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Diabetes Mellitus Type 2 :, Increased insulin production from the pancreas…
Diabetes Mellitus Type 2
:
Pathophysiology
Amelia Seiz, Abbie Salzstein, Amber Hueste, Julia Spalding, Ivy LePage, & Carly Fisher
Increased insulin production from the pancreas to allow increased glucose from diet into cells
Increased blood glucose due to cells being unable to take in as much glucose as is being consumed
Increased release of fatty acids
Increase of catecholamines and cortisol
Increased glucose production due to body being in a state of stress
Further increased blood glucose levels
Increased concentrations of glucose due to Type II diabetes and increased sodium due to elevated functioning of RAAS draws water out of organs into bloodstream
Hyperosmolarity/Solute Diuresis
Dehydration and increased serum osmolarity causes stimulation of thirst center in brain
Polydipsia
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mild cognitive impairment
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dehydration with increase thirst causing Na to be 136
skin turgor reduced
Hyperglycemia may cause changes in vascular function/structure which can lead to hypertension.
Hypertension
Decreased Cardiac Output because heart has to work harder to pump blood
Increased RAAS in order to compensate for decreased cardiac output
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BP= 165/95, HR= 92, +2 BUE pulses, +1 BLE pulses
Increased glucose causes endothelial damage along blood vessel walls
Plaques (fat, cholesterol, and other substances) develop on top of this endothelial damage
Blood vessels harden and become narrow
Increased difficulty of blood flow through the blood vessels due to narrowing makes it difficult for blood to travel to extremities
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Increased blood glucose blocks small blood vessels of the eyes
Abnormal blood vessels grow out of the retina to provide blood flow to the eye despite the blocked blood vessels
Abnormal vessels blocks fluid from being able to drain from the eye
Open Angle Glaucoma
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Development of reactive oxygen species (ROS)
Encourages production of inflammatory cytokines
Effects the joints and can lead to
Osteoarthritis
Celecoxib 200mg PO BID: produces anti-inflammatory effects.
Aspercreme with Lidocaine Max: treats knee pain from osteoarthritis.
Occasional joint pain in R knee, L knee replacement in 2009 and denies pain.
Fat builds up in the liver causing increased LDL, decreased HDL, and increased plaques
Atorvastatin 40mg po daily
Excess blood glucose and elevated blood pressure damages and narrows arteries leading into the kidneys and can damage the nephrons themselves over time
Further exacerbates hypertension as blood must filter through narrowed arteries and damaged nephrons
Diabetic Nephropathy
Elevated BUN (29 mg/dL) because wastes are not successfully being filtered out of the blood by the damaged kidneys
Cr not yet outside of normal limits, but it is reaching the upper limit (1.3 mg/dL) due to damaged kidneys being unable to excrete waste products from the blood
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Decreased production of erythropoietin
decreased RBC production (3.9 cells/mcL)
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Scarring of the glomerulus causing impaired filtering of the blood
loss of protein
loss of protein in urine (microalbuminuria)
Endothelial cell dysfunction due to body's state of stress with associated build up of glucose in the blood and platelet aggregation
Endothelial Damage
Atherosclerosis
Peripheral Artery Disease - blood vessels narrow due to damage
Coronary Artery Disease - plaques build up along artery walls from LDL deposits
symptoms of heart burn, light headness, SOB
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Hyperglycemia (148 mg/dL)
Longterm elevation of glucose as evidenced by elevated HgA1C which measures the average blood glucose over a 3 month period (8.0)
Metformin 500mg PO BID: given to lower blood glucose level.
Decrease in insulin sensitivity of cells in muscle, fat and the liver
History of poor diet --> high consumption of sugary drinks and does not like cooking for himself
Genetic factors --> Family history of DM Type 2
Potential risk for malnutrition as evidenced by low albumin (2.4 g/dL)
MVI, q day: Supplements
vitamins to replenish what he is missing due to his poor nutrition.
Barley Green 1 TBSP once every morning and CoQ10 capsule once every day to further supplement health
Patient states that he has occasional stomach upset.
Patient states "I get full so easy and my food takes forever to move..."
Heartburn
Gastroparesis
Bowel sounds present in all 4 quadrants
rapid weight loss
skin thin and loose with inelasticity
Patient has dyslipidemia which may be result of poor diet and/or family history of DLD.