Discussion Post
Week Eleven
NURS6531, N-8 Diabetes Mellitus (DM) is a disease process that affects much of the United States (U.S.) population. DM occurs when the body has trouble regulating the amount of glucose in the blood stream. As an advanced practice nurse (APN), one must be able to diagnose, treat, and educate patients about DM. The purpose of the paper is to evaluate a case study for a patient with DM and explain the factors that impact the treatment and education strategies for the individual.
Diabetes Mellitus DM is categorized into either diabetes mellitus type I or II. People can have a genetic predisposition to DM type I. In DM type I autoantigens form on the insulin-producing beta cells of the pancreas that circulate in the lymphatics and bloodstream. These autoantigens cause the activation of T-cytotoxic and autoantibodies toward these cells, thereby causing the destruction of the beta cells, which significantly decreases insulin secretion (Jones, Braashers, & Huether, 2012). This type of DM is considered juvenile diabetes. DM type II can also be due to a genetic-environmental interaction. …show more content…
However, most people have risk factors consisting of age, obesity, physical inactivity, hypertension, and family history. Metabolic syndrome is a collection of disorders such as dyslipidemia, prehypertension, elevated fasting blood glucose, and obesity. These factors are a precursor for patients acquiring DM type II. However, genetic predisposition and obesity lead to increased serum level of adipokines, increased level of inflammatory cytokines, free fatty acids, and decreases the activity of amylin, ghrelin, beta cell mass, and function causing insulin resistance. Insulin resistance increases the demand of insulin synthesis, thereby causing hyperglycemia (Jones, Brashers, & Heuther, 2012). Case Study The patient I chose for this discussion is a 45-year-old Caucasian female with uncontrolled DM type II and obesity. She presented in the office on this day for a follow-up three-month visit to discuss laboratory bloodwork, and for a diabetic check-up. S.A. is a non-smoker and denies alcohol use. Height is 66 inches; Weight: 228 pounds; BMI: 36.8; Pulse: 80; Blood Pressure: 110/76 sitting, right arm. Her physical exam displays an appropriately dressed, well-groomed individual. S.A. is alert and oriented x3. Eyes: conjunctivae clear, EOM intact; Respiratory: Lungs clear upon auscultation, no adventitious sounds noted; Cardiovascular: Regular rate and rhythm, normal S1 and S2, negative for murmur or rub; Extremities; negative for edema. Upon her foot exam, she had normal sensation throughout and no ulcers. S.A. reports that her fasting blood sugar levels are between 110-150 in the morning. Before meals, she states that they are between 130-200, and she checks then three times daily. However, her HbA1C is 9.1, which indicates that her DM type II is not well controlled. According to Wood (2013), The HbA1C level for non-pregnant adults should be less than seven percent. Her current medications for DM II are Metformin 500MG tablet PO TID, Lantus 30units subcutaneous BID, Humalog 15units subcutaneous AC, and Victoza 1.2MG subcutaneous daily. She states that she alternates injection sites frequently. Obesity and Physical Inactivity The patient factors I chose are obesity and physical inactivity. According to the American Diabetes Association (2016), being overweight is having a BMI of above 29.9 and increases the risk of DM II, heart disease, and stroke. Weight loss, physical activity, and diet changes increase the chance of normal blood glucose levels in types I and II DM (Joslin Diabetes Center, 2016). Therefore, losing weight is a fundamental component in S.A. being able to control her disease. She has consulted a bariatric surgeon in hopes of one day getting gastric bypass surgery. However, she must first get her HbA1C levels under seven percent. S.A. reports that she eats a well-balanced diet most days, but does eat foods high in fat and carbohydrates occasionally. The APN, patient, and I talked about steps to ensure healthy eating. Utilization of a shopping list will help her in buying only healthy and necessary food products. According to the ADA (2016) products such as lean meats, whole grains, and fresh fruits are essential for building a healthy plate. Also, avoidance of aisles containing high-fat food and snacks is crucial. This patient states that she does not get any physical exercise other than cleaning her
Week Eleven
NURS6531, N-8 Diabetes Mellitus (DM) is a disease process that affects much of the United States (U.S.) population. DM occurs when the body has trouble regulating the amount of glucose in the blood stream. As an advanced practice nurse (APN), one must be able to diagnose, treat, and educate patients about DM. The purpose of the paper is to evaluate a case study for a patient with DM and explain the factors that impact the treatment and education strategies for the individual.
