Diabetes Patients - Case Study Example

Patient Focused Case Study Q 1 The patient under study has a medical history of diabetes mellitus and morbid obesity. She is a forty-five years old woman with one daughter. She experienced serious abdominal pain, subjective fevers and vomited prior to her admission in the tertiary center for treatment and management. She had unwavering vital signs at admission, extended medical examination revealed changes in chronic erythematous and a diffuse gentle stomach. The chronic erythematous changes caused enlargement of her abdomen inclusive of her panniculus. She has been under medication with antibiotics such as empiric broad-spectrum. Administration of empiric broad-spectrum antibiotics was mainly to manage the presumed cellulitis. The doctors recommended insulin therapy after a series of medication on oral hypoglycaemic drugs (Brunette, 2005, p. 1). After consultations, the visiting surgeons recommended continued abdominal imaging to the patient. Abdominal imaging however, however, was not possible since the 45-year-old woman was too obese to fit in the CT scan. She could not fit in MRI due to her obesity. The doctors finally treated the woman’s abdominal pain using opiates after thorough medical observation. The current treatment care for the 45 year old woman is the six one after a series of medication and obesity management. The forty-five year old has also been suffering from frequent thirst and urination. Her status worsened six months ago after admission with hyperglycemia and later for a patient care program for management. The 45-year-old woman’s daughter also suffers from obesity. The daughter frequently complains of severe abdominal pain (Blak et al., 2012a, p. 2). Q 2 Obesity proves to be a serious problem in the modern world. Doctors in United Kingdom hospitals report many cases of obesity caused complications daily. Brunello et al., 2009, p. 2, discusses that obesity is a function of the body mass index. Doctors consider a body mass index greater than 25 kilogram per meters square as an overweight. Information from Management of obesity in adults,” 2004, p. 1 suggest that patients suffering from morbidly obesity have body mass index greater than 40 kilograms per meters square while obese weight patients have a body mass index greater than 30 kilograms per meters square. Obese individuals have higher probabilities of contracting associated illnesses such as diabetes, heart attack or kidney failure, respiratory problems, urinary stress incontinence and cancer. Health research indicates that morbid obese women are infertile. Mahmood and Arulkumaran, 2012, p. 405, elaborates that infertility of such women results from the changing levels of estrogen and progesterone that consequently affects regularity of menstrual cycle and fertility. The forty-year old was overweight, complained of frequent chest pains, and had polyuria symptoms. Diabetes mellitus refers to a biochemical, metabolic condition that results from abnormally high levels of blood glucose, a condition mostly known as hyperglycemia (Jenum et al., 2013, p. 1). Sugar in the form of glucose serves as a main source of energy for the body cells. Human liver has the capacity of producing small amounts of glucose through the gluconeogenesis process as well as incorporating into the blood stream some glucose from carbohydrate-rich diets (Tripathy et al., 2012, p. 43). Most glucose that the body does not require is stored in the adipose tissue as fat or the liver and muscle cells in the form of glycogen. Beta cells of the pancreas produce hormone insulin that helps in the regulation of blood glucose concentration. In cases of inadequate insulin concentration, glucose intolerance or hyperglycemia may result because tissue cells lose the ability to control usage and entry of glucose, as well as failure of beta cells function. Diabetes conditions are of two types, type 1 and type 2 diabetes. Type 1 diabetes results when the beta cells of the pancreas fail to produce sufficient insulin necessary for regulating blood glucose level. Boussageon et al., 2012, p. 2 ascertains that type 2 diabetes is the most frequent form of diabetes that is associated with obesity. It occurs when the body pancreas fails to produce adequate insulin necessary to maintain normal blood glucose level. It can also result when the human body fails to use the available insulin in a condition known as insulin resistance. Obesity always results into insulin resistance conditions within the body (Cholerton et al., 2011, p. 1463). Q 3 Psychological Factors Research has shown a positive relationship between low socioeconomic status (SES), deprivation, and traumata in adults and pathophysiological development of type 2 diabetes and obesity. Depression and stress also contribute to type 2 diabetes as well as obesity. Stress has positive associations with glucose control. It is evident in Yilmaz et al., 2011, p. 42 work that, acute stress within the general population results into increased heart rates, vasoconstriction within the vascular system in the periphery, increased muscular activity and elevated galvanic skin response. Such level of stress also implicates increase in levels of production of pituitary hormones, corticosteroids, catecholamine, and decrease in insulin production. The coordination of the release of the above factors contributes to increase in concentration of bloods glucose. Reduction in control of blood glucose level always results from decreased insulin production by the pancreas. As insulin production decreases, blood glucose concentration increases resulting into hyperglycemia. Stress factors