Introduction
Diabetes mellitus type II is a chronic metabolic syndrome that affects the body’s sugar metabolism by resisting the stimulation and production of insulin. Symptoms presented by most patients include blurred vision, frequent urge to urinate, excess feeling of thirst and constant hunger. This paper will provide a rationale for the top four differential diagnoses for a type II clinical condition, and identify the priority diagnostic pathophysiology and clinical tests. In addition, therapeutic interventions, care referrals and professional collaborations will be discussed. Finally, a recent journal article will be reviewed, and a follow up plan for future wellness will be provided.
Differential Diagnosis
Over the last few decades, medical associations have invented diagnosis methods that guide professionals in determining glucose levels in the body. Even so, decisions on methods to be adapted are made on an individual basis. The most used approaches are based on laboratory results from blood and urine samples. The following include the top four differential diagnosis for non-insulin diabetes.
Dyslipidemia
Hyperlipidemia is a common condition responsible for causing cardiovascular complications in diabetic patients. It is mostly associated with high concentrations of lipids in plasma, a characteristic condition of increased fatty acids caused by insulin resistance. Even though the genesis of diabetic dyslipidemia remains unknown, more evidence suggests that insulin resistance, a characteristic physiology in non-insulin dependent diabetes plays an important role (Mooradian, 2009).
Hypertension
High blood pressure is a common comorbid condition in patients suffering from diabetes. Studies by the American Diabetes Association reveal high metabolic predominance of the condition in insulin resistance, dyslipidemia and obesity. Hypertension increases risks for both macro and micro vascular problems (American Diabetes Association, 2003).
Urine Tests
Albuminuria gives an appropriate measure the presence of albumin or protein in the urine, especially in people with high blood sugar. In people with type 2 diabetes, kidneys excrete albumin, and thus, the test mark the presence of diabetes nephropathy (IHS Division of Diabetes Treatment and Prevention 2009).
Blood Tests
As indicated in the introduction, the main characteristic of diabetes mellitus type 2 is high glucose levels. Based on this, the primary criteria for diagnosis would be laboratory tests to measure and determine amounts of glucose levels circulating in blood plasma. The American Diabetes Association (2010) proposes diagnosis criteria for diabetes mellitus type II based on the following tests:
- Random Glucose Test: Blood is drawn randomly regardless of when the patient lastly had a meal. Results revealing 200mg/dl level or higher indicate high levels.
- Fasting Plasma Glucose (FPG): Blood is drawn after 8-12 hour fasting period. Results revealing 126 mg/dl level or higher indicate elevated levels.
- Hemoglobin AIC test: The test, done anytime of the day, either before or after meals measures average blood sugar levels over the duration of 2 to 3 months. Normal values should be 4 – 5.6 percent. Results revealing 6.5 percent or higher indicate high blood sugar.
- Oral Glucose Tolerance Test: Famously known as the OGTT, it involves interrupting blood sugar levels using special glucose solutions. Glucose levels are measured prior to taking the solution, as well as periodically after taking. Results revealing 200mg/dl level or higher after two hours indicate raised blood sugar.
Pathophysiology
Also known as non-insulin dependent or adult-onset diabetes, the condition is a characteristic of hyperglycemia triggered by excess circulation of glucose in the plasma, and moderate deficiency of insulin, a chemical substance responsible for controlling the amount of sugar in the body. Its origin is related to inadequate secretion and supply of insulin by pancreatic beta cells. Insulin resistance affects physiological processes in cells, leading to activated release of unwanted glucose by liver cells, elevated amounts of lipids, reduced levels of glucose in muscle cells, amplified breakdown of lipids, and resistance to incretin.
Induced insulin resistance from increased body lipids triggers elevated glucagon and insulinotropic polypeptide levels, which in turn cause intolerance. However, it is important to note that the process does not alter the glucagonlike peptide response and thus increases the excretion of glucagon (Khardori et al., 2014). Excess production of glucagon subverts the production of insulin-secreting hormones in the beta cell, leading to hyperglucagmenia, that later develops to hyperglycemia due to failure of suppressed gluconeogenesis. In turn, the development of hyperglycemia increases cardiovascular risks, cognitive dysfunction and other health related conditions.
Medical studies link the genesis of the disorder mainly to genetic, medical, and lifestyle factors (American Diabetes Association, 2010). It is important to note that some of these factors, such as obesity, lack of physical exercise and, unhealthy diet are controllable through individual interventions. However, other factors among them, aging, genetics, and gender need clinical interventions. Insulin resistance and unstable pancreatic functions may be heritable genes (Khardori et al., 2014). For example, Genetic variations involving incretin, a gastrointestinal hormone, may stimulate insulin secretion.
High amino acid concentrations in body metabolism play a significant role in the development of type two diabetes mellitus. These concentrations mostly develop from high carbohydrate diets. Khardori et al. (2014) studied medical reports that led to the conclusion, elevated amino acid concentrations exposed diabetic risk among normoglycemic individuals. In essence, for the disorder to crop up there must be an occurrence of insulin resistance, and inadequate insulin secretion. Even though obesity is related to type two, diabetes does not develop in all cases because, some obese people can sufficiently secrete insulin sufficient for stabilizing their insulin resistance.
From the discussion above, it is evident that the pathophysiology of the disorder differs among individuals. Nevertheless, more health complications, including cardiovascular risks, retinopathy, stroke, nephropathy, and neuropathy share the same risks.
