T2DM Assignment
Liberty University
Master of Exercise Science
HLTH 643
CASE STUDY: TYPE 2 DIABETES MELLITUS ASSIGNMENT
Kennedy Mills
ID: 27484490
November 30, 2023
Words: 2139
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T2DM Assignment
1. Type 1 diabetes mellitus is caused by a cell-mediated autoimmune response. This response
causes a slow decline in cell mass in people with genetic vulnerability.1 The gene that is
mainly responsible for T1DM is found in the human leukocyte antigen (HLA) section of
chromosome 6, but more than fifty genes have been linked to T1DM.1 Because of its genetic
nature, T1DM can be inherited and there is an increased risk for family members of someone
who is diagnosed.1 It is difficult to find the environmental cause that initially begins the
autoimmune response. There is a period of time between exposure and onset of diabetes
mellitus that is responsible for this inability to find the environmental agent.1 However,
research shows that multiple environmental agents and genetic interactions leads to the
autoimmune response.1 Some potential factors leading to autoimmune response include viral
infection, casein (from cow’s milk), and gluten.1 Environmental factors that contribute are
vitamin D levels and infant feeding habits (length of breastfeeding).1
2. Abnormal insulin secretion and insulin resistance combined can lead to T2DM.1 However,
this disease is multifactorial. Obesity, poor nutrition, and physical inactivity are primary
environmental factors for T2DM.1 There are also identifiable genetic abnormalities that can
be found in most families with T2DM.1 Adiposity in the central region of the body increases
a person’s degree of insulin resistance.1 Physical inactivity increases the risk of T2DM, but
physical activity is linked to reducing the risk for the disease.1 Physical activity has this
impact on T2DM because of its ability to impact insulin sensitivity in the body.1
Additionally, a high birth weight is linked to diagnosis of T2DM later in life.1 Ms. Herrera’s
mother and sister both have T2DM which increases her risk for the disease. Additionally,
Ms. Herrera is described as overweight, at her highest nonpregnant weight, and has a
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T2DM Assignment
sedentary job with limited physical activity during the week which all contribute to risks for
T2DM.
3. People with T2DM produce insulin but have insulin-resistant tissues.1 This leads to a greater
need for insulin and the pancreas increases production to meet the need.1 However, the
pancreas is not able to keep up with this great of a demand over long periods of time.1
Therefore, people with T2DM have insulin resistance and insulin deficiency.1 Insulin
resistance is caused by receptor cell defects that impact the body’s ability to use insulin. Cells
are incapable of transporting glucose transporters to their outer membranes to intake glucose
from the blood for fuel which is caused by the cell’s inability to respond to insulin.1 Someone
with T2DM also has excessive hepatic gluconeogenesis caused by defective insulin secretory
response.1 Insulin is supposed to inhibit glycogenolysis and gluconeogenesis when blood
sugar is elevated, so defective insulin secretory response happens in people with T2DM.1 In
someone with T2DM, first their postprandial glucose levels increase due to inability for cells
to use glucose. Then, hepatic gluconeogenesis increases to combat the lack of glucose in
cells. Finally, fasting hyperglycemia results.1 The primary difference in T1DM and T2DM is
that people with T1DM suffer from a lack of insulin caused by destruction of cells, but
people with T2DM produce insulin and suffer from insulin resistant tissues.1
4. According to the ADA, diabetes may be diagnosed on plasma glucose criteria or A1C
criteria.2 Plasma glucose criteria is based on a 75-g oral glucose tolerance test and shows
fasting plasma glucose value or 2-hour plasma glucose value.2 A fasting plasma glucose
>126 mg/dL, a 2-h plasma glucose of >200 mg/dL, A1C >6.5%, or a patient with classic
symptoms of hyperglycemia or in an emergency are ways to diagnose someone with
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T2DM Assignment
diabetes.2 Ms. Herrera had an A1C of 7.7% and fasting glucose of 165 mg/dL which can be
used to diagnose diabetes, according to the ADA.
5. Someone with diabetes has a greater risk for developing cardiovascular and kidney diseases.1
Both the kidneys and the heart may be damaged from diabetes. The high blood sugar levels
present in someone with diabetes may cause damage to the vessels of the kidney responsible
for filtering blood.2 High triglyceride levels and LDL leads to damage in artery walls and the
heart.2 Ms. Herrera’s lab work shows that her renal function is normal, and she is at low risk
for kidney disease. Ms. Herrera’s cardiovascular lab work, however, shows that she is at risk
for cardiovascular disease. She has hyperlipidemia, hypertriglyceridemia, and
hypercholesterolemia. These increase her risk for cardiovascular disease. The ADA
recommends ankle-brachial index (screens for peripheral artery disease), blood pressure
measurements, dilated eye exam, and bone mineral density scans for people who are newly
diagnosed diabetics.2 Someone with diabetes is at greater risk for lower functioning in other
bodily organs and these tests help to determine their functioning.
