Introduction
Following the increase in diabetes cases among the American population, the government, through the United States Department of Health and Human Services (HHS) office, spearheaded a health sensitization program to educate people. Through the United States Public Health Service Commissioned Corps, individuals with risk factors, such as expectant females and obese victims, were sensitized and advised to partake in diabetes diagnosis in various health centers.
A patient who had undergone an unexplained weight gain visited a local health center after experiencing a prolonged thirst and dry mouth despite taking water. In addition, the patient complained of blurred vision and constant urination. Following physical examination, the clinicians concluded the patient was suffering from diabetes.
However, the individual was subjected to further clinical diagnosis to establish the diagnosis type, where the result showed the patient was a victim of Type 2 diabetes mellitus. The report will analyze the pathophysiology and diagnosis of the patient suffering from Type 2 diabetes mellitus, explore dietary care plans for the victim, and evaluate the program’s outcome.
Patient Information
The patient was a male White older adult of age 56 from Minnesota, residing not far from the facility. From his medical history, the individual had been a victim of acute diabetes mellitus but recovered following quick medical intervention from a nearby health center. However, the illness resurfaced following the patient’s poor lifestyle and failure to adhere to clinical recommendations. The patient’s family history shows a record of diabetes in the family line, with the grandfather having died of diabetes mellitus.
Clinical Findings
The patient exhibited various physical symptoms, including dry mouth, frequent urination, blurred vision and hearing, weight loss, and fatigue. In addition, the victim had skin infections, tingling in both feet and hands and several sores in the body, which he complained of healing slowly. Following further clinical examination, the results showed that the patient’s blood sugar level had risen above normal, confirming he was suffering from Type 2 diabetes mellitus.
Timeline
- 2018 – Prediabetes diagnosis during a short hospital admission following an abnormal weight gain.
- 2018- Lifestyle advice
- 2018- Poor glycaemic control
- 2019- Diabetes diagnosis
- 2019- Episode of care: Subjected to an OHA primary care and further lifestyle advice.
- 2020 – Successful intervention and lifestyle advice
- 2021- Poor lifestyle leading to poor glycaemic control
- 2022- Excessive weight gain and diabetes-related symptoms
- 2023- Type 2 diabetes mellitus diagnosis
- 2023- Episode of care, started OHA in primary care, lifestyle advice
- 2023- Clinic review
Diagnostic Assessment
Physical Examination
Dry Mouth
The patient had a dry mouth, as exhibited by dehydrated lips. The victim was given water to drink to check if the dryness was caused by thirst. However, the mouth immediately became dry after drinking water (Tuttle et al., 2022). The patient was made to rest for some time before being given water for the second time, but the result remained the same. The mouth repeatedly went dry after partaking in water.
Extreme Thirst
The patient complained of abnormal thirst, which he reaffirmed was recurring even after drinking water. The victim was given some water to drink, and the remaining was left in a jug at his disposal (Suijk et al., 2022). After a short time, the victim went for more water, which he repeated until all the water in the jug was finished. The patient complained of thirst upon drinking all the water in the jug.
Blurred Vision and Poor Hearing
The victim was given a short script to read, which he did with difficulty. From his reading, it was evident that his vision had been affected to some extent. In addition, the patient was further subjected to a further physical examination to assess his hearing ability (Sharma et al., 2022). An audio record was played in an averagely low tone, but the patient could not get the message and the words clearly, confirming his poor hearing.
Excess Weight Gain
The patient exhibited abnormal weight going by his average weight, which stood at 175kgs. The weight increased from the initial mass, which stood at 82, showing a more than double gain. The patient confirmed that gain occurred quickly following his careless eating habit and lack of physical exercise (Gowri et al., 2022). The previous weight before diagnosis was normal and manageable for the patient.
Numbness
From the physical examination, the patient was experiencing numbness, as was evident by discomfort and restlessness in his limbs, feet, and hands. During the medical interview, the victim could not maintain his limbs relaxed but consistently engaged them either by swinging upwards, downwards, or sideways, confirming the tingling sensation (Raqib, Polus, and Mohammad, 2022). The tingling sensation was evident even during his sleeping time.
Slow-Healing Sores and Cuts
The patient had numerous sores all over his body, which were physically observable. From the legs running up to the upper body, sores were spread all over, with most being not fresh, indicating they were old wounds that had failed to heal (Sardu et al., 2022). The patient further confirmed most of his wounds take time before they heal, and even the ones that approached healing would be resuscitated repeatedly.
Skin Infections
The patient’s skin was not smooth but characterized by infections. The infection on the skin made the white complexion appear patched with black spots. From the outward look, the skin appeared to have been attacked by a severe infection, which removed the outer protective layer comprising the epidermis part, exposing the inner dermis layer to bacterial attack (Kadowaki et al., 2022). It was evident that the skin had lost its self-protective mechanism, rendering it vulnerable to infections.
