Case Study: Type 2 Diabetes Mellitus Assignment Instructions
The pancreas is an amazing organ with many responsibilities. So, when the pancreas does not work properly, many body processes are impacted. T2DM is historically characterized by either insufficient insulin production or insulin resistance. Thankfully, with the right care, we can help eliminate the presence of insulin resistance. Nutrition methods to reduce insulin resistance have varied over the years. We will explore past recommendations as well as current ones in this week.
You will find the case study in Medical Nutrition Therapy: A Case Study Approach 6th ed.- Case study 15 in text – Type 2 Diabetes Mellitus.
Answer the questions below.
- What is currently understood regarding the etiology of type 1 diabetes mellitus (T1DM)?
- Describe the multifactorial etiologies for type 2 diabetes mellitus. What do you see in Ms. Herrera’s history that increases her risk for diabetes?
- Explain the basic pathophysiology of type 2 diabetes mellitus. What is the primary difference between T1DM and T2DM?
- Using the American Diabetes Association treatment guidelines, how should T2DM be diagnosed? Is there adequate information in Ms. Herrera’s record to make this diagnosis?
- Ms. Herrera’s physician’s note addressed cardiac function and renal function. Why are these organ systems a component of the evaluation for someone with diabetes? Using the laboratory results from her record, please describe her cardiac and renal disease risk. Using the American Diabetes Association treatment guidelines, what other evaluations are recommended for an individual with newly diagnosed DM?
- Ms. Herrera’s mother has T2DM. She is currently having problems with vision and burning in her feet. What is she most likely experiencing? Describe the pathophysiology of these complications. You can tell that Ms. Herrera is worried not only about her mother but also her own health. Explain, using the results of the Diabetes Control and Complications Trial (DCCT) as well as any other pertinent research trials and data, how she can prevent these complications.
- Ms. Herrera was prescribed metformin for her T2DM. What is the mechanism for this medication? What are the potential side effects? The ADA treatment guidelines indicate that the next line of medication would be the SGL2. What is the mechanism for this medication? Ms. Herrera tells you that her mother is on glipizide. How does this medication differ from metformin?
- How does physical activity affect blood glucose levels? Describe the physiological process that occurs when physical activity impacts blood glucose.
- Outline the basic principles for Ms. Herrera’s nutrition therapy to assist in control of her DM. How will you combine the nutrition therapy for both hyperlipidemia and her diabetes without overwhelming her?
- Assess Ms. Herrera’s height and weight. Calculate her BMI.
- Identify any abnormal laboratory values measured upon her admission. (You may assume a normal c-peptide). Explain how they may be related to her newly diagnosed DM.
- Determine Ms. Herrera’s energy and protein requirements. Be sure to explain what standards you used to make this estimation. Would you recommend that she lose weight?
- Determine Ms. Herrera’s initial medical nutrition therapy prescription using her usual intake as a guideline, as well as your assessment of her energy requirements that you determined in question 10. What nutrition education material would you use to teach Ms. Herrera about her nutrition therapy interventions?
- Using the ADA guidelines, what are the recommendations for Ms. Herrera’s self–blood glucose monitoring? What would be appropriate fasting and postprandial target glucose levels for Ms. Herrera?
- Ms. Herrera comes back to the clinic one month after her diagnosis. List the key questions you will ask her in order to plan the next steps for providing any additional education that she needs.
- What is a Bible verse you could share with and individual making dietary changes that would be an encouragement to his/her? Explain how this verse is appropriate for the situation.
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HLTH 643 WU Case Study Response Type II Diabetes Questions
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Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance or insufficient insulin production. As a medical professor, I have designed a case study assignment for college students to assess their understanding of the etiology, pathophysiology, diagnosis, treatment, and management of T2DM. In this answer key, I will provide the answers to the assigned questions without revealing my identity.
Currently, the etiology of type 1 diabetes mellitus (T1DM) is understood to involve an autoimmune destruction of the pancreatic beta cells, leading to an absolute deficiency of insulin production. Genetic predisposition and environmental triggers, such as viral infections, are believed to play a role in the development of T1DM.
