Cold Spring Harbor Perspectives In Medicine: Discussion On Type 2 Diabetes

Pathophysiology Of Type 2 Diabetes

The pathophysiology of type 2 diabetes can be considered to be a combination of insufficient insulin secretion, exterior insulin resistance, and inappropriate or excessive glucagon secretion by pancreatic beta cells. The sources of type 2 diabetes mellitus vary with different factors which are both environmental factors and genetic factors that interfere with insulin sensitivity and beta cell functions (Kahn, Cooper, & Del Prato 2014). As in Melanie’s case Type 2 Diabetes Mellitus could be as a result of genetically transmitting because we find that her mother and older sister were diagnosed with the same disease, or could result from old age because we find that at the age of 63 years Melanie was found to have Type 2 Diabetes and also could have produced from obesity.

Type 2 Diabetes risk factors are of two types that is factors that cannot be modified and the factors that can be modified. The factors that can be modified are obesity, physical inactiveness, depression and decreased level of cholesterol and a high level of triglycerides (Ginter & Simko 2013). The non-modifiable factors include; aging 45years or older, increased blood pressure, history of Type 2 diabetes in the family, past record of gestational diabetes,  delivered a baby with a weight 9 pounds and above, disorder of  polycystic ovary lastly, if one has a past record  of heart disorder or stroke (Kwak et al 2013).  Cold Spring Harbor Perspectives In Medicine Discussion Paper

The process in which type 2 diabetes develops in a human body is not clearly defined. Nevertheless, abdominal obesity and insulin resistance are the key causes. The metabolic disorder is normally linked with abdominal obesity and resistance of insulin which are the collective risk factor for Type 2 Diabetes Mellitus (Yabe, Seino, Fukushima, & Seino, 2015).  Through the genetic and environmental influence, clinical features may arise, which makes it difficult to accurately determine the basic cause of type 2 diabetes in an individual patient. Genetic tendency may also contribute; though, choices of lifestyle have an incredible contribution to the development of Type 2 Diabetes Mellitus (Meier & Bonadonna 2013). The metabolic disorder is in most cases obvious in patients with high weight, history of smoking and an inactive lifestyle.  .

Heart diseases and stroke- Due to increased blood glucose level in connection increased blood pressure and high cholesterol, Type 2 Diabetes Mellitus can cause stroke and heart disease. Hearing- Type 2 Diabetes Mellitus is likely to cause hearing loss through associated complications, Kidney diseases- Type 2 diabetes can cause damage to the kidneys. The injuries are not noticed until it’s quite advanced. In case kidneys do not function, waste products that are toxic remain in the body, fluids increases in the body, and the balance of chemical become upset. Eye diseases- the back of the eye can be damaged by Type 2 Diabetes which affects vision. The expansion of diabetic retinopathy is intensely connected to the percentage of blood glucose control and the extent of time diabetes has been present in the body. Hyperglycemia which means increased blood glucose levels.  Type 2 Diabetes can cause blood glucose levels to be high above average. Type 2 Diabetes Mellitus causes nerve damage and lower limb complications (Constantino et al. 2013). Other complications include sleep apnoea, hypoglycemia, Sexual health complications, foot complications and Oral health complications.

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Risk Factors For Type 2 Diabetes

The first level option is promoting insulin secretion in the body which worked by binding to a regulatory protein on pancreatic β-cells. Increasing action of insulin in the body and reducing requirement of insulin in the body (Qaseem, Humphrey, Sweet, Starkey, M., & Shekelle, 2012).

Type one diabetes is not connected with overweight while overweight is a major contributor in type two diabetes.

Type one diabetes generally is connected with complex ketone at diagnosis while type two diabetes mellitus is in most times linked to high levels of cholesterol and increased blood pressure at diagnosis.

Whereas type two diabetes in most cases is linked to old age, type one diabetes in most is diagnosed in children.

Type two diabetes is treated at first stages with tablets or with no medication while type one diabetes is treated with either insulin injections or an insulin pump.