6. Ms. Herrera’s mother is likely experiencing retinopathy and peripheral neuropathy caused by
her diabetes.1 Retinopathy is the most frequent cause of blindness in adults.1 Its
pathophysiology is not completely understood, but damage to the eye is likely caused by the
hyperglycemic damage to its blood vessels.1 Retinopathy is attributed to changes in the eye’s
blood vessels and accumulation of sorbitol.1 Hypertension is also associated with retinopathy
development.1 Progression of this issue is limited through glycemic control and normalizing
blood pressure.1,3 Ms. Herrera’s mother’s pain in the feet (peripheral neuropathy) is also
caused by her chronic hyperglycemia.1,3 The accumulation of sorbitol and glycated proteins
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T2DM Assignment
damage the cells and impact nervous system pathways. The pain can be limited by glycemic
control and normalizing blood pressure.1,3
7. Metformin is in the medication class biguanide.1 This medication decreases hepatic glucose
production and increases insulin uptake in the muscles.1 The potential side effects are
transient diarrhea, nausea, bloating, anorexia, flatulence, and lactic acidosis.1 SLG2 inhibitors
are the next line of medications, according to the ADA. These medications reduce renal
glucose reabsorption and increase urinary glucose excretion.1 Glipizide falls into the
medication class of sulfonylurea agents.1 This medication stimulates insulin secreation.1 The
side effects of this medication are hypoglycemia and weight gain.1 Metformin focuses on
insulin uptake into muscles and Glipizide increases insulin secretion.1
8. People with diabetes greatly benefit from physical activity. Exercise uses glycogen stores in
the muscles in order to power cells.4 After exercise bout ends, the body needs to replenish
these stores. Doing so takes glucose from the blood trough glucose transporters and lowers
overall blood sugar levels.4 The individual’s body also becomes more sensitive to insulin as a
result of physical activity.4 Over time, consistent exercise leads to more regulated blood
sugar levels and greater insulin sensitivity.4
9. There are substantial impacts to be seen for people with diabetes who modify their diet.1
Overall health, metabolic control, and treatment of complications all benefit from nutritional
therapy.1 A nutritional assessment would be completed first to assess where Ms. Herrera
currently stands with health status, eating habits, and mental readiness for nutritional
therapy.1 It is important to teach Ms. Herrera basic nutrition knowledge.1 Additionally, she
will lead about interventions such as carbohydrate-to-insulin dosing, prevention of acute
complications like hypoglycemia, blood glucose monitoring, and physical activity.1 Some
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T2DM Assignment
strategies that may be helpful are motivational interviewing, goal setting, self-monitoring,
problem solving, stress management, and relapse prevention.1 There is not a specific diet to
help with diabetes control, so the individual will need to have good knowledge in other areas
to manage their diabetes well.1 Macronutrients should be consumed in a way that is
consistent with the patient’s current eating patterns, preferences, and goals.1 These patients
should aim to have healthy eating habits. Carbohydrates play a big role in availability of
insulin and amounts and types of carbohydrates should be considered when controlling
hyperglycemia.1 Teaching Ms. Herrera about a balanced diet that incorporates an emphasis
on whole foods will help her intake macronutrients. The diabetes plate method focuses on
vegetables, protein, and carbohydrates.1 This would be a simple way to introduce Ms.
Herrera to nutrition therapy without overwhelming her. Also, having everything written
down in simple terms as a handout will help her keep the suggestions organized without
having to memorize it all upfront.
10. Ms. Herrera’s BMI is 31.2 which is categorized as overweight.
BMI: pounds/inches2 • 703 = 182/642 • 703 = 182/4096 • 703 = 31.2
11. Laboratory results:
Lab Test Reference Range Result DM Relation
Glucose 70-99 mg/dL 165 Hyperglycemia
Cholesterol <200 mg/dL 220 Too many lipids
in the blood
LDL 0-99 mg/dL 143 Raised by DM
Triglycerides <150 mg/dL 175 Result of DM
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T2DM Assignment
HbA1C <5.7% 7.7 High blood
sugar, indicated
DM is present
Protein Negative +1 Damage in
kidneys caused
by DM
Glucose Negative +1 Excess glucose in
urine
Ketones Negative +1 Caused by
diabetic
ketoacidosis,
excess glucose
leads to ketone
build up
12. It is recommended that patients with diabetes have a protein intake of 0.8 g/kgBW.5 For Ms.
Herrera, that would be 0.8g • 83kg, or 66 g of protein per day. She is considered to be
overweight on the BMI charts and her obesity is adding negative consequences to her body,
including furthering her T2DM symptoms. Because of this, I would recommend that she lose
weight. To lose weight, 25-30 kcal/kgBW can be used to estimate energy intake. For Ms.
