormones are causing a natural increase in blood glucose level. This implies that more blood glucose is supplied to the bloodstream. Diabetic patients are not able to control the levels of blood glucose in addition to the fact that insulin resistance prevents the muscles and fat cells from utilizing the sugar, thus causing a rise in the blood sugar level in the morning (Wu, Ding, Tanaka, & Zhang, 2014).
1.Cortisone injections are used to treat several diseases such as cysts. Physicians administer a cortisone injection by injecting the medicine directly to the inflammation area. This injection can cause the fatty tissue near the place of injection to appear sunken. However, this side effect is short-lived. The number of cortisone injections that can safely be administered is limited due to its side effects (ADAa, 2014). The study by Stepan, London, Boyer, and Calfee (2014) showed that cortisone injection might weaken the immune system and deteriorate the present illness or lead to new infections. Cortisone injections in diabetic patients can increase blood sugar levels and thus should be used cautiously. Some of the side effects of the medication include thinning of the skin, weight gain, and formation of cataract among others (Stepan et al., 2014). Therefore, Melanie should first notify the doctor that she had T2DM to help avoid or mitigate any further complications such as the sudden increase in plasma sugar levels.
Metformin is used in the regulation of blood sugar for those diagnosed with T2DM. It is usually an alternative after the change in lifestyle has failed. Metformin works by assisting the body to restore its appropriate response to insulin production. The drug also lowers the amount of sugar produced by the liver and stimulates the intestines to absorb it. The drug should be used at the same time every day in order to be effective (ADAa, 2014). Metformin medication is likely to lead to side effects such as vomiting, nausea, fatigue, and stomach upset. Stomach upsets are common and might occur during the initial intake of the drug, but persistent stomach upsets should be reported to the doctor. Any allergic conditions and medical history should be disclosed to the physician before taking metformin. Any activities that demand alertness such as driving should not be engaged in during medication because of the usual experiences of dizziness and blurred vision. This medication is appropriate for Melanie who has been unable to change her eating habits (Inzucchi et al., 2014).
Glipizide is an oral T2DM medicine that aids in the regulation of blood glucose by aiding the pancreas to secrete insulin. It can be used alongside other diabetic drugs. The drug is of the sulfonylureas class and works by lowering blood sugar by stimulating the natural secretion of insulin. The medicine should be taken half an hour before breakfast. The side effects of Glipizide include vomiting, nausea, headache, constipation, diarrhea and appetite loss. The drug can lead to hypoglycemia especially when the patient took fewer calories from food. Hypoglycemia symptoms include shaking, hunger, sweating, etc. any allergic condition should be disclosed to the physician in addition to medical history (Abbasi, Ali, & Alshammari, 2014). Since Melanie has no recorded allergic condition, then glipizide medication is appropriate for her.
2.Blood glucose level (BGL) is measured in terms of millimoles per liter of blood (mmol/L). HbA1c test is the test that is utilized in the diagnosis and regulation of people with diabetes. HbA1c is glucose and hemoglobin combined. HbA1c shows the amount of sugar in the blood for the past few months (Torimoto, Okada, Mori, & Tanaka, 2013). Melanie had BCL of 22.9 mmol/L after a fast and before surgery but after surgery and receiving some medications on T2DM her BGL was 8.8 mmol/L. The reduction change in her BGL is because of the medications and reduction in her stress levels after surgery. Studies have indicated that BGL is high in the morning due to hormonal changes (Mergenthaler et al., 2013).
Additionally, stressful situations such as infections or emotional stress increase blood sugar levels (Asmat et al., 2016). Melanie was distressed because of the surgery that she had to undergo and the BGL was taken in the morning hence the reason for the high BGL. The second BGL was measured after the surgery and after receiving some diabetic medications that were aimed at normalizing her BGL, hence the reason for the low BGL of 8.8 mmol/L. The reduction change in HbA1c was also for similar reasons.
1,The terms insulin dependent and non-insulin dependent diabetes mellitus are misleading because in both cases the problem is the inability of the pancreas to produce enough insulin (ADAb, 2014). Furthermore, both disorders have generally similar symptoms, and their treatment approaches are more or less the same. Early and the mature onset of diabetes mellitus is confusing because one leads to the other and the diabetes symptoms at the start are the same as the disease progresses with the exception that the symptoms continue to advance
2.Dantic (2014) defines the teach-back method as an education tool for assessing the comprehension of the patient regarding the instructions or education already offered by allowing the patients to re-instate in their own words. The teach-back method is a valuable tool for healthcare providers to confirm whether the explanations delivered have been understood by the patients (Dinh, Bonner, Clark, Ramsbotham, and Hines, 2016). The teach-back method essentially involves three steps; explaining to the patient the information about the illness, the intervention, and instructions on medication. The second step is to teach-back, and this involves asking the patient to show or demonstrate how she or he will undertake the recommended treatment, observe the illness, or take the prescribed medication. The third and last phase is to assess the patients understanding of the information already provided. Any incorrect explanation is an indication that the patient has not fully comprehended the instructions, and therefore the physician should repeat using more straightforward language and reassess by asking open-ended questions (Caplin, & Saunders, 2015).
Using the teach-back method, I will begin by explaining to Melanie the procedure on how to use the BGL machine. Before she starts, she will need to set the date and time on the meter and wash her hands with clean water. The first step is to get the blood sample using the lancing device and a new lancet from the fingertip. Secondly, apply the blood to strip. The drop of blood should be held to the narrow channel and ensure that the channel in the strip is full. Any error implies to discard the trip and repeat the procedure. The last step is to read the outcomes.
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