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Diabetes Mellitus: Type 2, The body is resistant to insulin, so due to the…

- - - - Insulin Resistance
    - - George has a history of HyperTN, Diet is poor; soda mentioned, He also is a retired farmer living independently since his wife passed away
    - - George's mother was also diagnosed with Type II diabetes
- - - - As circulation continues to decline, the neurological system becomes affected as reduced oxygen and nutrient delivery to peripheral nerves leads to neuropathy. This results in numbness, tingling, and decreased sensation—especially in the feet.
        
        Poor circulation combined with neuropathy affects the integumentary system by leading to an unrecognized foot injury and impaired wound healing - both of which George is experiencing
        
        The ongoing vascular issues, elevated glucose levels, and systemic strain eventually overwhelm the renal system, leading to impaired kidney function. As the kidneys struggle to filter waste and maintain balance, signs of declining renal function begin to appear.
- - - - Macro-Vasculature Damage (Artery/Venous)
        
        glucose sticks to proteins and lipids, causes endothelial damage, oxidative stress, amd dyslipidemia
        
        atherosclerotic plaque to build up
        
        Coronary Artery Disease
        
        Ischemic Stroke
        
        Peripheral Artery Disease
        
        Micro-Vasculature Damage (Capillaries/Arterioles)
        
        Occasional Dizziness
        
        Lack of blood flow via damaged vessels is what is causing George to feel dizzy since his brain is not receiving enough oxygen and nutrients.
        
        Retinopathy --> Vision Impairment
        
        Since blood vessels are damaged and become fragile, the lessened blood supply can cause this.
        
        2 more items...
        
        Both Micro & Macro Vascular
        
        Neuropathy
        
        Since there is a lack of blood supply due to damaged blood vessels, the nerves are receiving a lesser amount of oxygen and nutrient supply which causes this to occur.
        
        Impaired skin integrity and wound healing
        
        Diabetic Foot Ulcer (4cm x 4cm x 1cm deep) & Pale toes & Cool to touch
        
        1 more item...
        
        Body cannot store blood glucose for energy from insulin resistance
        
        body breaks down fat and muscle for energy
        
        Anorexia & Rapid Weight Loss
        
        Vagus nerve damaged and delays stomach emptying (gastroperesis)
        
        3 more items...
        
        Muscles don't make enough ATP
        
        Weakness and Activity Intolerance
        
        2 more items...
        
        Stress Hormone release of cortisol and adrenaline
        
        1 more item...
        
        Glomerulonephritis
        
        His kidneys are overworked due to his hyperglycemia and it is damaging the micro vessels as his kidneys continue to attempt to compensate.
        
        BUN/Cr = 32/1.3
        
        Urinalysis = glycosuria
      - Hyperinsulinemia that is not effective to lower blood sugar plus systemic inflammation from chronic high blood sugars
        
        Benign Prostate Hypertrophy
        
        Not a direct cause of DM Type II... BUT can increase the risk of this, or in George's case, presumably worsen it
  - - - Body pulls large amounts of water out of his body so blood sugar can be excreted through urine to try and compensate for insulin resistance
        
        Polyuria
        
        Increased risk for falls due to urgency to urinate
        
        frequent urination that eventually disrupts sleep
        
        Nocturia
        
        Increase risk for falls at night
        
        increased urination causes dehydration, triggering the brain to signal extreme thirst to compensate for the lost fluids. Geroge's urine color is dark yellow from dehydration
        
        Polydipsia
        
        George is prescribes medications that make him urinate frequently. He is on Hydrochlorothiazide (thiazide diuretic), Furosemide (loop diuretic), and Tamsulosin (helps trxt BPH)
        
        George's Kidney Function declining from constant filtering of glucose and potential glomerulonephritis from constant high blood sugar
        
        Urinalysis = glycosuria present
        
        BUN/Cr = 32/1.3
  - - - elevated LDL and triglycerides
        
        peripheral pulses +1 and thready
        
        Hypertension from vascular stiffness
  - - - MoCA
        
        Screening tool designed to detect cognitive impairment
        Domains: memory, attention, language, visuospatial skills, executive function, and orientation
        Normal Score = >26
        
        George's Score = 15
        
        Chronic high blood sugar can damage blood vessels in the brain, leading to vascular cognitive impairment and increased risk of dementia
      - Neuropathy, confusion, cognitive decline