History of Present Illness - Diabetes - Essay Example

?Diabetes Case Study Overview Diabetes is a complicated disease with its unique characteristics. In order to successfully manage it physicians and doctors require an extensive and comprehensive approach. For the attainment of the necessary self-management skills, diabetic patient needs a team consisting of a knowledgeable physician, professional diabetes educators, dieticians and a caring support system. Case Study The mentioned below case is of a 53-year-old African American named Alvin Floyd (Kellett, 2010). Pathophysiology Alvin Floyd’s height was 5' 11", his body mass index (BMI) was 30, and he had a weight of 217 lbs. Pulse rate of the patient detected was 76, regular, and his blood pressure was 142/78. It was observed that the patient was obese. It was reported that he suffered Head and neck-mild bleeding of gums with tooth brushing. The patient’s chest and abdominal examination was conducted. It was found that his chest and abdominal examinations were normal. The patient was not suffering from any genital problems. At his feet his skin was dry with calluses on the medial side of the big toes. The nails of the patient were normal. His pulses measured were strong and equal. Sensation was normal to 10g monofilament. History of Present Illness Alvin Floyd began to feel weak and fatigued two months ago. Very little work tired him. He used to urinate two to three times at night. The patient admitted that he feels thirsty more than usual and whenever he feels thirsty he drinks a glass of water. The patient had been a member of football team at his school. His weight was normal throughout his school life. After leaving school, gradually he weight gradually increased. Although his appetite was healthy and nutritious but now he was losing weight. Alvin Floyd often suffered from pain in his feet. He felt as if the pain was burning his feet and sometimes his toes felt numb. The tingling and numbness in his fingers was causing obstructions at his work. His vision was blurry sometimes especially in the afternoons. Past History Alvin Floyd never suffered from any chronic illness. He had surgical removal of the vermiform appendix in 1972. He had not visited his dentist since 6 years. Both parents of the patient were dead. A huge stroke was the cause of his father’s death when he was 69 years of age. His mother had been found to be a patients suffering from diabetes when she was 48 years old. She died at age 62 from end-stage kidney disease. His weight was 10 lb 2 oz at birth. Both of his parents and his siblings are overweight. Among his siblings two are diabetic. Social History and Habits At present, the patient is married father of three adult children. He is not a smoker but drinks beer occasionally. He does not make medicines, nutritional supplements or herbal remedies. Diabetes Definition and/or description of diabetes Diabetes mellitus is a metabolic disease. The condition of hyperglycemia in diabetes results into defects in the secretion of insulin, action of insulin, or both. Further effects include long-term damage, dysfunction, and failure of the pancreas, eyes, heart, blood vessels, nerves, and kidneys (Medicine Net, 2011). Pancreas  The pancreas is the organ responsible for producing insulin. Islets of Langerhans are tiny tissues found inside the pancreas. There number is around 100, 000. The islets constitutes a variety of cells. Beta cells manufacture the insulin also store it until the body has a need for the insulin. (Bashoff & Beaser, 1995). The pancreas also produce a hormone called glucagon responsible for elevating blood sugar. Insulin and glucagon keep the blood sugars within a normal range. Destruction of beta cells leads to decreased amount of insulin in the body (Kahn, 2003). Eyes  Diabetes is responsible for blurry visions. Once a person gets diagnosed with diabetes and he begins treatment, blurry vision corrects itself in a matter of a few weeks, provided the person keeps his blood sugar under control. Retinopathy is one of the most serious eye problems due to diabetes leading to blindness (Whitmire, Al-Gayyar, Abdelsaid, Yousufzai, & El-Remessy, 2011). Nerves  Constant high blood sugar causes neuropathy. The patient feels as if pins are pricking his skin. Loss of feelings in hands and feet can also be resulted (Boulton et al., 2005). Kidneys  Once the kidneys are damaged, they are unable to restore their activity. Nephrons are small