Case study BIOL 1051

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1 Case Study: Type 2 Diabetes on 55-Year-Old Type 2 Diabetes On a 55-Year-Old Divine Orji 0732096 Department of Biology (Physiology) BIOL 1051 March 30, 2023

2 Case Study: Type 2 Diabetes on 55-Year-Old Introduction Patient Background: John, a 55-year-old man, visits his doctor with complaints of thirst, fatigue, and frequent urination. He adds that recently, despite making no significant changes to his diet or exercise routine, he has seen an increase in appetite and weight gain. John's family has a history of hypertension and diabetes. John's body mass index (BMI) is 33.8 kg/m2 and his blood pressure is 146/90 mmHg according to a medical examination performed. Physiology/Pathophysiology: Type 2 diabetes (T2D), a persistent metabolic disorder, is characterized by insulin resistance and reduced insulin production. When blood sugar levels are high, the pancreas produces the hormone insulin (CDC, 2019b). It stimulates cell glucose absorption, especially in skeletal muscle and adipose tissue, and inhibits hepatic glucose synthesis. With T2D, cells develop insulin resistance, which impairs glucose absorption and increases the liver's synthesis of glucose (CDC, 2019b). As a result, blood glucose levels rise, which is a defining feature of diabetes (Galicia-Garcia et al., 2020). Obesity, sedentary lifestyles, and aging are a few environmental and genetic variables that are known to contribute to insulin resistance (Wondmkun, 2020). Excess adipose tissue in obesity secretes cytokines and adipokines that are pro-inflammatory, causing persistent low-grade inflammation that encourages insulin resistance (Wondmkun, 2020). Another defining feature of T2D is impaired insulin secretion. When the pancreas' beta cells are malfunctioning, the amount of insulin secreted in response to glucose is decreased (Cerf, 2013).

3 Case Study: Type 2 Diabetes on 55-Year-Old This is assumed to be brought on by a decrease of beta cell bulk and beta cell malfunction (Cerf, 2013). Treatments: Metformin is the first-line therapy for T2D because it reduces the liver's production of glucose and improves insulin sensitivity (Pfeiffer & Klein, 2014). Other medications include sulfonylureas, which improve insulin secretion, and GLP-1 receptor agonists, which promote insulin synthesis and prevent glucagon release. (Pfeiffer & Klein, 2014). Case Report: John, a 55-year-old man with a history of type 2 diabetes, visited a doctor complaining of recent bouts of increased thirst, frequent urination, and exhaustion. John's type 2 diabetes, hypertension, and hyperlipidemia have all been treated medically in the past with drugs. He said he was following his food and medicine regiment well. John has a family history of type 2 diabetes on his father’s side. He had a history of smoking but quit 5 years ago. He also reported occasional alcohol consumption. Physical Examination: John's vital signs were within normal limits, and his physical examination revealed no abnormalities in the head, neck, or chest. Abdominal examination revealed diffuse tenderness without guarding or rebound. Neurological examination was unremarkable (Khardori, 2023). The laboratory findings show John 's blood glucose levels at 215 mg/dL, and HbA1c was 9.2%. Urinalysis revealed glycosuria and proteinuria. Liver and renal function tests were within normal limits (CDC, 2019). John was diagnosed with uncontrolled type 2 diabetes with diabetic nephropathy (Mayo Clinic, 2021). For his treatment, John began receiving metformin and

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4 Case Study: Type 2 Diabetes on 55-Year-Old insulin medication, along with advice on how to change his lifestyle and frequent checks on his kidney and blood glucose levels. Discussion: A 55-year-old man with uncontrolled type 2 diabetes and diabetic retinopathy is the subject of this case study. Insulin resistance in peripheral tissues causes type 2 diabetes, which then leads in persistent hyperglycemia, which can have side effects including blindness. The blood vessels in the retina are impacted by diabetic retinopathy, which results in blindness and vision loss (CDC, 2021). Medication, lifestyle modifications, and routine checks are all part of management. This example demonstrates the need of early diabetes detection and treatment, frequent eye exams, adherence to therapy, and patient education to effectively control the illness and prevent complications (Mayo Clinic, 2022). Discussion Questions: 1. What are some risk factors for developing type 2 diabetes, and how can they be prevented or managed? Some risk factors for type 2 diabetes include age, obesity, physical inactivity, family history etc (CDC, 2022). Prevention measures include maintaining a healthy weight, engaging in regular physical activity, following a healthy diet, and managing other underlying medical conditions (CDC, 2022). 2. What are the potential complications of uncontrolled diabetes, and how can they be prevented or managed?

