October 13, 2012
1. Type 2 diabetes mellitus is the result of the pancreas being unable to produce adequate amounts of insulin and the resistance of cells to insulin. This results in glucose remaining in the blood and not being taken up by the cells leading to hyperglycemia. Because of insulin’s role in the stimulation of the synthesis of protein and the storage of fatty acids in adipose tissue, inadequate amounts of insulin also reduces nutrients that are essential for fuel and storage being accessed by tissues. Beta cells of the pancreas do not function correctly leading to inadequate amounts of insulin being produced. (P. 549) [ (Wolters Kluwer Health, 2012) ] [ (Khardori, 2012) ] 2. The major risk factors for the development of DM II include: 1) being overweight by a margin of at least 120% of ideal body weight; 2) being older than 45 (however, this is changing); 3) being of Hispanic, African American, Native American, Pacific Islander or Asian American heritage; 4) Having a first-degree relative who has a history of DM II; 5) Having hypertension or having low HDL cholesterol or high triglycerides; 6) Having a previous history of impaired fasting glucose or impaired glucose tolerance; 7) having previous had gestational diabetes or having given birth to a baby weighing over 9 pounds; 8) having polycystic ovarian syndrome. [ (Khardori, 2012) ] 3. The difference between a glucose tolerance test, fasting blood glucose and HgbA1C test are as follows: A glucose tolerance test is done with the patient eating normally for several days prior to the test, but fasting for 8-12 hours before the test. A blood sample is taken to establish a baseline. The patient then drinks glucose (usually 75 mL) in a liquid as quickly as possible. Blood tests are done every 30 minutes for up to 3 hours. [ (Dugdale, 2012) ] A fasting blood glucose test is done after not having eaten for 8 hours and then a blood test is done to determine the amount of glucose in the blood. [ (Healthwise Staff, 2011) ] An HgbA1C test is a glycohemoglobin test that measures the amount of glucose that has adhered to RBCs. It measures the estimated average of blood glucose levels for approximately the past 2-3 months. [ (Healthwise Staff, 2011) ] 4. Major complications that are associated with DM II are:
A. Neuropathy which is caused by the damage to the capillaries in the periphery. This is caused by excess glucose in the blood. Tingling and burning of the extremities, especially the lower extremities are a common symptom. Constipation, erectile dysfunction, nausea, vomiting and diarrhea are all effects of this nerve damage. [ (Mayo Clinic Staff, 2012) ] B. Nephropathy is also caused by nerve damage, this time in the kidneys. It can lead to the need for dialysis or kidney transplant due to the destruction of the nerves. [ (Mayo Clinic Staff, 2012) ] C. Retinopathy which can lead to blindness, glaucoma or cataracts is also caused by nerve damage, this time in the eye. [ (Mayo Clinic Staff, 2012) ] D. Infections of the foot that can lead to amputation are caused by nerve damage. [ (Mayo Clinic Staff, 2012) ] E. Alzheimer’s Disease which can be caused from blood flow to the brain being blocked or strokes, inflammation in the brain due to too much insulin or brain cells being deprived of glucose due to lack of insulin. [ (Mayo Clinic Staff, 2012) ] 5. Three areas for patient’s educational needs regarding diabetes are:
A. Adherence to meal planning. This is important because it helps maintain blood glucose levels at a therapeutic level, helps maintain a healthy weight, and helps in the prevention of cardiovascular disease. Making sure to include protein, carbohydrates, vegetables and fruits, and dairy in the correct proportion is the best way to attain these goals. (P. 76) [ (Omnigraphics, 2008) ]
B. Maintaining a physically active lifestyle. Being physically active helps in maintaining...