Mr. F. was diagnosed with Type 2 diabetes mellitus at age 46. At time, he was ov

Question

Mr. F. was diagnosed with Type 2 diabetes mellitus at age 46. At time, he was overweight, enjoyed foods with high carbohydrate and fat content, and led a sedentary life. His family history indicated that his mother and his brother had diabetes. Weight loss, appropriate diet, and exercise were recommended to reduce blood glucose levels.

1.List the factors contributing to diabetes mellitus in this case. At age 50, Mr. F. noticed that his vision was cloudy, particularly in one eye. Cataracts were removed from both eyes. 2.Describe a cataract and explain how diabetes promotes cataract formation.

3.Glyburide (Diabeta) was prescribed at this time. Describe the action of this drug. At age 56, a blister developed on the heel of one foot, which did not heal. An ulcer formed and persisted. Finally the foot was placed in a cast for 13 weeks to promote healing.

4.Explain several factors contributing to the delayed healing in Mr. F.

5.Why was it necessary in this case, to remove the cast and replace it each week? Peripheral nephropathy with total loss of sensory function had developed in both feet. Motor function was not directly affected Orthopedic shoes were ordered and arrangements made for a podiatrist to provide regular foot care.

6. Why is it essential that Mr. F examine his feet carefully each day? At this time body weight had again increased substantially and blood pressure was elevated .Fosinopril (Monopril) was pescribed, along with recommendation for weight loss and regular exercise.

7. Describe the usual manifestations of hypertension. At age 60,routine monitoring during a workout at the health club indicated atrial fibrillation.During consultation, the cardiologist also noted his blood pressure was very high.

8. state the purpose of the following medications prescribed at this time- Fosinopril ,Atorvastatin, Amlodipine, warfarin,and sotalol. Since that time,conti ued regular exercise and dietary modification have maintained weight at recommended levels.Blood pressure is within normal range,HbA is below 7 and atrial fibrillation is controlled

. 9.What does this HbA value mean?

10.Why does Mr F bruise easily? What precaution would be advisable at this time?

11. Briefly review the effects of diabetes over time in this case

Explanation / Answer

1.Non modifiable risk factors contributing to diabetes mellitus in Mr. F’s case include his family history with his mother and brother both having diabetes as well as his age. Modifiable risk factors include Mr. F’s weight, his diet consisting of high carbohydrates and fats, and sedentary lifestyle.

2.0), cataracts are formed as a result of changes in the way the cells of the lens are arranged and their water content, which results in a cloudy lens instead of clear a clear lens. When this happens, light cannot pass directly through lens.

Cataract is a degenerative process related to the abnormal metabolism of glucose or diabetes. It results in the accumulation of sorbitol and water in the lens .destroying the transparency. Diabetes means more glucose which is risk factor for cataract.

3.), Glyburide works to decrease blood sugar by the same mechanism as the other sulfonylurea hypoglycemic agents. This includes both stimulation of insulin secretion and amplified tissue receptiveness to insulin. The predominant extrapancreatic effect appears to be a decrease in hepatic glucose production, although effects on insulin receptors have also been reported. Glyburide lowers blood glucose levels initially by stimulating the release of insulin from the pancreas. This effect is dependent upon functioning beta-cells. Increased responsiveness of Beta-cells to glucose has been demonstrated in patients receiving Glyburide for 6 to 8 weeks. However, the mechanism by which sulfonylurea agents produce prolonged beneficial effects on glucose tolerance are not explained by pancreatic mechanisms alone.

4. Factors such as age, malnutrition, obesity, and macrovascular and microvascular disease are likely factors that contribute to wound infection and delayed wound healing especially in the type II diabetic patient. Additionally, hyperglycemia caused by a lack of insulin availability and increased resistance to insulin can alter the cellular response to tissue injury.

6.An individual with diabetes can develop different types of foot problems, but all of these can lead to serious complications if left untreated. Diabetes can do damage the nerves in the feet, causing a diabetic individual to lose their ability to feel pain or discomfort, also referred to as diabetic neuropathy.Diabetes can also cause circulation problems, which can prevent an individual with diabetes from healing as quickly as people without diabetes do. At this time body weight had again increased substantially and blood pressure was elevated.

11. The most common long-term effects of diabetes include damage to the large blood vessels of the heart, brain and legs, which are known as macrovascular complications. In addition damage to the small blood vessels is alsoseen, causing problems in the eyes, kidneys, feet and nerves, which are known as microvascular complications.

8..Fosinopril is an ACE inhibitor used to treat high blood pressure by blocking formation of angiotensin II and aldosterone (VanMeter & Hubert, 2014). Atorvastatin (Lipitor) is a statin utilized to lower cholesterol in the blood (VanMeter & Hubert, 2014). Amlodipine (Norvasc) is a calcium channel blocker which results in vasodilation (VanMeter & Hubert, 2014). Warfarin (Coumadin) is an anticoagulant which interferes with vitamin K in synthesis of clotting and would be utilized for treatment of a-fib (VanMeter & Hubert, 2014). Sotalol (Sotacor) is a beta blocker and is utilized for treatment of irregular heart beat and slows the heart rate (VanMeter & Hubert, 2014.

7.Most individuals with hypertension do not have signs or symptoms, even if blood pressure readings reach dangerously high levels. A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren't specific and usually don't occur until high blood pressure has reached a severe or life-threatening stage.

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