Herrera, this would be 25kcal • 83 kg, or 2075kcal, up to 30kcal • 83 kg, or 2490 kcal per
day. She should also add physical activity into her routine to help her to lose weight.
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T2DM Assignment
13. Ms. Herrera’s daily intake shows that she eats a lot of sugar, processed foods, and fast food.
Because of her diabetes and hyperglycemia, I would suggest that Ms. Herrera begins to
substitute her high sugar foods with other healthier options. Her breakfast donut or sweet roll
can be replaced with oatmeal, an omelet, or yogurt parfait. For lunch, she should pack a
lunch to prevent eating fast food and the added sugars found in those foods. Instead of
snacking on sweets, Ms. Herrera can find nuts, smoothies, air-popped popcorn, or fruit
instead. It will be helpful to limit sugar in managing her diabetes and hyperglycemia. Based
on her current diet, I would suggest that she adds more fruits, vegetables, and protein to her
diet. If she decides to follow the diabetes plate method, she will need to balance
carbohydrates, protein, and fats. To teach Ms. Herrera about nutrition therapy interventions, I
would use handouts with simple terms, example meal plans, exercise tips, and ways to
connect with other diabetics for support. I would teach her about reading food labels and
picking healthy options with low sugar. Her education would include finding low-sugar
snacking options that she enjoys and can keep on hand at her house. She will also learn about
the benefits of exercise on glucose uptake into muscles to reduce blood sugar levels. With all
of this education, it is expected that Ms. Herrera will want to make these diet and activity
changes to avoid further complications like her mother has.
14. The ADA recommends that self-blood glucose monitoring should be used by Ms. Herrera.
The ADA recommends that she checks her blood glucose levels at least four times per week
and have two fasting and two postprandial readings.2 The ADA recommends that the fasting
level should be between 70 and 130 mg/dL and the postprandial level should read <180
mg/dL.2
15. - How are you feeling?
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T2DM Assignment
-How have your eating habits changed? What does your normal daily intake look like?
-How can I support you? What questions do you have?
-Is there anything that is still difficult for you to understand about your diabetes?
-Have you been checking your blood sugar? How often?
-Have you noticed changes in your blood sugar level readings?
-Do you understand how to change your blood sugar after a high or low reading?
-Are you feeling as if you’re getting the hang of managing your diabetes?
- Any high or low readings? Do you understand what caused them?
16. I would share 1 Corinthians 10:31 with Ms. Herrera. This verse says, “So whether you eat or
drink or whatever you do, do it all for the glory of God.”6 This verse will remind her that
managing her diabetes well, taking care of her body, and selecting her foods carefully are all
ways that she is able to glorify the Lord. Knowing that her actions are not for her own good,
but for the Lord to be glorified will help her to stay on course and push through hard things.
Taking care of her body will enable her to live a healthy life and be a playmaker in the
Kingdom. Without a healthy management of diabetes, she will very quickly notice other
systems in her body declining and it will be harder for Ms. Herrera to live life to the fullest as
God intends. Doing all for the glory of God includes caring for our bodies and managing
illnesses to the best of our abilities.
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T2DM Assignment
References
1. Nelms MN.KNutrition Therapy and Pathophysiology.;
2006.Khttp://lib.tums.ac.ir/site/catalogue/50707.
2. ElSayed NA, Aleppo G, Aroda VR, et al. Classification and diagnosis of diabetes:
Standards of care in diabetes.KDiabetes Care. 2022;46(Supplement_1):S19-S40.
doi:https://doi.org/10.2337/dc23-s002
3. Diabetes Control and Complications Trial (DCCT): Results of Feasibility Study. The
DCCT Research Group.KDiabetes Care. 1987;10(1):1-19.
doi:https://doi.org/10.2337/diacare.10.1.1
4. Riddell M, Perkins BA. Exercise and Glucose Metabolism in Persons with Diabetes
Mellitus: Perspectives on the Role for Continuous Glucose Monitoring.KJournal of
Diabetes Science and Technology. 2009;3(4):914-923.
doi:https://doi.org/10.1177/193229680900300439
5. Hamdy O, Horton ES. Protein Content in Diabetes Nutrition Plan.KCurrent Diabetes
Reports. 2011;11(2):111-119. doi:https://doi.org/10.1007/s11892-010-0171-x
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