[Solved] J.T., a 48-year-old Diabetic Case Study

Diabetes Case Study

Pathophysiology & Clinical Findings of the Disease

Based on the review of the history, physical, and lab findings, what is this patient’s most likely diabetes diagnosis?

Based on the patient’s medical history and findings from clinical assessment, he is likely to have developed type 1 diabetes. The patient reports that he began experiencing symptoms such as fatigue, weight loss, and increased appetite three weeks ago. Although both type 1 and 2 diabetes have similar symptoms, they differ in onset and rate of progression (Jende et al., 2018, p. 588). For type 1 diabetes, symptoms may worsen over a couple of days or weeks, while type 2 diabetes may take years to show severe symptoms (DiMeglio et al., 2018, p. 2449). Therefore, since the patient’s symptoms progressed within three weeks, he is likely to have developed type 1 diabetes.

Explain the pathophysiology associated with the chosen diabetes diagnosis.

Type 1 diabetes mainly results from irregularities in the immune system that result in a decline in insulin concentration. When the immune system attacks and destroys the insulin-producing beta cells of the pancreas, the level of insulin concentration gradually declines (Gómez-Díaz, 2019, p. 89). Consequently, the body loses its capacity to convert blood sugar into energy, resulting in a high blood glucose concentration. Excessive blood sugar concentration brings about symptoms such as excessive thirst, increased urine output, fatigue, weight loss, and increased appetite (Paschou et al., 2018, p. 38). In severe cases, patients may experience recurrent headaches, leg cramps, and dizziness.

Identify at least three subjective findings from the case which support the chosen diagnosis.

Three subjective findings from the case indicate the presence of type 1 diabetes, including symptoms presented by the patient, his underlying health conditions, and his genetic predisposition to the disease. The patient reports that he has been experiencing symptoms such as fatigue, weight loss, extreme thirst, and increased appetite for the last three weeks. Such symptoms indicate the presence of diabetes. Additionally, the patient reports that he had previously been diagnosed with hypertension, obesity, and hyperlipidemia. Such health conditions often progress to attract diabetes and cardiovascular diseases. For example, hypertension constitutes one of the leading risk factors for diabetes (Lonardo et al., 2018, p. 335). The patient also confirms that his brother lives with diabetes. Therefore, he might be genetically predisposed to the disease.

Identify at least three objective findings from the case which support the chosen diagnosis.

Three objective findings from the case that indicate the presence of type 1 diabetes include results from physical examination, urinalysis, and fasting blood sugar test. Findings from physical assessment indicated that the patient has high blood pressure reaching up to 136/80, accompanied by a high pulse frequency. While high blood pressure constitutes a risk factor for type 1 diabetes, the patient ought to be diagnosed with the condition (Yamazaki et al., 2018, p. 147). The patient underwent a urinalysis, which indicated that he passed urine more frequently. A fasting blood sugar test indicated his blood sugar concentration was high, indicating diabetes.

Management of the Disease

The required Clinical Practice Guideline (CPG) is utilised to support the chosen treatment recommendations.

Treatment recommendations for type 1 diabetes could include the intake of insulin, regular physical exercise, and dietary control. The treatment goal for the condition is to keep the patient’s blood sugar levels as close to normal as possible to prevent progression and alleviate symptoms (American Diabetes Association, 2022). Taking insulin could help restore the body’s capacity to regulate blood sugar concentration, alleviating symptoms and reducing the risk of progression in the long run. Regular physical exercise and dietary control could help the patient reduce excess weight and minimize the risk of progression.

Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.

The condition could be treated by administering an alpha-glucosidase inhibitor, a biguanide, or a bile acid sequestrant. An alpha-glucosidase inhibitor, such as miglitol (Glyset), could help to lower the patient’s blood sugar levels by inhibiting the breakdown of starches in the intestines (Komatsu et al., 2018, p. 1092). A biguanide, such as metformin (Glucophage), could help alleviate disease symptoms by making muscle tissue more sensitive to insulin to facilitate greater glucose absorption from the blood (Li et al., 2018, p. 1039). Administering such medications could help to alleviate symptoms of type 1 diabetes and reduce the risk of disease progression.