Therapeutic Interventions
Effective treatment depends on introduction of both scientific and non-scientific methods. Pharmacological medications initiate glycemic control and thus reduce long-term complications (Khardori et al., 2014). Nevertheless, it is important to bear in mind an individual’s symptoms and clinical results. In this case, the patient has symptoms that reveal an onset of the disorder. The best-recommended intervention would be a combination of anti-diabetics (biguanides) and insulin medications.
Anti-diabetics (biguanides)
Just as their name suggests, they fight against diabetes by reducing hyperglycemia. These agents control the effects of hyperglycemia by decreasing hepatic gluconeogenesis, and increasing the peripheral insulin secretion (Khardori et al., 2014). In addition, they have negative effects in elevating insulin levels and obesity. Biguanides do not undergo metabolism and hence are quickly removed by the kidneys. Furthermore, lactic acidosis rarely occurs.
Insulin
Transitory insulin treatment to patients with initial presentation of diabetes reduces glucose in the blood, and relieves early symptoms such as polydipsia and polyuria (Khardori et al., 2014). The reduction of glucose toxicity reduces secretion of insulin in the beta cells, which in turn worsens resistance. Injectable insulin solutions provide glycemic levels without any unfavorable effects. Since most patients are insulin resistant, induction of insulin using small doses of scientific drugs may be inefficient.
Non-Pharmacological Interventions
The American Diabetes Association (2013) clinical practice guidelines recommends patients using non-insulin therapies or regular insulin injections to adjust to other non-pharmacological therapies, which include, adjusting to medications, physical activity, and low-calorie diet to reach individualized glycemic goals. The modification of diet is important in management of diabetes. Glycemia can also be controlled by regulating weight and thus medications aimed at inducing weight loss, such as orlisat could be helpful to patients.
Referrals and Professional Collaboration
Diabetes mellitus 2 has numerous complications that affect the general health of a human person. For effective management, clinicians work with other specialists and make appropriate referrals, which include:
- Diet Modifications therapy
- Depression screening
- Renal screening
- Eye Screening
Journal Literature Review
Rochester, Leon, Dombrowski, & Haines (2012) carried out a study to determine the management of insulin in patients with type two diabetes mellitus using collaborative drug therapy. The study revealed unsatisfactory treatment of glycosylated hemoglobin with oral antihyperglycemic agents alone. After the introduction of an insulin initiation primary care clinic, which was developed to offer required insulin therapy, the use of oral medication decreased within the first three months. As a result, pharmacists were required to follow insulin dosing protocols to guide therapeutic decision making. In addition, patient comprehensive education and training about blood-glucose self monitoring skills, using insulin injection, treating hypoglycemia, and lifestyle modifications was introduced. Patients were then discharged to primary care providers after a duration of six months. The journal sets off a conclusion that planned insulin initiation would improve patients’ glycemic control.
Planning for Future Wellness
In line with the 2013 American Diabetes Association recommendations, clinicians not only have the duty to educate their patients about self-monitoring and data interpretation, but also they should conduct follow-up routine assessment. In this case, I would recommend the following approaches for preventing complications related to the disorder.
- Glycated hemoglobin tests every 3 months to determine the effectiveness of medication, and make necessary changes if required.
- Statin therapy to reduce the presence of lipidoproteins in cholesterol
- Blood pressure tests every visit to ensure that lipids do not affect cardiovascular processes
- Microalbumi checks after 6 months to ensure kidneys do not leak albumin to urine and cause renal complications
- Foot checks every visit to detect and survey diabetic neuropathy and peripheral arterial disease.
For effective management, the patient should be trained about self-monitoring techniques, interpretation of results, and suitable actions. For effective and accurate results, clinicians should check and recalibrate glucose testing meters every visit.
Conclusion
In summation, it is important to strike the difference between the diabetes mellitus type 1 and 2 that appear to share symptoms. Diabetes mellitus type 2 is preventable through both natural and pharmacological strategies. Natural methods are acquired through a change of lifestyle that would encourage the maintenance of age-appropriate body weight through engaging in physical activity. This drives away the obesity condition. The observation of a nutritious diet characterized by low fats, regulated fats and more intakes of water, fluids and fruits is also a natural way of regulating the level of insulin and fat in the body. Lastly, medication at early stages can prevent deaths caused by cardiovascular related disorders.
References
American Diabetes Association (2013). Clinical practice recommendations: 2013. Diabetes Care, 36 (1), 1-110.
American Diabetes Association. (2010). Diagnosis and classification of diabetes mellitus. Diabetes Care, 33 (1), 10-62. Web.
American Diabetes Association. (2003). Treatment of hypertension in adults with diabetes. Diabetes Care, 26 (1), 80-82. Web.
IHS Division of Diabetes Treatment and Prevention. (2009). Urine Albumin Screening and Monitoring in Type 2 DM.
Mooradian, A. (2009). Dyslipidemia in type 2 diabetes mellitus. Nature Clinical Practice Endocrinology & Metabolism, 5, 150-159. Web.
Rochester, D., Leon, N., Dombrowski, R., & Haines, T. (2012) Collaborative drug therapy management for initiating and adjusting insulin therapy in patients with type 2 diabetes mellitus. American Journal of Health-System Pharmacy, 67 (1), 42-48.
Khardori, R., George, G., Howard, B., Barry, B., William, I., Kenneth, L., Anne, P., David, S., Don, S., Erik, S., Francisco, T., & Scott, V. (2014). Type 2 diabetes mellitus medication. Web.