Type two diabetes can be controlled without medication, but type one diabetes can only be controlled by taking insulin

Insulin resistance causes type two diabetes while type one diabetes is triggered by immune system destructing pancreatic beta cells which produce insulin (Ozougwu, Obimba, Belonwu, & Unakalamba, 2013).

Increased levels of blood sugar for a person with type 2 diabetes in the morning are as a result of body changes and reactions that takes place while the person is sleeping.  There are two main reasons for increased levels of blood glucose to a person with type 2 diabetes which are dawn phenomenon and Somogyi effect. Dawn phenomenon occurs due to body requirement for blood glucose that is necessary for energy generation. It is essential to have enough or extra energy to be able to wake up in the morning. The body starts stirring out glucose that is stored during morning hours in preparation of the forthcoming day. The body also discharges hormones which lower the sensitivity of the body to insulin (Yau et al. 2012).

Furthermore, these release of hormones may be taking place while the diabetes medication doses taken the day before are wearing off. These events lead the body’s level of blood sugar to rise during morning hour.  The other reason for increased levels of blood sugar during morning hours is the Somogyi effect, also referred to as rebound hyperglycemia. When the blood sugar goes below the desired level in the mid-night while sleeping, the body discharges hormones to protect the body from the dangerously low blood sugar. The hormones do this by stimulating the liver to discharge stored glucose in higher amounts than usual. This system is not impeccable for a diabetic person, so the liver releases extra sugar than desired which leads to a high blood sugar level in the morning. This is what is referred to as the Somogyi effect.

Complications Of Type 2 Diabetes

Melanie was treated with a cortisone injection to transiently raise the blood glucose level in her body. Use of the cortisone injection put the diabetic patient at risk of developing the trigger fingers complications, familiar hand infection and also the patient is at risk of developing hyperglycemia. It is the responsibility of the nurse to discuss and give the consent regarding the benefits of the cortisone injection, uncertainties and other option treatment concerning the surgery. Also, the patient should know that the complications due to cortisone injection are associated with the part of the body where it was injected, whether on the knee, shoulder, hand or wrist (Chapple, Genco & Working Group 2 of the Joint EFP/AAP Workshop, 2013).

The metformin drugs are useful incorporation with exercises and proper diet program and more appropriate with other medications to regulate the blood sugar. In type 2 diabetes like in Melanie’s case-patients, it helps to control high blood sugar by preventing kidney damage, loss of limbs, sexual functioning complications, and nerve problems. Metformin works by assisting in the restoration of the patient’s body reaction to the insulin that is formed by the body naturally. The drug also reduces the quantity of sugar that the liver makes and the one intestines absorb (Meier, 2012).

Due to the side effects of metformin, the doctor prescribes on usage at the low dose at the beginning and gradual increase of the treatment according to the disease progression. Some of the side effects of the drugs include; stomach upset, nausea, diarrhea, vomiting, weakness or cases of a metallic taste in the mouth. Cold Spring Harbor Perspectives In Medicine Discussion Paper It essential for the nurse to advise the patient clearly on the side effect and encourage the patient to follow the correct prescription to enable the drugs to work effectively. It is advisable to inform the doctor or the pharmacist on some complications like being allergic to metformin or any other allergies. It is also necessary for the patient to alert the doctor on his or her past medical history like breathing or blood problems. Some of the risky historic issues may be kidney disease, anemia, asthma, vitamin B12 deficiency or lung disease (Bolinder et al., 2012).

Glipizide is a diabetic medicine taken orally and helps one to control the blood sugar levels through raising the ability of the pancreas to produce insulin. Glipizide also requires much exercise and proper diet for proper regulation of the blood sugar. It is not safe to use glipizide with the other medication as the other drugs may affect the level of the blood sugars.  Some of the side effects of glipizide include; redness, rash, itching of the skin, drowsiness, diarrhea, mild nausea, constipation, dizziness and can also harm the unborn.