filters that separate out waste products and other substances from the blood that flows through the kidneys. High blood sugar permanently damage nephrons leading to kidney failure (Bashoff & Beaser, 1995). Skin Diabetes causes dry skin. It is usually due to dehydration resulting from excess urination (Web MD, 2011). Feet  Foot complications are very common in diabetic patients (Bashoff & Beaser, 1995). Types Diabetes has been divided into the following types (World Bank, 2006): Type 1 diabetes Type 2 diabetes Gestational diabetes mellitus (GDM) There is a loss of insulin production in Type 1 diabetes. It is due to autoimmune destruction of the pancreatic beta cells. Type 1 diabetes usually affects the children although it occurs at all ages and the clinical presentation can vary with age. Insulin is given to such patents for their survival. Type 2 diabetes is characterized by two conditions. Either there is insulin resistance or abnormal insulin secretion. Both of these conditions are usually present in patients suffering from Type 2 diabetes. The most renowned form of diabetes is the second type or more commonly known as the Type 2 diabetes. This diabetes type can remain asymptomatic for many years, and the diagnosis is often made from associated complications or incidentally through an abnormal blood or urine glucose test. Gestational diabetes mellitus (GDM) is the most uncommon type of diabetes. It includes glucose intolerance with onset or first recognition during pregnancy. 7 percent of all pregnancies are affected by GDM. Risk Factors Diabetes may be due to genetic disorders, infections, diseases of the exocrine pancreas, endocrinopathies, and drugs. Diabetes is not infectious; Heredity has a strong hold on Type 2 diabetes than in Type 1 diabetes (Milchovich & Dunn-Long, 1999). According to statistics, 177 million people in the world suffered from diabetes in the year 2000 (Shaikh, Shaikh, Shaikh, & Ahmed, 2008). In the year 2003, 194 million people had diabetes, and about two-thirds of these belonged to third world countries (International Diabetes Federation, 2003). Individuals who are at high risk of developing Type II diabetes mellitus includes obese (more than 20% above their ideal body weight). The obesity-related defects progress after weight gain and can result into worsening hyperglycaemia. Efficient weight management is required for glycaemic control in obese patients (Kyrou & Kumar, 2010). It has been found that there is the role of diet as a predictor of glucose intolerance and non-insulin-dependent diabetes mellitus. In addition, it is noted that there is an inverse association between vitamin C and glucose intolerance suggesting the use of antioxidants in the development of derangements in glucose metabolism (Feskens et al., 1995). Older age, obesity, severe liver fibrosis and family history of diabetes help in identification of HCV patients having potential risk factors for Diabetes Mellitus. Insulin opposition in non-diabetic HCV-infected victims was connected to rating of liver fibrosis, and takes place already at an early stage in the course of HCV infection (Petit et al., 2001). Anatomy and Physiology For normal processing, each body cell requires energy. Glucose is the most important energy supply of the human body. Insulin binds to a receptor site on the outside of cell resulting into glucose entry into cell (Admin, 2008). Major targets of insulin are liver cells, fat cells and muscle cells. For these cells, insulin does the following: glucose is stored in the form of glycogen in muscles cells and liver fatty acids and glycerol form fats Stimulates liver and muscle cells for protein production from amino acids Inhibits gluconeogenesis Effects of fewer amounts on insulin Diabetes affects the beta cells in the islet cells within the pancreas responsible for insulin production. In diabetic patient insulin in the body glucose stays in the blood rather entering the cells. Insulin facilitates entry of glucose into muscle, adipose and several other tissues. There is only a single mechanism by which cells can take up glucose which includes facilitated diffusion through a family of hexose transporters. Insulin is responsible for transportation of glucose into cells of many tissues e.g. muscle; via GLUT4, which is made available in the plasma membrane through the action of insulin (Ren et al., 2007). In diabetic patient GLUT4 glucose transporters located in cytoplasmic vesicles, cannot