within diabetic individuals typically stimulate hyperglycemic conditions (Wackerhage, 2014, p. 213). Diabetes patients with comorbid depression tend to possess indigent metabolic control compared to those without comorbid depression. Poor metabolic control suggests that such patients cannot regulate glucose metabolism within the body (“BOMSS abstracts 2012,” 2012, p. 13). Increased blood concentration would not suppress the body metabolic regulatory mechanisms that may likely contribute to hyperglycemia or possibly obesity. Comorbid depression relation to diabetes depends on the type of diabetes, population, and sex(Stone et al., 2008, p. 892). Research indicates that diabetic patients who have no comorbid depression comply more with medical recommendations and therapeutic treatments than those depressed patients do. Depression leads to the development of diabetes as well as coronary heart disease. Depressed patients commonly develop an array of diabetes-related complications such as acute diabetes. Patients with prolonged hypoglycemia possess increased depressive symptomatology. Similarly, patients suffering from depressive symptomatology subsequently express risks of developing type 2 diabetes. Biological Factors Based on Aisbitt, 2007, p. 1 discussions, biological factors are known to because obesity has inherent relations to an individual’s genetics. The theory of genetics and obesity states that an individual’s genome contributes to the human body mass. Fundamentally, obesity results from excessive intake of energy with comparison to the amount spent. Akabas et al., 2012, p. 93, further agrees to the increased carbohydrate consumption, for instance, contributes to increased chances of development of obesity. Decreased physical activity also helps to irregularities in metabolism and consequent development of obesity (Watson, 2008, p. 65). As explained by Schiemer et al., 2011, p. 341, Obesity may also result from Cushing’s syndrome. Cushing’s syndrome has a close association with visceral or truncate obesity that easily differentiates it from simple obesity. Diabetes risks increases by 9 percent for every kilogram gained by the body in self-reported weights. Such increment starts as the body mass index elevates 22 and even develops to 40 times at BMI of 35. Insulin resistance occurs fundamentally into defects such as type 2 diabetes and obesity. Risks of developing type 2 diabetes are considerably higher in obese patients in spite of gender. Reports indicate that 90 percent of diabetic patients are obese as well. The ability to gain weight resulting from insulin resistance typically precedes the start of diabetes. As evident in Blak et al., 2012b, p. 195, discussions, type 2 diabetes results from cases where output of the beta cells of the pancreas cannot supply enough insulin to offset the increasing blood glucose and insulin resistance. Insulin resistance typically results from increased lipotoxicity. Lipotoxicity refers to the condition of increased cellular levels of fatty acids within the body that normally results into failure of myocytes and hepatocytes to take insulin. Such failure contributes to insulin resistance resulting into hyperglycemia and possibly obesity. Q 4 Admission examination report indicates that the forty-year old developed propensity to drinking water and other beverages. Diabetes mellitus normally associates with increased thirst and frequent urination just as experienced by a woman. High blood glucose results into increased osmotic potential of the cell and fluids flows from tissues to the bloodstream where there is a high concentration. As the tissues drains, diabetic patients become thirsty and lean to drinking a lot of water. The patient had open wounds in her legs that had taken one year and seemed not to heal. Frequent infections and slow healing of sores associated with type 2 diabetes degrades the immune system ability to fight diseases. She also had velvety skin, patches of dark surfaces and creases on her neck and armpits. All these symptoms are indicative of acanthosis nigricans condition. The condition mostly associates with symptoms of insulin resistance. The woman was also overweight evidently from the body mass index that was more than 40. She also had stretch marks all over her body and besides she could barely walk more than an hour. Besides her weight, the woman was also too fatigued to walk. Fatigue in diabetes patients results from depletion of glucose from the body storage cells. Bloodstream then gets highly concentrated with glucose at the expense of tissue cells. She was obese because of her high blood pressure. The high blood pressure contributed to the frequent heart pains experienced by the patient. Q 5 Blood tests conducted diagnosed possibility of diabetes mainly because most type 2 diabetes may not have definite symptoms. Blood analysis was of the essence in ensuring the accuracy of the traditional test results. A1C test was use for analysis to detect the presence of type 2 diabetes. AIC tests typically reflect without daily variations the average of a patient’s blood glucose concentration within the past three months. AIC test has more advantages than the traditional glucose tests techniques because it does not need patients to fast. Moreover, Choudhary et al., 2013, p. 132, affirms the possibility of conveniently using AIC test at any time of the day in diabetes testing. Laboratory technicians then analyzed and presented the results obtained from AIC tests in the form of rates. The higher rates in the results reflect high blood glucose concentration in the body. The AIC test conducted using the woman blood