NURS 6501 ENDOCRINE DISORDERS MODULE 4 Scenario 3: Type II DM A 55-year-old male presents with complaints of polyuria, polydipsia, polyphagia, and weight loss.
He also noted that his feet on the bottom are feeling “strange” “like ants crawling on them” and noted his vision is blurry sometimes. He has increased an increased appetite, but still losing weight. He also complains of “swelling” and enlargement of his abdomen.
PMH: HTN – well controlled with medications. He has mixed hyperlipidemia, and central abdominal obesity. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 333 mg/dl.
Diagnosis: Type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching.
Question:
- How would you describe the pathophysiology of Type II DM?
Your Answer:
Type II diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by resistance to the effects of insulin, impaired insulin secretion, and excessive or inappropriate glucagon secretion.
Insulin Resistance
In the early stages of T2DM, the body’s cells become resistant to the effects of insulin, a hormone produced by the pancreas that facilitates the entry of glucose into cells for energy production. The exact mechanisms of insulin resistance are complex and multifactorial, involving genetic factors, obesity (especially central abdominal obesity, as seen in this patient), physical inactivity, poor diet, and other lifestyle factors.
When the body’s cells are insulin resistant, more insulin is required to keep blood glucose levels within the normal range. The pancreas responds by increasing the production of insulin, leading to a state of hyperinsulinemia.
Beta-cell Dysfunction
Over time, the pancreatic beta cells, which produce insulin, cannot keep up with the body’s increased demand for insulin. This insulin deficiency leads to elevated levels of blood glucose, or hyperglycemia, a hallmark sign of diabetes. The persistent high blood glucose levels can lead to glucotoxicity, which further deteriorates beta-cell function and insulin secretion.
Inappropriate Glucagon Secretion
In T2DM, the alpha cells of the pancreas, which secrete the hormone glucagon, are not suppressed by high glucose levels as they should be. This leads to an excessive release of glucagon, which promotes the conversion of stored glycogen in the liver into glucose, further exacerbating hyperglycemia.
In the patient’s case, the symptoms of polyuria (excessive urination), polydipsia (excessive thirst), polyphagia (excessive hunger), and unexplained weight loss, along with his history of central obesity and high blood pressure, are typical manifestations of T2DM.