Describe the mechanism of action for each of the medication classes identified above.

Miglitol (Glyset) works by slowing down the breakdown and absorption of carbohydrates in the intestines. As a result, the medication reduces the absorption of glucose into the blood to gradually reduce its concentration (Bazdar et al., 2021, p. 114339). Metformin (Glucophage) reduces the amount of blood sugar absorbed in the body by increasing the body’s sensitivity to insulin and inhibiting glucose production in the liver. The medication ensures that blood glucose concentration remains at a normal range to minimize the risk of progression.

Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.

Non-pharmacological treatments for type 1 diabetes include nutrition interventions and lifestyle changes. The patient could minimize the intake of fast foods and take more carbohydrates, vegetables, and fruits to reduce the risk of progression and alleviate symptoms (Korsmo‐Haugen et al., 2019, p. 15). He should also implement lifestyle changes such as engaging in regular physical exercise and avoiding a sedentary lifestyle to reduce obesity and minimize the risk of disease progression.

References

American Diabetes Association. (2022). Introduction: Standards of Medical Care in Diabetes—2022. https://doi.org/10.2337/dc22-Sint

Bazdar, P., Jalalvand, A. R., Akbari, V., Khodarahmi, R., & Goicoechea, H. C. (2021). Resolving interactions of miglitol with normal and glycated human serum albumin by multivariate methods. Analytical biochemistry, 630, 114339. https://doi.org/10.1016/j.ab.2021.114339

DiMeglio, L. A., Evans-Molina, C., & Oram, R. A. (2018). Type 1 diabetes. The Lancet, 391(10138), 2449-2462. https://doi.org/10.1016/S0140-6736(18)31320-5

Gómez-Díaz, R. A. (2019). Pathophysiology of Type 1 Diabetes. The Diabetes Textbook, 89-99. https://doi.org/10.1007/978-3-030-11815-0_7

Jende, J.M., Groener, J.B., Oikonomou, D., Heiland, S., Kopf, S., Pham, M., Nawroth, P., Bendszus, M. and Kurz, F.T. (2018). Diabetic neuropathy differs between type 1 and types 2 diabetes: insights from magnetic resonance neurography. Annals of neurology, 83(3), 588-598. https://doi.org/10.1002/ana.25182

Komatsu, M., Tanaka, N., Kimura, T., Fujimori, N., Sano, K., Horiuchi, A., Sugiura, A., Yamazaki, T., Shibata, S., Joshita, S. and Umemura, T. (2018). Miglitol attenuates non‐alcoholic steatohepatitis in diabetic patients. Hepatology Research, 48(13), 1092-1098. https://doi.org/10.1111/hepr.13223

Korsmo‐Haugen, H. K., Brurberg, K. G., Mann, J., & Aas, A. M. (2019). Carbohydrate quantity in the dietary management of type 2 diabetes: A systematic review and meta‐analysis. Diabetes, Obesity and Metabolism, 21(1), 15-27. https://doi.org/10.1111/dom.13499

Li, M., Li, X., Zhang, H., & Lu, Y. (2018). Molecular mechanisms of metformin for diabetes and cancer treatment. Frontiers in physiology, 9, 1039. https://doi.org/10.3389/fphys.2018.01039

Lonardo, A., Nascimbeni, F., Mantovani, A., & Targher, G. (2018). Hypertension, diabetes, atherosclerosis and NASH: cause or consequence?. Journal of hepatology, 68(2), 335-352. https://doi.org/10.1016/j.jhep.2017.09.021

Paschou, S. A., Papadopoulou-Marketou, N., Chrousos, G. P., & Kanaka-Gantenbein, C. (2018). On type 1 diabetes mellitus pathogenesis. Endocrine Connections, 7(1), 38-46. https://doi.org/10.1530/EC-17-0347

Yamazaki, D., Hitomi, H., & Nishiyama, A. (2018). Hypertension with diabetes mellitus complications. Hypertension Research, 41(3), 147-156. https://doi.org/10.1038/s41440-017-0008-y