Pathophysiology of Type 2 Diabetes Mellitus

The purpose of this assignment is to apply endocrine pathophysiological concepts to explain assessment findings of a patient with Diabetes. Students will examine all aspects of the patient’s assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template.

Activity Learning Outcomes

Through this assignment, the student will demonstrate the ability to:

1. Examine the case scenario and analyze the exam and lab findings results to determine the patient’s type of diabetes. (CO1)
2. Explain the pathophysiology of the type of diabetes. (CO1)
3. Differentiate between subjective and objective findings which support the chosen diagnosis. (CO4)
4. Apply evidence-based practice guidelines to develop an appropriate treatment plan. (CO1, CO5).

Preparing the Assignment

Requirements

Content Criteria

1. Read the case study listed below.
2. Refer to the rubric for grading requirements.
3. Utilizing the Week 6 Case Study TemplateLinks to an external site., provide your responses to the case study questions listed below.
4. You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.
5. You must use the current Clinical Practice Guideline (CPG) for the Standards of Medical Care in Diabetes -Abridged for Primary Care Providers provided by the American Diabetes Association to determine the patient’s type of diabetes and answer the treatment recommendation questions. The most current guideline can be found at the following web address: https://professional.diabetes.org/content-page/practice-guidelines-resourcesLinks to an external site.At the website, locate the current year’s CPG for use.
6. Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.

Case Study Scenario

Chief Complaint

J.T. is a 48-year old male who presents to the primary care clinic with fatigue, weight loss, and extreme thirst and increased appetite.

History of Present Illness

J.T. has been in his usual state of health until three weeks ago when he began experiencing symptoms of fatigue, weight loss, and extreme thirst. He reports that he would like to begin a walking program, but he feels too fatigued to walk at any point during the day. Now he is very concerned about gaining more weight since he is eating more. He reports insomnia due to having to get up and urinate greater than 4 times per night.

Past Medical History 

• Hypertension
• Hyperlipidemia
• Obesity

Family History

• Both parents deceased
• Brother: Type 2 diabetes

Social History

• Denies smoking
• Denies alcohol or recreational drug use
• Landscaper

Allergies

• No Known Drug Allergies

Medications

• Lisinopril 20 mg once daily by mouth
• Atorvastatin 20 mg once daily by mouth
• Aspirin 81 mg once daily by mouth
• Multivitamin once daily by mouth

Review of Systems

• Constitutional: – fever, – chills, – weight loss.
• Neurological: denies dizziness or disorientation
• HEENT: Denies nasal congestion, rhinorrhea or sore throat.
• Chest: (-)Tachypnea. Denies cough.
• Heart: Denies chest pain, chest pressure or palpitations.
• Lymph: Denies lymph node swelling.

General Physical Exam  

• Constitutional: Alert and oriented male in no acute distress
• Vital Signs: BP-136/80, T-98.6 F, P-78, RR-20
• 240 lbs., Ht. 5’8″, BMI 36.5

HEENT 

• Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva.
• Ears: Tympanic membranes intact.
• Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.
• Mouth: Oropharynx clear. No mouth lesions. Teeth present and intact; Oral mucous membranes and lips dry.

Neck/Lymph Nodes 

• Neck supple without JVD.
• No lymphadenopathy, masses or carotid bruits.

Lungs 

• Bilateral breath sounds clear throughout lung fields. Breathing quality deep with fruity breath odor

Heart 

• S1 and S2 regular rate and rhythm; – tachycardia; no rubs or murmurs.

Integumentary System 

• Skin warm, dry; Nail beds pink without clubbing.

Labs

Test	Patient’s Result	Reference
Glucose (fasting)	132	60-120 mg/dL
BUN	20	7-24 mg/dL
Creatinine	0.8	0.7-1.4 mg/dL
Sodium	141	135-145 mEq/L
Sodium	141	135-145 mEq/L
Chloride	97	95-105 mEq/L
HCO3	24	22-28 mEq/L
A1C	7.2
Urinalysis Protein Glucose Ketones	Negative Positive Negative
Oral glucose tolerance test (OGTT)	220 mg/dL

J.T. is diagnosed with diabetes. Review all information provided in the case to answer the following questions.

Case Study Questions

Pathophysiology & Clinical Findings of the Disease

1. Review the lab findings and decide if the diagnosis is Type 2 or Type 1 Diabetes Mellitus.
2. Explain the pathophysiology associated with your chosen diagnosis
3. Identify at least three subjective findings from the case which support the chosen diagnosis.
4. Identify at least three objective findings from the case which support the chosen diagnosis.

Management of the Disease

*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

1. Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
2. Describe the mechanism of action for each of the medication classes identified above.
3. Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.
4. Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations

Pathophysiology & Clinical Findings of the Disease:

1. Based on the provided information, the diagnosis is more consistent with Type 2 Diabetes Mellitus rather than Type 1. This conclusion is supported by the patient’s age (48 years old), gradual onset of symptoms, presence of obesity, and absence of acute symptoms like ketoacidosis or rapid weight loss typically seen in Type 1 diabetes.
2. Pathophysiology of Type 2 Diabetes Mellitus: Type 2 diabetes involves insulin resistance and relative insulin deficiency. Peripheral tissues become less responsive to insulin, leading to impaired glucose uptake by cells, particularly muscle and adipose tissue. This insulin resistance prompts the pancreas to produce more insulin to compensate. Over time, the pancreas may fail to maintain this increased insulin production, resulting in inadequate insulin secretion. This dysregulation of insulin leads to hyperglycemia.
3. Subjective Findings Supporting Type 2 Diabetes Diagnosis:
   • Gradual onset of symptoms over three weeks.
   • Extreme thirst (polydipsia) and increased appetite (polyphagia).
   • Nocturia with frequent urination (polyuria) disrupting sleep.
4. Objective Findings Supporting Type 2 Diabetes Diagnosis:
   • Elevated fasting glucose level (132 mg/dL) and elevated OGTT result (220 mg/dL) indicative of hyperglycemia.
   • Obesity with a BMI of 36.5 and weight of 240 lbs.
   • Fruity breath odor indicative of diabetic ketoacidosis, a potential complication of uncontrolled diabetes.

Management of the Disease:

1. Recommended Medication Classes:
   • Biguanides: Metformin is an example of a drug in this class. (e.g., Metformin 500 mg twice daily)
   • Sulfonylureas: Glipizide is an example of a drug in this class. (e.g., Glipizide 5 mg once daily)
2. Mechanism of Action:
   • Biguanides (e.g., Metformin): Decrease hepatic glucose production, enhance peripheral glucose uptake, and reduce insulin resistance in muscle tissue.
   • Sulfonylureas (e.g., Glipizide): Stimulate insulin secretion from pancreatic beta cells, thereby increasing insulin levels in the blood.
3. Recommended Non-pharmacological Treatment Options:
   • Medical Nutrition Therapy (MNT): Provide dietary counseling focusing on carbohydrate counting, portion control, and balanced meals to achieve and maintain glycemic control.
   • Regular Physical Activity: Encourage a structured exercise program, such as walking, tailored to the patient’s preferences and capabilities to improve insulin sensitivity and aid in weight management.
4. Utilization of Clinical Practice Guideline (CPG): The recommended treatment options are aligned with the Clinical Practice Guidelines provided by the American Diabetes Association, emphasizing lifestyle modifications including diet and exercise as first-line interventions along with pharmacotherapy, specifically Metformin, as initial medication management for Type 2 Diabetes Mellitus.