Treatment Options For Type 2 Diabetes

Melanie’s blood result before the surgery was blood glucose level 8.8 mmol/l; HbAc: 8% and the blood test from the clinic visit were 22.9 mmol/l; HbA1c: 11% and they are the tests done to establish the level of glucose in the body. They also measure the glucose level which is contained hemoglobin. An operational doctor has to know about the current glucose level in the blood of the patient before carrying out the surgery to avoid severe mistakes that could lead to death. The patient’s fear of the surgery lead to shock and this altered the level of glucose in the blood. Another factor that may cause the decrease in the blood glucose level is due to the physical activities that Melanie had been doing to try to overcome diabetes (Inzucchi et al., 2012). It is normal for the fluctuations of the blood glucose levels in all people even to those who do not have diabetes. Majority of the healthy people with an average blood sugar level ranges from 4.0 to 5.0o mmol/L (72 to 99 mg/dl when one is fasting. After eating the blood sugar level goes up to 140 mg/dl which is 7.8 mmol/L.

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Insulin-dependent diabetes mellitus occurs when insulin secretory function is limited, and it ordinarily starts before age 15 years, but can also occur in adults though in rare cases. The beta cells of the pancreas produce a hormone called insulin. Diabetes that is non-insulin-dependent is a genetic metabolic syndrome which is categorized by hyperglycemia with ketosis resistance. The disease is triggered by a collective defect of insulin discharge and insulin resistance. Early onset of diabetes mellitus is similar to the later onset characterized by obesity-induced insulin and beta-cell failure, but the rate of deterioration in beta-cell function appears to be faster. The mature onset of diabetes is the hereditary form of diabetes mellitus triggered by mutations in dominant autosomal gene interfering with insulin production (Odegaard & Chawla 2012). The reason why the terms are confusing is that all of them are talking about insulin secretion either in small quantities or large quantities, but it cannot be easily quantifiable.

Clean the sampling area and the hands using hot water and soap, also clean the finger that you will prick with rubbing alcohol on a cotton ball or alcohol swab.

Collect the device. Insert a test strip into the glucometer, making sure you insert the required end inward. Insert a lancet into the lancing device you have used to prick your finger.

Side Effects Of Type 2 Diabetes Medications

Wait for the glucometer to alert you for a sample. The information on the glucometer will inform you to place the drop of blood on the strip. The information may indicate “put the sample on the strip,” or it can provide you with a symbol, such as an icon which resembles a droplet of liquid (Wong, et al. 2014).

Next step test blood sample. Stab the finger with the lancing device. It may be necessary to massage or squeeze the finger you pricked on both sides to push out a drop of blood. Allow a small bead of the blood to be formed on the finger. Hold the blood bead to touch the tip of the strip at the exact place, which must be specified on the piece.

Wait for the results. The glucometer counts down in seconds until the results are ready to be read. The meter beep when the result is prepared to learn.

The result will show on the digital screen. They will vary depending on the time of the day, what a person ate and what he has recently eaten.

The teach-back method is a method utilized by the provider of healthcare to check whether a patient comprehends what is being clarified to them. If a patient understands, he can be able to teach-back the information correctly. This is a communication method aims to advance health literacy. I would use the teach-back method to give Melanie information about diagnosis, plan for treatment, benefit, and risk of therapy and medication which include the procedure of using BGL machine (Ong, Chua & Ng 2014).

Reference

Bolinder, J., Ljunggren, Ö., Kullberg, J., Johansson, L., Wilding, J., Langkilde, A. M., … & Parikh, S. (2012). Effects of dapagliflozin on body weight, total fat mass, and regional adipose tissue distribution in patients with type 2 diabetes mellitus with inadequate glycemic control on metformin. The Journal of Clinical Endocrinology & Metabolism, 97(3), 1020-1031.

Chapple, I. L., Genco, R., & Working Group 2 of the Joint EFP/AAP Workshop. (2013). Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Journal of Clinical Periodontology, 40, S106-S112.  Cold Spring Harbor Perspectives In Medicine Discussion Paper