Type 2 Diabetes Mellitus
Answer 1: According to Lucier and Weinstock, the exact etiology of T1DM is still unknown,
researchers believe there is a genetic predisposition with a strong link with specific HLA (DR
and DQ) alleles.1 In people with T1DM, the pancreas produces a reduced or non-existent amount
of insulin. Without insulin, the body cannot regulate the amount of sugar in the blood, leading to
hyperglycemia and/or other serious complications.
Answer 2: T2DM is deemed multifactorial as a result of numerous risk factors that promote
onset of the disease. The risk factors include genetics, obesity, lack of physical activity, and
inadequate nutrition. Ms. Herrera’s history shows several factors that increases her risk for
diabetes. First, her mother and sister have T2DM. Additionally, she is Latin American. Ms.
Herrera appears to be overweight and states this is her highest nonpregnant weight. Based on her
food history, she has poor eating habits with little to no physical activity.
Answer 3: In T2DM, insulin production is sufficient, but the body’s tissues resist the insulin.
The lack of insulin absorption triggers the pancreas to produce more. Insulin resistance leads to
hyperinsulinemia – a higher amount of insulin in your blood than what’s considered normal.2
The primary difference between T1DM and T2DM is type 1 diabetics do not produce enough
insulin. Conversely, type 2 diabetics produce enough insulin, but their cells resist it.
Answer 4: T2DM can be diagnosed using various methods. The American Diabetes Association
discusses the following methods.3
A1C - measures average blood glucose for the past two to three months, fasting not
required, 6.5% or higher indicates diabetes.3
Fasting Plasma Glucose – checks fasting glucose level, no food or drink 8 hours prior to
testing, 126 mg/dL or above indicates diabetes.3
Oral Glucose Tolerance Test – 2 hour test checks blood glucose before and 2 hours after
drinking a special sweet drink, shows how the body processes sugar, 200 mg/dL or higher
indicates diabetes.3
Random/Casual Plasma Glucose Test – checks blood whenever there are severe signs of
diabetes, 200 mg/dL or higher indicates diabetes.3
Based on these guidelines, the information in her record is sufficient for making the diagnosis.
Answer 5: These organ systems are a component of evaluation because of the close-knit
physiology of the metabolic, cardiac, and renal systems. Type 2 diabetes frequently coexists with
cardiovascular disease and chronic kidney disease.4 Ms. Herrera’s high lipid panel increases her
risk of cardiovascular disease. This is because accumulated cholesterol in the arteries inhibit
blood flow to the heart. Her BUN test result is just within the normal range. If this value
increases, she could be at risk for renal disease. For newly diagnosed patients, other evaluations
include intermittent blood tests and urinalysis, monitoring patient for diabetic complications (i.e.,
retinopathy, neuropathy), and weight management.
Answer 6: Ms. Herrera’s mother is most likely experiencing microvascular problems,
specifically retinopathy and peripheral neuropathy. These complications result from
hyperglycemia which damages blood vessels in the eye and nerves in the legs and feet,
respectively. There are several methods Ms. Herrera can use to prevent these complications. A
method proven to be effective is carbohydrate counting. The idea is that daily carbohydrate
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Type 2 Diabetes Mellitus
consumption impacts the glucose levels before and after a meal. In this concept, the significance
is the amount of carbohydrates consumed rather than the type of carbohydrate. Another
preventative measure is increasing her physical activity. Physical activity not only improves
A1C, but it also decreases the possibility of developing secondary conditions such as
cardiovascular disease.
Answer 7: According to Corcoran and Jacobs, metformin reduces blood glucose levels by
decreasing glucose production in the liver, decreasing intestinal absorption, and increasing
insulin sensitivity.5 The potential side effects include, but not limited to gastrointestinal upset,
weight loss, or flushing. As written in the course eBook, SGLT2 inhibitors reduce renal glucose
reabsorption and increase urinary glucose excretion.6 Glipizide activates the pancreas to make
more insulin. Metformin controls insulin resistance.
Answer 8: Physical activity lowers blood glucose levels. While exercising, blood glucose levels
drop because the muscles are using sugar in the blood as energy. However, intense physical
activity can cause a temporary increase in blood glucose levels. This occurs because the
additional stress on the muscles triggers more insulin productions. So, it’s important for diabetics
to monitor their glucose levels prior to, throughout, and post exercise.