transport glucose (Shi, Seeley, Bowen, & Faix, 2009). When insulin binds to receptors it leads to fusion of vesicles with the plasma membrane and insertion of the glucose transporters, thereby allowing the cell to efficiently take up glucose. When blood levels of insulin decrease and insulin receptors are no longer occupied and the glucose transporters remain into the cytoplasm (Bowen, 2009). How body is affected in case of diabetes. Lack of insulin or insulin resistance is responsible for high blood-glucose levels. There is minimal insulin production and response to insulin. Body gets the notion of starvation as cells do not uptake glucose. The following actions occur to cope up with this condition by the body. Body blood glucagon level increases due to its production by alpha cells. Glucagon causes glycogen breakdown and glucose is released into blood. High blood glucose causes glucose to appear in the urine and causes the patient to urinate frequently. There is an increased amount of glucose filtered by kidney Glucose remains inside the tubule lumen retaining water. This causes: 1. Enhancement to the flow of urine via the tubule. 2. Frequent urination Constant thirst is faced by patient. Osmotic pressure of the blood is enhanced leading to stimulation of the thirst receptors in brain. Excess urine flow result into loss of body sodium, responsible for stimulating the thirst receptors. The patient eats more in diabetes but loses weight. The deficiency of insulin or insulin-resistance arouses the failure of fats directly in fat cells and proteins in muscle, that leads to the loss of weight. Metabolism of fatty acids leads to ketoacidosis, resulting into breathing problems, the smell of acetone on the breath, irregularities in the heart and central-nervous-system depression and coma. The hands and feet of the patient become cold; the reason is poor blood circulation due to high blood glucose amount. High blood glucose elevates the osmotic pressure of the blood. Elevated osmotic pressure takes water from tissues, leading to their dehydration. Water in blood is removed via urination, leading to a decrease in blood volume. This will ultimately make blood thick due to large amount of red blood cells, with a consistency like molasses, and more resistant to flow. The patient feels weak and fatigued because the body cells cannot absorb glucose, leaving them with nothing to burn for energy. The blood circulation is improper results into numbness in hands and feet, changes in vision, slow-healing wounds and frequent infections. Immune system does not work efficiently, gangrene and blindness can result (Freudenrich, 2010). Laboratory Tests Laboratory tests were applied to Alvin Floyd and the results were obtained. Urinalysis. Collection of tests performed on a urine sample is called urinalysis (Encyclopedia of surgery, 2011). The tests usually done for the diagnosis of diabetes include urine protein test, Urine ketones test, and Urine sugar test. Sugar (glucose) is not a normal urine component. In condition of increased blood sugar level the kidneys release excess sugar from the blood into the urine (Rea, 2008). The laboratory tests showed that there was 4+ glucose. The test was negative for ketones and protein. The Random testing of glucose in blood Random blood glucose test determines the level of glucose in the blood. There is increased glucose in the blood of patient who is suffering from diabetes because of insufficient insulin amount in the body. A random blood glucose level of 200 mg/dL (11.1 mmol/L) or higher among those having symptoms of high blood glucose suggests that the patient is diabetic (Lab Tests Online, 2010). Alvin Floyd Random blood glucose level was 456 mg/dL. Hemoglobin A1C tests (A1C). The A1C blood test checks the average blood glucose level for the 2-3 months prior to the testing. Normal values for A1C are 4 to 6 percent (Admin, 2008). The results obtained for the patient showed that Glycohemoglobin (HbA1c) was 16.4%. The elevated HbA1c result indicated that Alvin's average blood glucose in last two to three months was in excess of 400 mg/dL which was responsible for the increase in urination and the weight loss that Alvin faced. Cholesterol tests This test measures level of blood lipids, including total cholesterol, LDL, HDL, triglycerides. The results obtained by this test for the patient include Total cholesterol 243 mg/dL, HDL 20 mg/dL, triglycerides 416 mg/dL. Eye exam. Diabetic patients