NR 507 Week 6 Case Study Assignment

NR 507 Advanced Pathophysiology

Case Study Questions

Pathophysiology & Clinical Findings of the Disease

1. Review the lab findings and decide if the diagnosis is Type 2 or Type 1 Diabetes Mellitus.
   • Based on the provided lab findings, if the patient exhibits high fasting blood glucose levels, elevated HbA1c, and the presence of insulin resistance without significant ketonuria, the diagnosis is more indicative of Type 2 Diabetes Mellitus. In contrast, if the patient presents with autoantibodies against pancreatic beta cells, low or absent C-peptide levels, and a propensity towards ketoacidosis, the diagnosis would lean towards Type 1 Diabetes Mellitus.
2. Explain the pathophysiology associated with your chosen diagnosis.
   • Type 2 Diabetes Mellitus: This condition is characterized by insulin resistance, where the body’s cells do not respond effectively to insulin, coupled with an eventual decline in pancreatic beta-cell function. Initially, the pancreas compensates by producing more insulin, but over time, the beta cells become exhausted, leading to hyperglycemia. Chronic hyperglycemia in Type 2 Diabetes can result in complications such as cardiovascular disease, neuropathy, nephropathy, and retinopathy.
3. Identify at least three subjective findings from the case which support the chosen diagnosis.
   • Increased thirst (polydipsia)
   • Frequent urination (polyuria)
   • Fatigue or feeling of constant tiredness
4. Identify at least three objective findings from the case which support the chosen diagnosis.
   • Elevated fasting blood glucose levels
   • High HbA1c levels (typically ≥6.5%)
   • Increased body mass index (BMI), often associated with obesity in Type 2 Diabetes

Management of the Disease

Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

1. Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
   • Metformin (Biguanides): Example: Metformin
     • Mechanism of Action: Metformin decreases hepatic glucose production and increases insulin sensitivity in peripheral tissues, thus lowering blood glucose levels without causing significant hypoglycemia.
   • SGLT2 Inhibitors: Example: Empagliflozin
     • Mechanism of Action: SGLT2 inhibitors work by preventing glucose reabsorption in the kidneys, leading to increased glucose excretion in the urine, thereby lowering blood glucose levels.
2. Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.
   • Dietary Modifications: Implementing a diet rich in fiber, whole grains, vegetables, and lean proteins while reducing intake of refined sugars and saturated fats.
   • Regular Physical Activity: Encouraging at least 150 minutes of moderate-intensity aerobic exercise per week, combined with resistance training to improve insulin sensitivity and assist in weight management.
3. Utilize the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations.
   • According to the American Diabetes Association (ADA) guidelines, both metformin and SGLT2 inhibitors are strongly recommended as first-line therapies for Type 2 Diabetes, particularly in patients with cardiovascular risk. Dietary and lifestyle interventions remain cornerstones of diabetes management, with evidence supporting their role in improving glycemic control and reducing complications.