Diabetes Mellitus DM is categorized into either diabetes mellitus type I or II. People can have a genetic predisposition to DM type I. In DM type I autoantigens form on the insulin-producing beta cells of the pancreas that circulate in the lymphatics and bloodstream. These autoantigens cause the activation of T-cytotoxic and autoantibodies toward these cells, thereby causing the destruction of the beta cells, which significantly decreases insulin secretion (Jones, Braashers, & Huether, 2012). This type of DM is considered juvenile diabetes. DM type II can also be due to a genetic-environmental interaction. …show more content…
However, most people have risk factors consisting of age, obesity, physical inactivity, hypertension, and family history. Metabolic syndrome is a collection of disorders such as dyslipidemia, prehypertension, elevated fasting blood glucose, and obesity. These factors are a precursor for patients acquiring DM type II. However, genetic predisposition and obesity lead to increased serum level of adipokines, increased level of inflammatory cytokines, free fatty acids, and decreases the activity of amylin, ghrelin, beta cell mass, and function causing insulin resistance. Insulin resistance increases the demand of insulin synthesis, thereby causing hyperglycemia (Jones, Brashers, & Heuther, 2012). Case Study The patient I chose for this discussion is a 45-year-old Caucasian female with uncontrolled DM type II and obesity. She presented in the office on this day for a follow-up three-month visit to discuss laboratory bloodwork, and for a diabetic check-up. S.A. is a non-smoker and denies alcohol use. Height is 66 inches; Weight: 228 pounds; BMI: 36.8; Pulse: 80; Blood Pressure: 110/76 sitting, right arm. Her physical exam displays an appropriately dressed, well-groomed individual. S.A. is alert and oriented x3. Eyes: conjunctivae clear, EOM intact; Respiratory: Lungs clear upon auscultation, no adventitious sounds noted; Cardiovascular: Regular rate and rhythm, normal S1 and S2, negative for murmur or rub; Extremities; negative for edema. Upon her foot exam, she had normal sensation throughout and no ulcers. S.A. reports that her fasting blood sugar levels are between 110-150 in the morning. Before meals, she states that they are between 130-200, and she checks then three times daily. However, her HbA1C is 9.1, which indicates that her DM type II is not well controlled. According to Wood (2013), The HbA1C level for non-pregnant adults should be less than seven percent. Her current medications for DM II are Metformin 500MG tablet PO TID, Lantus 30units subcutaneous BID, Humalog 15units subcutaneous AC, and Victoza 1.2MG subcutaneous daily. She states that she alternates injection sites frequently. Obesity and Physical Inactivity The patient factors I chose are obesity and physical inactivity. According to the American Diabetes Association (2016), being overweight is having a BMI of above 29.9 and increases the risk of DM II, heart disease, and stroke. Weight loss, physical activity, and diet changes increase the chance of normal blood glucose levels in types I and II DM (Joslin Diabetes Center, 2016). Therefore, losing weight is a fundamental component in S.A. being able to control her disease. She has consulted a bariatric surgeon in hopes of one day getting gastric bypass surgery. However, she must first get her HbA1C levels under seven percent. S.A. reports that she eats a well-balanced diet most days, but does eat foods high in fat and carbohydrates occasionally. The APN, patient, and I talked about steps to ensure healthy eating. Utilization of a shopping list will help her in buying only healthy and necessary food products. According to the ADA (2016) products such as lean meats, whole grains, and fresh fruits are essential for building a healthy plate. Also, avoidance of aisles containing high-fat food and snacks is crucial. This patient states that she does not get any physical exercise other than cleaning her