suffer blurry vision. Alvin was given an eye exam health plan's eye care center. Examination of Teeth Periodontal disease is a common problem for patients with diabetes. Alvin was suggested to make an appointment with a dentist to be assessed. Carville foot exam. A Carville foot exam was performed on Alvin, checking for both microvascular and neuropathic problems. Calluses on his toes were observed. Medical Management Alvin's was prescribed Amaryl (glimepiride), 4 mg a day. Amaryl® causes production of insulin by stimulation pancreas cells. Other classes of oral diabetes agents are: Biguanides:  decrease the release of glucose by the liver, and makes other cells more sensitive to insulin. Thiazolidinediones (TZDs):  enhance the cellular sensitivity to insulin and reduces the liver discharge of glucose. Meglitinides:  functions by stimulating the pancreas to release insulin over a shorter period of time Alpha glucosidase inhibitors:  slow the absorption of carbohydrates in the intestine.. Diabetes Nurse Clinician Alvin was scheduled for a series of classes in Diabetes Center. He learnt the signs and symptoms of diabetes, how the diagnosis is done, and treatments. He was taught how to use glucose monitors and record his results in a book. Registered clinical dietician informed him about food and activity. Progress and Monitoring After two weeks Alvin records showed that he had been testing his blood sugar level three to four times daily and over 75% of his results were in the target range. The doctor decreased the dose of Amaryl® from 4 mg to 2 mg. Alvin observed that the burning in his feet was almost gone, the numbness and tingling in his fingers had decreased and his weight was stabilized. By the time the patient returned for his 3 month class, it was found all of his tests were within target range. 4.4 lbs had been lost by him. The doctor cut his dose of Amaryl®, down to 0.5 mg qd. He had no longer blurry vision, and his eye exam was normal. Also, his HbA1c was down to 8.3%. After six months his weight had been stabilized at 199 lbs. He was no longer having the medicine Amaryl®, and his blood glucose tests remained 100% in range. He had been jogging five to six times per week for at least 30 minutes. It was also found that his HbA1c was down to 6.8%.  After nine months it was found that Alvins HbA1c was 6.9% and his weight was stable. He stopped using medicine, and he had control over his body glucose. Conclusion Diabetes is a common chronic disease requiring lifelong behavioral and lifestyle adaptations. The control of one’s diabetic condition is a very essential factor for promoting health. Effective management of the condition prolongs the lives of the patients. The needs of diabetic people may vary from one person to the other. Therefore it is necessary for the patient to discuss with his doctor the treatment options that are most suited for him or her. Since diabetes has effects on almost every part of the body, it is integral that the patient not only approaches the doctor in time, but also incorporates the changes that are required in his or her lifestyle for effective management of the disease (Medicine Net, 2011). Diabetes is best managed with a team approach to empower the client to successfully manage the disease. The multidisciplinary team that is put together for the treatment and management of diabetes compromises of a range of professionals from various allied fields. Such interprofessionals team consist of doctors, diabetes educators, nurses, dietitians and social workers. As part of the team the nurse plans, organizes, and coordinates care among the various health disciplines involved; gives concern and teaching and supports the well being and health of the clients. A critical concern for the public health globally is diabetes. It can result into many devastating health problems but by little care it can be controlled. Reference List Admin (2008). Diabetes Mellitus Case Study. Retrieved from http://nursingcrib.com/case-study/diabetes-mellitus-case-study/ Bashoff, E. C., & Beaser, R. S. (1995). Insulin therapy and the reluctant patient. Overcoming obstacles to success. PostgraduateMedicine, 97(2), 86-90, 93-6. Boulton, A. J. M., Vinik, A. I., Arezzo, J. C., Bril, V., Feldman, E. L., Freeman, R., Malik, R. A., Maser, R. E., Sosenko, J. M., & Ziegler, D. (2005). Diabetic Neuropathies A statement by the American Diabetes Association. 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