- Length: 1,800 words ± 10%- Weighting: 25%CaseBill McDonald is a 75-year-old male patient who was previously diagnosed with type 2 diabetes. He has smokedone pack per day of cigarettes for 35 years...

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Clinical Nursing
Case Study
This study is about Bill McDonald who is a 75/M who was diagnosed with Type 2 Diabetes one-year age. He was a heavy smoker and drinker but had quit both after being diagnosed with Diabetes. After being diagnosed with diabetes, he was started on Metformin 500 mg twice daily which is the first medicine to be given in diabetes. The dose had to be increased to 1000 mg twice daily 6 months ago to keep the blood glucose levels in control. The most recent blood test showed his HbA1c level to be 7.2% which does not show good control of blood sugar levels. His blood glucose level had been fluctuating in the past three months. On taking his family history, it was found that his mother had diabetes and died of heart attack at the age of 65 years. On the work front, Bill has a juice bar and he likes to eat fresh fruits specially banana. He is not much physically active.
One-week ago when Bill visited his GP it was found that he had raised blood pressure with no symptoms. He did not have any headache, dizziness or blu
ed vision but he mentioned that his eyes got tired easily. On further physical examination, it was observed that he is obese with a BMI of 40.2, and had lost 33 Kg weight in past two years. His other vitals were also bit away from the normal range. He also presented with edema in both lower legs. His urine and blood samples were sent for pathological investigations. The reports revealed that he had high protein (4+) in urine, increased urea (25 mg/dl) and serum albumin (6.1 mg/dl). The tests also revealed decreased Estimated Glomerular Filtration Rate. The 24 hour urine test showed high urinary albumin excretion rate.
Pathophysiology of Type II Diabetes
Type 2 Diabetes is a chronic or lifelong condition that affects the ability of the body to metabolize glucose mentions Zaccardi (2016). Glucose is an important source of energy to the body which is obtained from the ca
ohydrates that the humans eat. In the human body, hormones play a vital role in the normal metabolism and growth. The insulin hormone is produced in the body by pancreas that is situated near to the stomach. Insulin helps in the utilization of glucose for energy as and when required said Kautzky-Willer (2016). After utilization of glucose required by the body, the excess glucose is stored in liver for future use.
Insulin
Once the humans consume food, the ca
ohydrates are
oken down in simpler units i.e. glucose. This glucose enters the bloodstream via lining of the small intestine. The insulin hormone signals the cells of the body to use the glucose present in the blood. Once the cells have utilized the glucose, insulin signals the body to store the excess glucose from the blood in the liver. Thus, insulin helps in the regulation of blood glucose levels. This stored glucose is released when the blood glucose level decreases and energy is required i.e. between meals or under stress described Tesauro (2020).
Diabetes is a condition that occurs when the blood glucose levels remain high and are not regulated by insulin. This can happen in three conditions i.e. insulin production is absent; cells resist insulin or insulin level is not enough. The first condition is called Type 1 Diabetes in which the pancreas is unable to produce insulin explained Leslie (2016). Type 2 Diabetes, on the other hand, is the condition when the body cells resist the effect of insulin or the amount of insulin produced by the body in not enough to maintain the blood glucose levels. Type 2 Diabetes had also been known as adult-onset diabetes but these days it has been observed in young children as well.
Risk Factors
Diabetes has become a very common illness these days and it has been found that some people are more prone to Diabetes than other. The risk factors as described by Goldstein (2016) for this illness are as follows:
1) Weight – Overweight individuals are more prone to the development of Type 2 Diabetes but one need not be overweight to develop this illness.
2) Distribution of fat – If the storage of fat in the body is more in the abdomen than the chances of developing Type 2 Diabetes...