Describe the pathophysiology of T2DM with links to Melanie’s case. Include in your answer risk factors for T2DM, the pathogenesis of T2DM, possible complications of T2DM and outline the 3 levels of treatment options for T2DM. (600)
Type 2 Diabetes Mellitus is a heterogeneous syndrome characterized by fat metabolism and a combination of reduced insulin secretion along with increased requirements for insulin (Macaluso, Bauer, Deeb, Malone, Chaudhari, Silverstein & Rosenbloom, 2016). As an illustration, the insulin secretion usually tends to decline with the increase in the age which may reflect the role of diabetes-associated genes (American Diabetes Association, 2014). Obesity largely causes insulin resistance together with physical inactivity which both precedes and predicts the type 2 diabetes mellitus which is usually referred to as metabolic syndrome. However, later conditions are usually clusters of risk factors which are considered to be causes or the results of the insulin resistance (Bellamy, Casas, Hingorani & Williams, 2009).
In Melanie’s case, there is an increase in glucose which is an indication of T2DM and insulin resistance (Chang, Lee & Mills, 2017). The insulin resistance is termed to be the inability of insulin to produce its usual biological actions at the circulating concentrations which are effective in normal subjects. Accordingly, Melanie’s friend is said to be overweight, eats lots of cakes, rarely do exercises but does not have diabetes. The reason being is because he has a healthy insulin secretory capacity. Insulin output from the pancreas usually increases higher s diabetes develops but fails thereafter. This usually varies from person to person and that is the reason why Melanie and her friend are different.
The type 2 diabetes mellitus usually has many risk factors which are usually related to lifestyle choices. As an illustration, this disorder usually develops when the glucose which is needed by our body to make energy stays in the blood and can’t get into cells (Trivedi, Sinha, Satapathy, Sharma & Siddiqui, 2015). The first risk factor is the family history. T2DM usually has a hereditary factor whereby if someone within the family is affected then other family members are most likely to be affected too. The second factor is the ethnicity. Particular ethnic groups are typically likely to develop T2DM which includes the African American, Hispanic Americans along with Asians.
The third risk factor of T2DM is the age. Older people are usually at risk of developing T2DM than young individuals. The risk usually starts to increase at the age of 45 and increases exponentially at 65. The fourth risk factor is polycystic ovary syndrome (Inklebarger eta.l, 2017). This too raises the risk of T2DM since is related to insulin resistance. Within the PCOS, several cysts usually form within the ovaries and the major cause is insulin resistance. In the case of Melanie, she seems to have PCOS which means she is insulin resistant and that is why she has type 2 diabetes.
The pathogenesis of T2DM is based on an interplay between the beta-cells dysfunction along with insulin resistance. Conversely, the defects of insulin secretion comprise of loss of the first phase insulin response to the glucose load. Lowered beta-cell mass via the genetic or beta cell cytotoxic factors predisposes for glucose intolerance. The rise in blood glucose with excess fatty acids which are typically featured in obesity along with insulin resistance usually causes additional deterioration in beta function which then rises to full-blown diabetes (DeFronzo eta.l, 2015).
The possible complications of T2DM areas highlighted below. The first one is the Hypoglycemia. This usually occurs when the blood glucose is low. Conversely, this is usually more common in individuals injecting insulin (Wong, Constantino & Yue, 2015). Another complication is the sleep apnoea. This is a type of sleep disorder which is characterized by a pause in breathing during sleeping. The three levels of treatment options for T2DM are canagliflozin, dapagliflozin, and empagliflozin. These three drugs can be used differently.
Differentiate between T2DM and T1DM (at least 6 differences). (100)
T2DM is often diagnosed in adults of age thirty and above while T1DM is often diagnosed in young adults and children (Koloverou & Panagiotakos, 2016). Also, T1DM is not associated with excess body weight which is not the case in the T2DM which is associated with excess body weight. To treat T2DM the treatment incorporates of insulin, medications, exercise, and diet while T1DM is treated with an insulin pump or insulin injection since the body no longer produces insulin (American Diabetes Association, 2014).
During the diagnosis of T1DM, it is associated with higher than normal ketone levels but T2DM is usually associated with cholesterol and/ or hypertension during diagnosis. Furthermore, T1DM is hard to control without taking insulin while T2DM is sometimes possible to come off diabetes medication. Finally, the cause of T2DM is not known although it is related to age, genetics, inactivity, and weight in the case of T1DM it is caused by an autoimmune response against insulin-producing beta cells (DeFronzo eta.l, 2015).
