PATHOPHYSIOLOGY CASE STUDY

Name: Larry Ball
PATHO 271
5/7/2017

DISORDER/DISEASE: Type 2 Diabetes Mellitus (T2DM)

ETIOLOGY/CAUSE: Both genetic and environmental factors play a large role in the onset of Diabetes Mellitus. Obesity is a high-risk factor and accompanies diabetes in almost 90% of diabetes mellitus diagnoses. BMI (body mass index) is a system that measures obesity and higher BMI increases risk of diabetes based on distance from ideal BMI. Genetic factors also play a role as different ethnic groups are at different risk levels for developing diabetes mellitus. Whether driven by environmental or genetic factors, type 2 diabetes is characterized by cells no longer responding to insulin properly, and the pancreas is unable to produce enough insulin to compensate for the resistance. The exact reason why cells become resistant to insulin is unknown.

SIGNS/SYMPTOMS: Albert presented several symptoms including: being overweight, carb/fat intake, no physical activity, cloudy vision, non-healing wound, loss of sensation in foot, and increased blood pressure. Symptoms of type 2 diabetes mellitus may not present until the disorder is advanced, unlike type 1 diabetes where symptoms present almost immediately. Type 2 diabetes mellitus symptoms also include: increased thirst, frequent urination, extreme hunger, unexplained weight loss, presence of ketones in urine, fatigue, irritability, blurred vision, slow healing sores, and frequent infections. These symptoms may present for other disorders as well and diagnoses must be made by a doctor.

ORGAN(S)/ORGAN SYSTEM(S) INVOLVED: The endocrine system and lymphatic systems are mainly responsible for the symptoms of type 2 diabetes. However, they can cause adverse effects in the integumentary system, circulatory system, respiratory system, and sensory systems.

PATHOPHYSIOLOGY/PATHOGENESIS: (DESCRIPTION OF EFFECTS ON CELLS-TISSUES-ORGANS) In type 2 diabetes, the body either produces inadequate amounts of insulin to meet the demands of the body or insulin resistance has developed. Insulin resistance refers to when cells of the body such as the muscle, liver and fat cells fail to respond to insulin, even when levels are high. In fat cells, triglycerides are instead broken down to produce free fatty acids for energy; muscle cells are deprived of an energy source and liver cells fail to build up glycogen stores. This also leads to an overall rise in the level of glucose in the blood. Glycogen stores become markedly reduced and there is less glucose available for release when it may be needed. Obesity and lack of physical activity are thought to be major causes of insulin resistance.

DIAGNOSTIC TESTS: Blood tests are used to test for type 2 diabetes mellitus. These blood tests include: Oral glucose tolerance test (test to see how the body responds to sugar intake), Fasting blood sugar test (test taken after overnight period without eating to see how body utilizes internal sugar stores), Post-Prandial test (test take approx. 2 hours after a meal), Random blood sugar test (test taken at random regardless of last mealtime), A1C test (tests how much sugar is trapped inside of red blood cells). Any combination of these tests may be used when diagnosing type 2 diabetes, and during the lifetime of treatment.

TREATMENT: Treament for type 2 diabetes mellitus begins with constant upkeep and monitoring of blood sugar. Tests must be take regularly to maintain healthy A1C levels and be sure that other problems are not arising. Insulin is used to treat blood sugar irregularities and is commonly used, although type 1 diabetes is more likely to need insulin therapy. Sometimes other oral or injected medications are prescribed as well. Some diabetes medications stimulate your pancreas to produce and release more insulin. Others inhibit the production and release of glucose from your liver, which means you need less insulin to transport sugar into your cells. Still others block the action of stomach or intestinal enzymes that break down carbohydrates or make your tissues more sensitive to insulin. Metformin (Glucophage, Glumetza, others) is generally the first medication prescribed for type 2 diabetes. Transplantation of organs that are not functioning properly has also shown signs of improvement with type 2 diabetes patients. Bariatric surgeries have also shown positive effect on lessening symptoms and reducing internal stress factors related to diabetes, although it is NOT used as a treatment specifically for diabetes.
PROGNOSIS: According to the Centers for Disease Control and Prevention, diabetes