Case study in type two diabetes

Paauw, MD Presentation A year-old woman with a 3-year history of diabetes is seen for worsening dyspnea and cough. She has had chronic obstructive pulmonary disease COPD since age She now has dyspnea with walking one-third of a block and a persistent cough.

Case study in type two diabetes

Get Full Essay Get access to this section to get all help you need with your essay and educational issues. The pathophysiology of Diabetes mellitus type 2 with a description of some of the common presenting symptoms of polyuria, polydipsia and polyphagia.


Explore the importance of incorporating the 5 components of managing the disease and discuss why the Indigenous population are more than 3. Under normal circumstances insulin is the main regulator of the metabolism and storage of carbohydrates, fats and protein.

Another important role of insulin is in the peripheral tissues where it facilitates glucose into cells, transport of amino acids across muscle membranes to synthesise into protein and transport of trigylcerides into adipose tissue.

This resistance according to Capriotti encourages the pancreas to secrete increasing amounts of insulin as a regulatory response to control glycaemic levels. Lastly the liver can not regulate appropriate levels of glucose to match blood glucose levels creating an overflow into the bloodstream as insulin resistance continues and hyperglycaemia develops Capriotti Classic combinations of symptoms are seen as the 3 Ps, polydipsia, polyuria and polyphagia all of which are associated to the high levels of glucose in the blood.

Hyperosmolarity and depletion of intracellular water are a result which triggers sensors in the brain to interpret this as thirst polydipsia Hill An increase in hunger polyphagia is stimulated due to insulin deficiency activating catabolism of proteins and fats increasing appetite Hill and polyuria frequent urination is due to excess glucose creating an osmotic diuresis in the kidneys Hill drawing large amounts of water with it.

The newly diagnosed patient should be informed of the importance of these symptoms which if left unnoticed or ignored can lead to hyperosmotic non-ketotic state Hill Long term uncontrolled diabetes mellitus leads to chronic health issues, disability, a poor quality of life and premature death in Australia s worldwide Thomson A study by the National Aboriginal and Torres Strait Islander Health survey found that indigenous Australians were more than 10 times more likely to die from diabetes than the rest of the Australian population.

Traditional aboriginals lived as hunters and gatherers but with the exposure of westernised lifestyles the indigenous people have changed their affinity with the land Thomson This exposure to foods high in fat and sugars, alcohol and nicotine use along with a sedentary lifestyle have placed them in a high risk category of developing diabetes and at an earlier age than non indigenous people Thomson Aboriginal people had the genetic makeup to survive when food was scarce but now this once efficient metabolism, exposed to a western influence is now working against them Thomson As Mr Daley is a newly diagnosed patient, there is a real need to focus on education.

Education has been identified as a significant factor in the effective control of blood glucose levels.

Case study in type two diabetes

Jerreat Managing diabetes can be challenging and support is needed if the individual is to have a close to normal life AIHW Firstly education is important to emphasise to the patient the importance of close monitoring and management as diabetes can become a chronic disease with multiple health issues and a poor quality of life AIHW Mr Daley should be educated on diabetes and provided with pamphlets to take home.

The nurse could also ask him to attend a clinic daily for more education and supervision with blood glucose monitoring and she could also answer any questions he may have AIWW The newly diagnosed patient will need to know the importance of making changes to their lifestyle in regards to nutrition, diet and weight control Farrell Obesity is a major contributing factor to the likelihood of developing diabetes mellitus type 2 as fat cells in particular are resistant to insulin action therefore these people can develop the disease.

For this reason weight loss can dramatically improve blood glucose levels Farrell The nurse could provide information on low GI foods and the benefits of consuming these in relation to maintaining blood glucose levels for longer periods Capaldi Educate the patient to eat regular meals, foods high in fibre and at least 5 portions of fruit and vegetables each day.

Reduce sugar — containing foods and drink alcohol in moderation and with food Capaldi Alcohol consumption greatly reduces the diabetic person from being able to control blood glucose as the physiological processes are changed Farrell The patient affected by alcohol may not recognise the symptoms of hypoglycaemia and place themselves in danger Farrell Exercise has been found to be an effective tool in controlling blood glucose levels in people with diabetes type2 Thomas et al.

Exercise lowers the level of glucose in the blood as muscles use up glucose when they are working Farrell It also helps reduce weight as it increases the resting metabolic rate Farrell The nurse can recommend that Mr Daley exercise at least for 30 minutes of moderate to intense impact at least 5 times a week Diabetes Australia Careful monitoring particularly of people on insulin or oral hyperglycaemic lowering medications are needed as hypoglycaemia can occur after exercise AIHW Type 1 diabetic patients should be screened 5 years after diagnosis of diabetes and after puberty.

People with type 2 diabetes should be screened from the time of diagnosis, since many type 2 diabetic patients have had undiagnosed disease for some time.

Case Notes This patient presented to the emergency department with acute-onset diabetes with classic symptoms of insulin deficiency compatible with a diagnosis of type 1 diabetes.

Type 2 diabetes: a case study

Approximately 25% of patients that present with DKA have new onset of type 1 diabetes. In this case, had one assumed that this was a case of type 2 diabetes and treated R.M. solely with metformin, the patient may have done well initially, during her honeymoon phase.

Case study in type two diabetes

However, she would have been at high risk for progression to diabetic ketoacidosis as her honeymoon period waned or when faced with an intercurrent illness or stress. R.C. is a year-old man with type 2 diabetes first diagnosed 2 years ago.

Other medical problems include obesity and hypothyroidism. He has a history of heavy alcohol use . Silvio E.

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Inzucchi, MD, offers his clinical perspectives in this case study exploring management and treatment of a patient with type 2 diabetes and multiple comorbidities, including heart failure, obesity, and coronary artery disease.

The following case study illustrates the clinical role of advanced practice nurses in the management of a patient with type 2 diabetes. Case Presentation A.B. is a retired year-old man with a .

Case Study: A Year-Old Man With Type 2 Diabetes, Hypertension, and Microalbuminuria