Identify at least 2 reasons Melanie’s BGL is high on admission. Discuss how each reason you identify effects BGLs. (300)
Melanie notices that she is stressed up because of the surgery she is going to undergo. Stress can be physical, emotional or mental. In the case of Melanie, she is undergoing a physical and mental stress. She has a physical stress of a Bakers Cyst and a mental stress of having diagnosed with Type 2 Diabetes Mellitus and this stress produces very high levels of stress hormones which drives blood sugar levels up (Macaluso eta.l, 2016). Furthermore, Melanie has not been able to do some exercises due to her knee which has a lot of pain when she tries to walk. In this case, when she suffers pain her body is under assault and her caveman DNA goes into its primitive fight-or-flight mode. However, the pain leads to a constant dribble of adrenaline into her blood as long as it lasts hence raising the blood sugar level.
The increased blood glucose is usually a common finding among patients with trauma or acute medical conditions which warrants admission to medical wards along with intensive care. Accordingly, its counter-regulatory hormones which usually releases the stress hyperglycemia which opposes the actions of insulin (DeFronzo eta.l, 2015).
PART 2
Discuss the three medications Melanie is on. Include in your answer the action, complications/side effects and nursing considerations linked to Melanie’s situation. (500)
The first treatment that Melanie is on is Metformin. This is the medicine which is used in treating type 2 diabetes along with polycystic ovary syndrome. This medication usually lowers the blood sugar levels by improving how the body handles insulin (DeFronzo eta.l, 2015). In that case, it is usually prescribed when diet and exercise are not enough to control blood sugar levels. It is usually best to take Metformin with meals in order to reduce the side effects. The metformin tablets are usually in different strengths and the daily dose that Melanie has to take is 2,000mg a day (Shah, Diwakar & Dargar, 2016).
The metformin is used to slow down absorption of sugar within the small intestine, stops the liver from converting the stored sugar into blood sugar along with helping the body to use natural insulin more efficiently. Some of the side effects of metformin are diarrhea along with not feeling well mostly if it is not taken together with meals.
Melanie is also on Glipizide medication which helps to release insulin from the pancreas. The insulin usually moves sugar from the bloodstream to the cells which decrease the blood sugar levels. The Glipizide medication is usually used with proper diet along with an exercise program to control the high blood sugar. This medication belongs to the class of drugs called sulfonylureas. As an illustration, it usually lowers the blood sugar by triggering the release of natural insulin in the body. This medication is usually taken 30 minutes before breakfast or as directed by the doctor (American Diabetes Association, 2014).
The third medication that Melanie is undergoing is sulfonylureas. This kind of medication usually helps the body to produce more insulin. This drug should not be taken by individuals with type 1 diabetes. Furthermore, people who has liver or kidney issues should not take sulfonylureas. Some of the individuals usually develop allergy reactions to sulfonylureas while others increase in weight.
Discuss the two blood results, one from prior to surgery and one from the clinic visit of Melanie’s BGL and HbA1c. What are they? What do they measure and why have they changed? (200)
The first blood results which are prior to surgery was 22.9 mmol/L and HbA1c: 11%. On the other hand, the blood results from clinical visit were 8.8 mmol/L and HbA1c: 8%. After surgery HbA1c seems to have lowered abet from 11% to 8 % which implies diabetes is reducing. This is because the Hemoglobin A1c levels at 4% to 5.6% shows that the individual does not have diabetes (DeFronzo eta.l, 2015). To my opinion, the blood results changed because before surgery we are told Melanie had been fasting from midnight. In that case, it seems she used to take food rich in glucose.
The blood results usually check variety of things including how particular organs function, infections along with particular disease which are genetic. Accordingly, the blood results usually details the various components within the blood and at what level they are present. The mmol/L usually measures the blood glucose level in terms of molar concentration. On the other hand, the HbA1 is a form of hemoglobin which is bound to glucose and is usually measured to reflect how well diabetes can be controlled.
PART 3
Discuss why the terms insulin dependent diabetes mellitus/ non-insulin dependent diabetes mellitus and early onset/mature onset are misleading. (100)
The insulin dependent diabetes mellitus or the non-insulin dependent diabetes mellitus is misleading since it’s a chronic condition which affects the way the body metabolizes sugar (Ichai, & Preiser, 2018). However, a person can think it’s a disorder which does not involve insulin at any point. On the other hand, early onset or mature onset is also misleading. Maturity-onset diabetes is a genetically and clinically heterogeneous subtype of non-insulin dependent diabetes mellitus but someone might think they are totally different (DeFronzo, Ferrannini, Groop, Henry, Herman, Holst & Simonson, 2015).