predicted a percentage level of 9, which indicated that the patient was, diabetic. Laboratory technicians remained cautious during testing in order to avoid analysis of abnormal results, which are unreliable. Abnormal results are typically indicative of specific interfering conditions from sick cell anemia patients. The study also tested the obesity level of a woman using body mass index scale where the patient had a BMI of 45. Q 6 Physicians prescribed for the woman medications that manage blood glucose levels within the body. Doctors managed the woman under treatment drugs such as insulin secretagogues, Amylin analogues, and alpha-glycosidase inhibitors. Primary aim of blood glucose management is to maintain the glucose levels within the body and not risk development of hypoglycemia. In maintaining the glucose levels, diabetic associations recommend an A1C target of no more than 7 percent. It is vital that during glycemic control, the patient should be possessed visual, motor, and cognitive skills necessary for individualized monitoring and management of blood glucose concentration. Alpha-glucosidase inhibitors function through receptor-based blockage at small intestines brush border. The drug is a potent competitive inhibitor of glycosidase enzymes that are responsible for the catabolism of complex carbohydrates (Gadsby, 2006, p. 1). The drug also partially inhibits absorption of glucose into the blood stream as well as postprandial glycemic curve flattening. Amaryl drug that prescribed for a woman is an insulin secretagogue that can enhance insulin secretion by shutting down potassium channels within the surface of beta cells of the pancreas. Increased insulin secretion consequently enhances absorption of glucose from the blood stream. The multidisciplinary team of nurses, physicians, pharmacists, dietitians, and mental health professional helped in extending medical care to the 45-year-old woman. The woman participated in an integrated team of diabetes victims for collaborative care. MDT recommends such individualized therapeutic alliance among diabetic patients as a method for harmonizing management technology. In proper and successful diabetes treatment plan, self-management education needs integration into health care. Since the oral hypoglycemic drugs given to the 45-year old seemed cause any noticeable change, treatment shifted to a session of oral drugs and bedtime intermediate-acting insulin. The regimen started with general practice, and there were improvements in glycaemic control. Q 7 According to Arterburn and Courcoulas, 2014, p. 1, the main expectations are that the woman would be able to take control of her blood glucose levels once she participates in primary care. Besides, the primary care unit would assist her in adhering to oral hypoglycemic and antidepressants necessary for treatment of diabetes. The levels of disease resultant depression would also significantly decrease within the 45-year old woman .Diabetes education and self-management plans are essential in improving the knowledge and confidence of diabetic patients. The program would enable such patients to be in control of their condition and initiate effectual self-management abilities in their daily endeavors. The standard health education advanced to the woman would significantly improve her life standards. Some of the most outstanding benefits of effective patient education program that the 45-year old woman would enjoy include advancements in health beliefs, lifestyles, and general knowledge (Type 2 Diabetes, 2012, p. 2). She will also be able to acquire improved patient outcome benefits such as decreased levels of depression, loss of weight and psychosocial changes. Lastly, the patient education program would help the obese woman to enhance her rate of physical activity. Insulin therapy sessions would help in supplementing the level of insulin in the body (Blak et al., 2012b, p. 195). Supplemented insulin helps in regulating glucose levels through increased absorption of glucose from the blood stream. Maintenance of low blood sugar levels is of the essence in decreasing the associated risks and type 2 diabetes impediments such as blindness, kidney failure, heart attack, and foot ulcers (Haslam, 2008, p. 1). Prolonged hyperglycemia can also lead to the development of macro vascular and micro vascular complications especially when type 2 diabetes detecting is later. The 45-year old woman would be able to avoid all of these complications through insulin therapy, patient care programs, and other medications. The regimen of combined daytime oral drugs and bedtime insulin resulted into positive change in glycaemic control. The patient could manage alternative treatment involving nighttime insulin injection with ease after thorough education on insulin therapy. Q 8 Successful management of diabetes mellitus requires integration of self-management programs for the patients. Moreover, elimination of diabetes and obesity requires more patient care programs such as education than medications. Patient care programs are also imperative in reducing stress and depressions related to diabetes and obesity. Bibliography Aisbitt, B., 2007. Obesity – should we blame our genes? Nutr. Bull. 32, 183–186. doi:10.1111/j.1467-3010.2007.00652.x Arterburn, D.E., Courcoulas, A.P., 2014. Bariatric surgery for obesity and metabolic conditions in adults. BMJ 349, g3961–g3961. doi:10.1136/bmj.g3961 Blak, B.T., Smith, H.T., Hards, M., Curtis, B.H., Ivanyi, T., 2012a. Optimization of insulin therapy in patients with Type 2 diabetes mellitus: beyond basal insulin. Diabet. 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