What habits lead to Diabetes Mellitus - Essay Example

Case Study – Diabetes Mellitus 1. Explain the potential outcomes of Josef’s current dietary habits and lifestyle, in relation to the pathophysiology of diabetes mellitus. 54 year old Josef is suffering from diabetes mellitus- type-2. Decreased ability of the peripheral tissues to respond to insulin and inadequate secretion of insulin by beta cells of pancreas are the main metabolic defects in type-2 diabetes. From the case report it is evident that Josef has a sedentary life stle. He is not eating appropriate diabetic diet which is evident from his glucose levels, glycosylated hemoglobin and weight gain. His weight indicates that he is significantly obese. There is enough research supporting the association between obesity and insulin resistance. This is because there is an inverse correlation between fasting plasma free fatty acids (FFAs) and insulin sensitivity. Central obesity is more associated with diabetes. Intracellular triglycerides are markedly increased in muscle and liver tissues in obese individuals because the increased circulating FFAs are deposited in these organs (Kumar, 1195). It is very important for a patient suffering from diabetes to take appropriate diet and exercise to maintain normal glucose levels. In the long-term, diabetes leads to 3 main conditions, disease of the eyes (retinopathy), nerves (neuropathy), and kidneys (nephropathy) (Kumar, 1195). These effects are due to the damaging effect of hyperglycemia on the blood vessels in these tissues. Tissues like nerves, lenses, kidneys and blood vessels do not require insulin for transport of glucose. Hence blood glucose can enter the cells without insulin. The hyperglycemia leads to increased intracellular glucose which is then metabolized by aldose reductase to sortibitol and then fructose. This process uses NADPH which gradually gets depleted resulting in oxidative stress in the cells. Thus damage to the organs occurs (Kumar, p.1195). In the retina, increased intracellular glucose stimulates the de novo synthesis of diacyl glycerol from glycolytic intermediates which further causes activation of protein kinase C. Protein C causes revascularization in retina and diabetic retinopathy, increased depositon of extra cellular matrix, fibrinolysis and production of pro-inflammatory cytokines (Kumar, p.1195). Thus various tissues in the body are damaged as a result of blood hyperglycemia. Studies have shown that hyperglycemia appears to be the determinant of microvascular and metabolic complications and that glycemia is much less related to macrovascular disease. Insulin resistance, along with concominant lipid and thrombotic abnormalities, as well as conventional atherosclerotic risk factors like smoking, hypertension, elevated low-density lipoprotein-cholesterol, low high-density lipoprotein and family history of heart disease determine cardiovascular risk (Ligaray, 2007). Though Josef has given up on smoking and states that he is consuming alcohol only in social limits, the fact that he consumes alcohol everyday is not healthy for his heart. He also suffers from hypertension, high LDL and low HDL levels which further contribute to cardiovascular risk. Chronic hyperglycemia is associated with an increased risk for cardiovascular disease in persons with diabetes (Selvin, Marinopoulos, & Berkemnblit, 2004). 2. Discuss the meaning and significance of Josef’s assessment data and test results. Josef's glycosylated hemoglobin level is 10%. This test is the standard for monitoring long-term glycemic control and reflects glycemia for the previous 3 months ((Ligaray, 2007). It is a more accurate and stable measure than fasting blood glucose levels. Studies have shown that treatment regimens which reduce glycosylated hemoglobin levels to less than 7% were associated with fewer long-term microvascular complications (American Diabetes Association, 2004). As such persons with diabetes mellitus are at an increased risk for cardiovascular disease. They have more than a 2-fold increased risk for cardiovascular death compared with persons without diabetes (Haffner et al, 1998, quoted in Lingaray, 2007). In fact, research has shown that 75% of all deaths among persons with diabetes mellitus can be accounted to cardiovascular pathology (Lingaray, 2007). Glycosylated hemoglobin level more than 9% is considered to be very high risk for cardiovscular complication. The total cholesterol: HDL ratio is 4.0. The average ratio would be about 4.5. The best ratio would be 2 or 3, or less than 4 (Thomas, 2007). The LDL-cholesterol 3.2 mmol/L which is above normal value. High LDL-cholesterol is defined as LDL greater than or equal to 3.5mmol/L (Diabetes: Australian Facts, 2008). Patients with type 2- diabetes have an increased prevalence of lipid abnormalities that contributes to cardiovascular risk. The target for LDL-cholesterol in diabetic patients should be Read More