You need to teach Melanie how to use her BGL machine. Discuss the “teach back” method for patient education (include evidence from peer-reviewed sources). Discuss how you would use this method to teach Melanie how to use her BGL machine. (200)
The teach-back method is a communication confirmation method which is utilized by the health care providers to check if the patients comprehends what is being explained (Inklebarger, Galanis, Kumar, Krishaswa & Leddy, 2017). This is confirmed when the patients explain back in their own words to the educator. In that case, I would use the teach-back method to teach Melanie how to use the BGL machine by first ensuring that the dates and time of the meter are accurate. The first step is to get a blood sample through the use of the lancet device from the fingertip.
The second step is to apply the blood strip. The drop of blood has to be held to the narrow channel at the edge of the test strip. The third step is to read the results which are displayed by the meter. In that case, I will ask Melanie to repeat all the steps on her own to see if she understood properly. Therefore, I will pretend to be a patient and her a care provider.
References
Bellamy, L., Casas, J. P., Hingorani, A. D., & Williams, D. (2009). Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. The Lancet, 373(9677), 1773-1779.
DeFronzo, R. A., Ferrannini, E., Groop, L., Henry, R. R., Herman, W. H., Holst, J. J., … & Simonson, D. C. (2015). Type 2 diabetes mellitus. Nature reviews Disease primers, 1, 15019.
American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes care, 37(Supplement 1), S81-S90.
Macaluso, C. J., Bauer, U. E., Deeb, L. C., Malone, J. I., Chaudhari, M., Silverstein, J., … & Rosenbloom, A. L. (2016). Type 2 diabetes mellitus among Florida children and adolescents, 1994 through 1998. Public Health Reports.
Inklebarger, J., Galanis, N., Kumar, D., Krishaswa, K., & Leddy, J. (2017). Bakers Cyst Occurrence Following Arthroscopic Medial Meniscal Debridement in a Recreational Athlete: Some Potential Indications for Ultrasound-Guided Needle Aspiration.
Trivedi, S., Sinha, M. B., Satapathy, B. C., Sharma, D. K., & Siddiqui, A. U. (2015). Bakers Cyst: A Case Report and its clinical significance. Inter Jour of Biomed Research, 6(01), 55-7.
Shah, D. P., Diwakar, M., & Dargar, N. (2016). Bakers Cyst with Synovial Chondromatosis of Knee-A Rare Case Report. Journal of orthopedic case reports, 6(1), 17.
Mythili, S. (2015). Incretins Role in the Pathophysiology of Type 2 Diabetes Mellitus. RESEARCH JOURNAL OF PHARMACEUTICAL BIOLOGICAL AND CHEMICAL SCIENCES, 6(6), 698-702.
Wong, J., Constantino, M., & Yue, D. K. (2015). Morbidity and mortality in young-onset type 2 diabetes in comparison to type 1 diabetes: where are we now?. Current diabetes reports, 15(1), 566.
Koloverou, E., & Panagiotakos, D. B. (2016). Macronutrient composition and management of non-insulin-dependent diabetes mellitus (NIDDM): a new paradigm for individualized nutritional therapy in diabetes patients. The review of diabetic studies: RDS, 13(1), 6.
Ichai, C., & Preiser, J. C. (2018). Hyperglycemia in ICU. In Metabolic Disorders and Critically Ill Patients (pp. 379-397). Springer, Cham.
Chang, C. P., Lee, T. T., & Mills, M. E. (2017). Experience of Home Telehealth Technology in Older Patients With Diabetes. CIN: Computers, Informatics, Nursing, 35(10), 530-537.
Leiras, C., & Keller, K. (2015). The effectiveness of the Teach Back method in improving health literacy in a primary care practice.
Dinh, T. T. H., Bonner, A., Clark, R., Ramsbotham, J., & Hines, S. (2016). The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI database of systematic reviews and implementation reports, 14(1), 210-247.
Peter, D., Robinson, P., Jordan, M., Lawrence, S., Casey, K., & Salas-Lopez, D. (2015). Reducing readmissions using teach-back: enhancing patient and family education. Journal of Nursing Administration, 45(1), 35-42.
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