Question

Case study:

Mr. F. was diagnosed with type 2 diabetes mellitus at age 46. At that time, he was overweight, enjoyed foods with high carbohydrate and fat content, and led a sedentary life. His family history indicated that his mother and his brother had diabetes. Weight loss, appropriate diet, and exercise were recommended to reduce blood glucose levels.

1. List the factors contributing to diabetes mellitus in this case.

At age 50, Mr. F. noticed that his vision was cloudy, particularly in one eye. Cataracts were removed from both eyes.

2. Describe a cataract, and explain how diabetes promotes cataract formation.

3. Glyburide (DiaBeta) was prescribed at this time. Describe the action of this drug.

At age 56, a blister developed on the heel of one foot, which did not heal. An ulcer formed and persisted. Finally the foot was placed in a cast for 13 weeks to promote healing.

4. Explain several factors contributing to the delayed healing in Mr. F.

5. Why was it necessary in this case to remove the cast and replace it each week?

Peripheral neuropathy with total loss of sensory function had developed in both feet. Motor function was not directly affected. Orthopedic shoes were ordered and arrangements made for a podiatrist to provide regular foot care.

6. Why is it essential that Mr. F. examine his feet carefully each day?

At this time body weight had again increased substantially and blood pressure was elevated. Fosinopril (Monopril) was prescribed, along with recommendations for weight loss and regular exercise.

7. Describe the usual manifestations of hypertension.

At age 60, routine monitoring during a workout at the health club indicated atrial fibrillation. During consultation, the cardiologist also noted his blood pressure was very high.

8. State the purpose of the following medications prescribed at this time (see Chapter 18): fosinopril (Monopril), atorvastatin (Lipitor), amlodipine (Norvasc), warfarin (Coumadin), and sotalol (Sotacor).

Since that time, continued regular exercise and dietary modification have maintained weight at recommended levels. Blood pressure is within normal range, HbA1c is below 7, and atrial fibrillation is controlled.

9. What does this HbA1c value mean?

10. Why does Mr. F. bruise easily? What precautions would be advisable at this time?

11. Briefly review the effects of diabetes over time in this case

Answer 1

1 Contributing factors in this patient

• Family history of diabetes
• Sedentary lifestyle
• Overweight
• Increased consumption of refined carbohydrates
• Increased consumption of lipids

2 Cataract is any opacity in the lens of the eye or it's capsule.

Diabetes - > hyperglycemic state - > activation of polyol pathway - > Glucose converted to Sorbitol by Aldose reductase in lens - > accumulation of sorbitol in lens - > hyperosmotic effect - > imbibition of water into lens - > CATARACT

3 GLYBURIDE

Also Known as Glibenclamide. It is a Sulfonylurea group of drug. Action : provokes brisk release of insulin from pancreas, the rate of insulin secretion at any glucose concentration is increased. On long term usage,they also sensitive target tissues to the action Of insulin(especially liver).

Mechanism : Blocks the Sufonyl urea receptor (SUR1) which is a component of ATP - sensitive potassium channels in the membrane of pancreatic beta cells >> depolarization >> opening of calcium channels >>exocytotic release of insulin (through granules)

4 Delayed wound healing in Diabetes mellitus

• Hyperglycemic state >> increased activity of aldose reductase and sorbitol dehydrogenase >> increased sorbitol and fructose respectively >> decreased myoinositol >> Neuropathy >> decreased growth factor production and chemotaxis >> delayed wound healing
• Sorbitol dehydrogenase uses up NADPH >> decreased glutathione >> increased reactive oxygen species (ROS) >> affects inflammation and angiogenesis >>delayed wound healing
• Hyperglycemic state >> formation of Advanced Glycation End Products (AGEs) >> generation of ROS >>delayed wound healing

Answer 2

what are the factors what controbute for nothealing.

Answer 3

Explain several factors contributing to the delayed healing in Mr. F.