Running head: CASE STUDY 4 DIABETES MELLITUS
Case Study 4 Diabetes Mellitus
Brandy Schnacker
Washburn University
Advanced Pathophysiology
NU 506
Sue T. Unruh, MSN, RN & Karen Fernengel, RN, PhD, ARNP-BC
November 22, 2010
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CASE STUDY 4 DIABETES MELLITUS
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Case Study 4 Diabetes Mellitus
1.
What condition is Juan likely presenting with? Outline the wide spectrum of
physiologic abnormalities that occur with this disorder.
He is presenting with Type 2 Diabetes Mellitus (DM) Insulin Resistance. The
most common abnormalities of Type 2 DM are the three polys: 1. Polyuria which
is excessive urination, 2. Polydipsia which is excessive thirst and 3. Polyphagia
which is excessive hunger (Porth & Matfin, 2009)(Page 1060). These are the
three main signs of DM. Some of the other signs or abnormalities can be blurred
vision, fatigue, paresthesias, skin infections and obesity. Some of the skin
infections can be caused by yeast organisms. Pruritus and vulvovaginitis in
women and balanitis in men. These are caused by a candida infection (Porth &
Matfin, 2009)(Page 1060).
2.
What is the significance of Juan’s waist diameter? Discuss how truncal obesity is
hypothesized to increase insulin resistance in the body.
Juan’s waist diameter is significant because this is where abdominal fat is stored
in excess. It has been found that people with upper or central obesity are at a
higher risk for insulin resistance diabetes (Porth & Matfin, 2009)(Page 1058).
The fat that is found around the abdomen can have hormonal effects that can be a
precipitating cause of insulin resistance (Insulin resistance). Also with obesity
and insulin resistance can be theorized by the increased concentration of free fatty
acids (FFAs). There are several consequences from the FFAs within the body.
First is the excessive and chronic elevation of FFAs can lead to beta cell
dysfunction, then the FFAs act that the level of peripheral tissues to cause the
insulin resistance and glucose underutilization by inhibiting glucose uptake and
glycogen storage and the last is the accumulation of FFAs and triglycerides
reduces hepatic insulin sensitivity, leading to incrased hepatic glocose production
and hyperglycemia, especially in the fasting state (Porth & Matfin, 2009)(Page
1058). Also a decrease in adiponectin coincide with insulin resistance in obesity
and DM type 2(Porth & Matfin, 2009)(Page 1058).
3.
In type 1 diabetes, there is hypoinsulinemia and hyperglycemia. In type 2 diabetes, it
is common to see hyperinsulinemia and hyperglycemia. Explain why this is so.
People who are obese have the increased resistance to the action of insulin and
impaired suppression of glucose producation by the liver resulting in both
hyperglycemia and hyperinsulinemia (Porth & Matfin, 2009)(Page 1058). Obesity
plays a big role in treating DM type 2 in the human race these days. Fat plays an
important role on how people will react to treatments.
CASE STUDY 4 DIABETES MELLITUS
REFERENCES
Insulin resistance. (n.d.). Retrieved November 22, 2010, from
http://encyclopedia.thefreedictionary.com/insulin+resistance
Porth, C. M., & Matfin, G. (2009). Pathophysiology Concepts of Altered Health States. China:
Lippincot Williams & Wilkins.
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