Type 2 Diabetes Mellitus - Paper Example

The article by DeFronzo et al.2015 that is titled type 2 diabetes mellitus Nature reviews states that the type 2 diabetes mellitus is an expanding global health problem that is closely linked to obesity. This condition is characterized by insulin resistance, high blood sugar and relatively lack of insulin. The symptoms include frequent urination, unexplained weight loss, increased thirst, sores that do not heal, increased hunger and feeling of tiredness which are all present in our imaginary patient. The article points out that the long term complications are a heart attack, blindness, kidney failure, stroke and poor blood flow to the limbs which could lead to amputations. From the medical history, the family of the patient has a history of shock and heart attack. The type 2 diabetes occurs due to obesity and lack of exercise. However, some people are more genetically predisposed or at risk than others. Insulin resistance, as well as impaired insulin secretion, are the core defects that contribute to the pathophysiological abnormalities that contribute to the dysregulation of body glucose metabolism (DeFronzo, Ferrannini, Groop, Henry, Herman, Holst & Simonson, 2015)

Treatment and management of Diabetes mellitus

The management of diabetes mellitus is based on lifestyle interventions, lowering cardiovascular risk factors and maintaining normal glucose levels.The lifestyle interventions include exercise and the right diet. Treatment of type 2 diabetes mellitus consists of combined lipid therapy like metformin and insulin based medications (ACCORD Study Group, 2010).Due to the multiple pathogenetic disturbances present in the type 2 diabetes mellitus, multiple antidiabetic agents are used in combination to maintain normoglycemia. The agents that enhance insulin sensitivity halt the progressive pancreatic beta cell failure as well as prevent or even reverse the microvascular complications are used (American Diabetes Association, 2014).

Laceration of the Foot/actual infection

Uncontrolled type 2 diabetes mellitus which our imaginary patient has can lead to diabetic wounds especially diabetic foot. The primary concern with the diabetic wounds is due to the poor or delayed healing. The healing problems are caused mainly by the peripheral arterial disease and peripheral neuropathy that occurs with diabetes. The small blood vessels especially in the extremities (hand and feet) grow narrower and reduce the blood circulation in those regions. The lack of circulation in the extremities results in reduced oxygen and nutrient to the tissues and nerves necessary for healing hence leading to the diabetic foot which may be infected due to lack of proper defense mechanisms. The diabetic foot infections begin in a wound mostly a neuropathic ulceration. The infections are usually due to aerobic gram-positive cocci especially staphylococci (Lipsky, Berendt, Cornia, Pile, Peters, Armstrong & Pinzur, 2012). This explains why our imaginary patient has a laceration on the foot that may be infected.

Treatment of Diabetic Foot

Diabetic wounds that are infected are usually managed by empiric antibiotic therapy, but those patients with severe infections require a broader spectrum regimens (Bakker, Apelqvist & Schaper, 2012). Most of the diabetic foot require surgical intervention that can range from debridement to resection or even amputation. Wounds are also appropriately dressed and off-loaded of pressure (Dorresteijn & Valk, 2012).

References

ACCORD Study Group. (2010). Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med, 2010(362), 1563-1574.

American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes care, 37(Supplement 1), S81-S90.

Bakker, K., Apelqvist, J., & Schaper, N. C. (2012). Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes/metabolism research and reviews, 28(S1), 225-231.

DeFronzo, R. A., Ferrannini, E., Groop, L., Henry, R. R., Herman, W. H., Holst, J. J., ... & Simonson, D. C. (2015). Type 2 diabetes mellitus. Nature reviews. Disease primers, 1, 15019-15019.

Dorresteijn, J. A., & Valk, G. D. (2012). Patient education for preventing diabetic foot ulceration. Diabetes/metabolism research and reviews, 28(S1), 101-106.

Lipsky, B. A., Berendt, A. R., Cornia, P. B., Pile, J. C., Peters, E. J., Armstrong, D. G., ... & Pinzur, M. S. (2012). 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections a. Clinical infectious diseases, 54(12), e132-e173.