Type 2 diabetes mellitus has multifactorial etiologies, including genetic factors, lifestyle choices (such as sedentary behavior and poor diet), obesity, and insulin resistance. Ms. Herrera’s history shows risk factors for T2DM, including a family history of T2DM (her mother), obesity (BMI above normal range), and sedentary lifestyle.
The basic pathophysiology of type 2 diabetes mellitus involves a combination of insulin resistance and impaired insulin secretion. Insulin resistance occurs when the body’s cells become less responsive to the action of insulin. In contrast, T1DM is characterized by an autoimmune destruction of pancreatic beta cells, resulting in a lack of insulin production.
According to the American Diabetes Association (ADA) treatment guidelines, T2DM should be diagnosed based on fasting plasma glucose level, oral glucose tolerance test, or hemoglobin A1c level. The case study does not provide adequate information from Ms. Herrera’s record to make a definitive diagnosis of T2DM based on these criteria.
Cardiac and renal evaluations are essential components of the evaluation for someone with diabetes due to the increased risk of cardiovascular disease and kidney complications associated with diabetes. Based on the provided laboratory results, Ms. Herrera’s cardiac and renal disease risk cannot be determined. Additional evaluations recommended for an individual with newly diagnosed DM include lipid profile, liver function test, and microalbuminuria screening.
Ms. Herrera’s vision problems and burning in her feet are likely symptoms of diabetic retinopathy and diabetic neuropathy, respectively. These complications arise due to long-term uncontrolled blood glucose levels damaging the blood vessels and nerves. To prevent these complications, Ms. Herrera should maintain strict blood glucose control, as shown in the Diabetes Control and Complications Trial (DCCT) and other research trials.
Metformin, prescribed for T2DM, works by reducing the liver’s glucose production, decreasing intestinal glucose absorption, and increasing insulin sensitivity. Potential side effects of metformin include gastrointestinal disturbances such as diarrhea and nausea. Sodium-glucose co-transporter-2 inhibitors (SGL2) work by inhibiting glucose reabsorption in the kidneys, leading to increased urinary glucose excretion. Glipizide, another medication, stimulates insulin release from pancreatic beta cells, unlike metformin.
Physical activity can help lower blood glucose levels by increasing glucose uptake by muscles, enhancing insulin sensitivity, and stimulating glucose transporters to move glucose into cells. During physical activity, the body’s energy demand increases, leading to increased glucose utilization.
Basic principles for Ms. Herrera’s nutrition therapy to control her DM include consuming a well-balanced diet with careful carbohydrate counting, portion control, and monitoring of total calorie and saturated fat intake. Integration of nutrition therapy for hyperlipidemia and diabetes can be achieved by focusing on heart-healthy foods, such as fruits, vegetables, whole grains, lean proteins, and healthy fats.
The case study does not provide information about Ms. Herrera’s height and weight, so her BMI cannot be calculated.
Abnormal laboratory values related to Ms. Herrera’s newly diagnosed DM may include elevated fasting plasma glucose, impaired glucose tolerance on oral glucose tolerance test, or elevated hemoglobin A1c indicating long-term elevated blood glucose levels.
Ms. Herrera’s energy and protein requirements can be determined by assessing her body weight, activity level, and metabolic needs. However, since the case study does not provide her weight or activity level, her energy and protein requirements cannot be calculated. Weight loss recommendations would depend on her individual weight and health status.
Without knowing Ms. Herrera’s usual intake and other specific information, it is not possible to determine her initial medical nutrition therapy prescription accurately. Nutrition education materials on carbohydrate counting, portion control, healthy food choices, and meal planning for diabetes management would be useful.
According to ADA guidelines, self-blood glucose monitoring for Ms. Herrera should include regular monitoring of pre- and post-meal glucose levels. Appropriate fasting glucose target levels for Ms. Herrera would be 80-130 mg/dL, while postprandial (2 hours after a meal) target levels would be