5 Case Study: Type 2 Diabetes on 55-Year-Old Nephropathy, neuropathy, retinopathy, and cardiovascular disease are some of the complications of uncontrolled diabetes. Good glycemic control, regular monitoring of blood glucose levels and kidney function, and management of other risk factors including hypertension and hyperlipidemia are all examples of prevention approaches (CDC, 2022a). Complications may need to be managed with drugs, dietary changes, and/or specific medical procedures (CDC, 2022a). 3. What is the role of insulin in the management of type 2 diabetes, and how does it work? In type 2 diabetes, the body becomes resistant to the effects of insulin, leading to high blood sugar levels. Insulin therapy can lower blood sugar by enhancing glucose uptake and reducing liver glucose production (CDC, 2019b). The type and dosage of insulin depend on individual needs and may change over time (CDC, 2019b). Conclusion: In conclusion, this case report highlights the importance of early detection and management of type 2 diabetes to prevent or delay the onset of its complications, including diabetic nephropathy (Lim, 2014). The combination of medications and lifestyle modifications, along with regular monitoring of blood glucose levels and kidney function, is crucial in the management of this chronic condition (Hahr & Molitch, 2015). Close attention to individual patient needs and risk factors is necessary for optimal outcomes. References References

6 Case Study: Type 2 Diabetes on 55-Year-Old CDC. (2019a, May 15). Diabetes Testing . Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/getting-tested.html#:~:text=Fasting%20Blood %20Sugar%20Test&text=A%20fasting%20blood%20sugar%20level CDC. (2019b, August 12). The Insulin Resistance–Diabetes Connection . Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/insulin- resistance.html#:~:text=Insulin%20helps%20blood%20sugar%20enter CDC. (2021, May 7). Diabetes and Vision Loss . Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/managing/diabetes-vision-loss.html#:~:text=This %20common%20eye%20disease%20is CDC. (2022a, March 9). Prevent Diabetes Complications . Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/managing/problems.html#:~:text=Common %20diabetes%20health%20complications%20include CDC. (2022b, April 5). Diabetes Risk Factors . Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/risk-factors.html#:~:text=If%20you%20have %20non%2Dalcoholic Cerf, M. E. (2013). Beta Cell Dysfunction and Insulin Resistance. Frontiers in Endocrinology , 4 (37). https://doi.org/10.3389/fendo.2013.00037 E., H., & MD., L. (n.d.). Pathogenesis of Type 2 Diabetes . Medscape. https://www.medscape.com/viewarticle/412682#:~:text=The%20pathogenesis%20of %20type%202 Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus.

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7 Case Study: Type 2 Diabetes on 55-Year-Old International Journal of Molecular Sciences , 21 (17). https://doi.org/10.3390/ijms21176275 Hahr, A. J., & Molitch, M. E. (2015). Management of diabetes mellitus in patients with chronic kidney disease. Clinical Diabetes and Endocrinology , 1 (1). https://doi.org/10.1186/s40842-015-0001-9 Khardori, R. (2023, January 4). Type 2 Diabetes Mellitus Clinical Presentation: History, Physical Examination . Emedicine.medscape.com. https://emedicine.medscape.com/article/117853-clinical#:~:text=A%20diabetes %2Dfocused%20examination%20includes Lim, A. (2014). Diabetic nephropathy – complications and treatment. International Journal of Nephrology and Renovascular Disease , 7 (7), 361. https://doi.org/10.2147/ijnrd.s40172 Mayo Clinic. (2021). Diabetic nephropathy - Symptoms and causes . Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/symptoms- causes/syc-20354556 Mayo Clinic. (2022, June 3). Diabetes management: How lifestyle, daily routine affect blood sugar . Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes- management/art-20047963 Pfeiffer, A. F. H., & Klein, H. H. (2014). The Treatment of Type 2 Diabetes. Deutsches Aerzteblatt Online , 111 (5), 69–82. https://doi.org/10.3238/arztebl.2014.0069 Wondmkun, Y. T. (2020). Obesity, Insulin Resistance, and Type 2 Diabetes: Associations and Therapeutic Implications. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy , Volume 13 , 3611–3616. https://doi.org/10.2147/dmso.s275898

8 Case Study: Type 2 Diabetes on 55-Year-Old

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