Answer 9: To prevent overwhelming Ms. Herrera, I would advise a diet consisting of foods that
control glucose levels while simultaneously helping lower cholesterol. Next, I would educate her
on how good nutrition impacts her health conditions. Additionally, Ms. Herrera should increase
her physical activity and monitor her glucose levels daily. Also, there should be 3-6 patient
encounters within the first 6 months of diagnosis, followed by one annual encounter.6
Answer 10: Ms. Herrera’s height is 5’4”, weight 182 lbs., and BMI is 31.2; indicative of obesity.
Answer 11: Ms. Herrera’s blood tests show abnormalities in the following.
Glucose – Ms. Herrera’s blood glucose is 165 mg/dL. A person with test results of 126
mg/dL or higher is in the diabetic category.
A1C – Her elevated hemoglobin levels relate to the abnormal blood glucose. With an
A1C of 7.7%, she is considered diabetic. As the normal range is 5.7% or below.
Cholesterol, LDL, Triglycerides – HDL, LDL, and triglycerides make up her overall
cholesterol number. As evident in Ms. Herrera’s test results, DM affects HDL and LDL
by lowering one and increasing the other, respectively. High levels of triglycerides are
indicative of insulin resistance. All of which correlate with T2DM.
Her urinalysis is positive for the following.
Protein – The kidney’s filtration process is diminished due to blood vessel damage
caused by diabetes.
Glucose - The positive glucose value is the result of her kidneys not absorbing sugar. So,
the sugar is excreted in urine.
Ketones – The cells are not getting enough insulin. Therefore, her body is using fat
instead of glucose for energy, causing an accumulation of ketones which are excreted in
urine.
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Type 2 Diabetes Mellitus
Answer 12: Based on the Schofield equation (8.126 x (82.7 kg) + 845.6), Ms. Herrera’s daily
estimated requirement is 1518 k/cal. Ms. Herrera’s weight is indicative of obesity. So, I would
recommend that she lose weight.
Answer 13: Ms. Herrera’s current diet is mostly comprised of foods high in carbohydrates and
sugar. Based on her current intake and energy requirements, my plan would include fresh
vegetables and fruit, diabetic friendly dairy foods, whole grains, nuts, seeds. To satisfy her
dessert need, I would recommend foods with natural sweeteners. Also, I would advise her to
limit alcohol and sodium intake. There are a host of educational materials such as pamphlets,
books related to recipe/meal suggestions, and digital articles and videos.
Answer 14: Ms. Herrera should self-monitor based on her needs and the goals outlined in her
treatment plan. Appropriate target glucose levels would be fasting (80-130 mg/dL) and
postprandial (180 mg/dL or less).6
Answer 15:
1. Do you feel better/worse since your last appointment?
2. Have you monitored your blood glucose as outlined? Decreases/Increases?
3. How are you adjusting to the new dietary plan?
4. Have you implemented any additional healthy eating habits?
5. Have you noticed weight gain/loss?
6. Have you noticed issues with your vision or numbness/tingling in hands or feet?
7. Have you increased your physical activity?
8. Do you think the current therapy is effective? Why or why not?
Answer 16: The Bible verse I would share is 1 Corinthians 10:31, “so whether you eat or drink
or whatever you do, do it all for the glory of God”.7 I know from personal experience the
difficulties of changing your eating habits and accomplishing healthy lifestyle goals. Therefore, I
think this verse is appropriate because the strength of God enables us to accomplish anything.
4
1.Lucier J, Weinstock RS. Type 1 diabetes. March 3, 2023. Accessed June 19, 2023.
https://www.ncbi.nlm.nih.gov/books/NBK507713/.
2.Cleveland Clinic. Hyperinsulinemia. Reviewed September 20, 2022. Accessed June 19, 2023.
https://www.my.clevelandclinic.org/health/diseases/24178-hyperinsulinemia.
3.American Diabetes Association. Diagnosis. Accessed June 25, 2023.
https://diabetes.org/diabetes/a1c/diagnosis.
4.Usman MS, Khan MS, Butler J. The interplay between diabetes, cardiovascular disease, and
kidney disease. June 1, 2021. Accessed June 25, 2023.
https://diabetesjournals.org/compendia/article/2021/1/13/144946.
5.Corcoran C, Jacobs TF. Metformin. May 2, 2022. Accessed June 20, 2023.
https://www.ncbi.nlm.nih.gov/books/NBK518983.
6.Nelms M, Sucher KP. Nutrition Therapy & Pathophysiology. 4th ed. Boston, MA: Cengage; 2020.
7.1 Corinthians 10:31 (RSV). Accessed June 25, 2023. https://www.biblegateway.com.
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