Comorbidity Analysis - Essay Example

Patient profile

Hillary is a 65-year-old African-American. He is divorced but lives with his two children. He was diagnosed with type II diabetes at the age of 46 years. He is also asthmatic, a condition he has lived with since the age of 31. He is a retired accountant and, most of the time sits in his backyard and rarely leaves his home (reported by his elder son). Today he presents to the health facility with uncontrolled blood sugar and breathing difficulty.

Pathophysiology of diabetes type II

Diabetes type II results from peripheral insulin resistance (hyperinsulinism), impaired functions of the beta cells as well as an impaired regulation of glucose production in the liver (hepatic) cells. Chronic hyperinsulinemia affects cellular insulin sensitivity as well as cellular action. Eventually, there is a total failure of the beta cells, leading to insulin unresponsiveness (Chatterjee, Khunti & Davies, 2017). The long term effects of the factors mentioned above include suppressed liver function, impaired beta cells functions, and cellular insulin insensitivity.

Pathophysiology of asthma

Asthma starts with the presence of an allergen, such as pollen in the airway. Such a foreign body causes the cytokine and the lymphocytes to respond by initiating inflammatory episodes. As a result, the airway becomes constricted hence obstructing airflow (Sullivan, Hunt, MacSharry & Murphy, 2016). There is an association between diabetes and asthma. According to Rogala, Bożek & Gluck (2019), insulin resistance, which characterizes diabetes type II, is associated with impaired lung function and respiratory distress.

Influence of patient factors and sociodemographic indicators

Both modifiable and non-modifiable factors increase the risk of developing diabetes type II. Patient factors and sociodemographic factors include age, level of activity, age, family history, and weight. People aged 45 years and above are at increased risk of developing diabetes type II. Also, overweight is noted to have an increased risk of developing the disease. If the patient has a family member with diabetes, then there is an increased chance that he or she will develop the condition. Asthma is also affected by both personal and sociodemographic factors. Smoking is one factor that strongly links with asthma. The patient’s family history of asthma increases the risk of developing the condition.

Health assessment and diagnostic evaluation

Diabetes type II requires a comprehensive health assessment. The clinician should begin with history taking to establish the presence of the disease in the family. Skin assessment (inspection) should also form a part of the physical examination. The reason for skin inspection is to determine ulceration, commonly noted in diabetes type II patients. The patient needs an A1C test, which reveals the average level of blood sugar concentration for the last three months. If the result indicates values above 6.1 on two different occasions indicates that the patient has diabetes (Chatterjee, Khunti & Davies (2017). The assessments of asthmatic conditions are based on respiratory functions. The gold assessment criteria for asthmatic patients is the lung function test, performed by spirometry. The test reveals the lung’s ability to accommodate and expel air. The use of spirometry can reveal the patient’s breathing rate.

Compensatory mechanism exhibited by the patient

Weight loss is one of the compensatory mechanisms evident in the patient. Since the body cells are resistant to insulin, there is a limited source of energy. As a result, most of the stored body fats are metabolized to yield energy. The result is a drastic loss of body weight. The patient is depressed due to the underlying conditions. His elder son reports of reduced activity and interaction compared to some years back. His elder son is worried that the condition may worsen with time. Also, the patient exhibits a respiration rate of 40 breaths per minute to compensate for the obstructed airway.

Pharmacokinetics and pharmacodynamics of the medications

The patient's medications are metformin (for diabetes type II) and albuterol (asthmatic attacks). Metformin is administered orally with a bioavailability of about 60%. Upon administration, the drug reaches peak plasma concentration after one hour and has a plasma half-life of 8 hours. The metabolized drug is eliminated from the body via urine. The drug affects blood sugar concentration—Metformin act by increasing insulin sensitivity (Rena, Hardie & Pearson, 2017). The drug does that by increasing the activity of the receptor tyrosine kinase. Albuterol is inhaled as a fume. After inhalation, the drug has a rapid effect, with a half-life of four hours. A larger percentage of the drug metabolites are excreted via urine. The mechanism of action albuterol is through the stimulation of beta-adrenergic receptors, leading to smooth muscle relaxation (Johnson & Bounds, 2019). The effect causes bronchodilation.

Drug interactions

Albuterol medication may have a significant effect on the blood glucose concentrations and control in diabetic patients. Also, albuterol is revealed to lower the effectiveness of metformin. However, the drug interaction between metformin and albuterol is less serious and, therefore, does not warrant cessation. The interaction may be lowered by adjusting the dose of metformin when the patient is under albuterol therapy.

Impacts of the drugs on the body system

Metformin is noted to have a significant impact on the reproductive system. The drug reduces the level of testosterone level and subsequently lowers sex drive. The patient needs to be informed of the side effect and be prepared to deal with the situation. Under low doses, metformin has less effect on the reproductive system. Albuterol is associated with cardiovascular impacts, such as a pounding heart and rapid heart rate. Also, the drug affects the musculoskeletal system, where it causes muscle aching. The effect is less serious and does not necessitate medical intervention.

Patient education

The patient needs to understand the pathophysiology of diabetes type II and asthma. He should be aware of the risk factors and healthy living styles. I will provide the patient with a pamphlet containing the information for the two conditions. Also, I will inform the patient diet on dietary modification and medication adherence. Since he is living with his sons, they will be responsible for ensuring that he takes his medications as prescribed by the clinician. I will also schedule a two-week check-up to the health facility with or without complications.

Reference

Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085), 2239-2251.

Johnson, D. B., & Bounds, C. G. (2019). Albuterol. In StatPearls [Internet]. StatPearls Publishing.

Rena, G., Hardie, D. G., & Pearson, E. R. (2017). The mechanisms of action of metformin. Diabetologia, 60(9), 1577-1585.

Rogala, B., Bożek, A., & Gluck, J. (2019). Is there a relationship between asthma and diabetes?. Journal of Asthma, 1-7.

Sullivan, A., Hunt, E., MacSharry, J., & Murphy, D. M. (2016). The microbiome and the pathophysiology of asthma. Respiratory Research, 17(1), 163.