Clinical Examination
Fasting Plasma Glucose Test
The fasting glucose test, commonly known as FPG, was recommended to measure the patient’s blood glucose level at a single point. For reliable results, the patient was made to fast for 8 hours without food and only sips of water. The fasting was necessary to prevent any additional glucose that would have comprised the test result, leading to misdiagnosis (Agarwal et al., 2022). The result from the FPG showed that the victim’s blood sugar level was 126mg/d at the point the test was done.
A1C Test
Second, the patient underwent an A1C test to check the blood glucose for the past three months. Since the FPG test only gave the blood sugar level at a single point, it was necessary to measure the glucose level for longer to obtain the actual glucose level in the victim’s body (Vargas-Uricoechea et al., 2022). Before conducting the test, the patient’s blood was tested for anemia or blood-related complications caused by certain types of hemoglobin to assess his eligibility for the A1C test (Steinbrenner, Duntas, and Rayman, 2022). After confirming the patient was free from anemia and other blood-related problems, the A1C test was conducted to check the glucose level. The A1C test result produced an 8%, showing a high glucose level in the patient’s blood and a positive diagnosis of diabetes mellitus.
Oral Glucose Tolerance
After the diagnosis of diabetes mellitus in the A1C test, the patient underwent an oral glucose tolerance test to determine the specific type of diabetes mellitus he had. The A1C test provided the results for the glucose level in the blood and the presence of diabetes mellitus (Ke et al., 2022). However, it was necessary to find out the type of diabetes mellitus of the patient to develop the right therapeutic response and the necessary general episode of care.
Before the test, the patient was put on a fast for 8 hours. Then, the victim’s blood sample was taken, and the glucose was measured following fasting and recorded. Next, the individual was given a fervent drink with high sugar, and the blood sample was taken after 2 hours, and the sugar level was measured (Rizzo et al., 2022). The result showed that glucose level was higher in the second test compared to the first test after fasting, indicating the presence of type 2 diabetes mellitus.
Diagnostic Challenges
Race
Diabetes mellitus affects various races differently, making it hard to diagnose a patient. Even though there are common symptoms, such as frequent urination and excess thirst, which are shared commonly by all races, some physical manifestations vary according to race, making it hard to diagnose through physical examination (Wu et al., 2022). For instance, acute obesity is common among older White adults but does not necessarily mean they suffer from diabetes mellitus. To overcome the challenge, the patient underwent a clinical examination to evaluate the glucose level in his blood. Subsequently, the victim underwent various tests to establish the type of diabetes he was suffering from.
Diet
The difference in diet and eating habits among individuals is another aspect that contributes to diagnostic challenges. Since some people are addicted to snacks and junky foods that contribute to excessive weight gain, it is possible to wrongly diagnose a normal, heavily-bodied individual with diabetes mellitus (Agwaral et al., 2022). The patient was, therefore, subject to an A1C test and oral glucose tolerance test to estimate the glucose level in the individual’s blood over 3 months to obtain a clear reflection of sugar level and define a type of diabetes mellitus in the patient.
Differential Diagnosis
Since there is a thin difference between the various types of diabetes mellitus, especially Type 1 and Type 2, diagnosis is always challenging. Type 1 and Type 2 diabetes mellitus have similar physical symptoms, including numbness, blurred vision, hearing problems, dry mouth, sores, and frequent urge to urinate (Uehara et al., 2022). It was, therefore, difficult to assess and establish the type of diabetes the patient was suffering from through physical examination.
Similarly, most clinical tests for diabetes mellitus, such as the FPG test, random blood sugar test, fasting blood test, and the A1C test, only measure the glucose level in the blood, which is common among all diabetes mellitus. However, they do not provide the results for the specific type of diabetes. For instance, the A1C test produced an 8% result, indicating a high blood glucose level confirming the presence of diabetes mellitus. However, the result did not indicate whether the diabetes was Type 1 or Type 2 (Joshua et al., 2023).
Similarly, the FPG test produced a glucose level of 126mg/d but did not indicate the type of diabetes the patient suffered from. Type 1 and Type 2 diabetes mellitus are characterized by high sugar levels in the blood (Holmes‐Truscott et al., 2022). To overcome the challenge and avoid the wrong diagnosis, the patient was subjected to an oral glucose tolerance test to establish the type of diabetes mellitus the individual suffered from.
Second, all diabetes mellitus cases are caused by the lack or inefficiency of insulin, leading to the failure to regulate glucose levels. As a result, it is possible to confuse various types of diabetes mellitus during diagnosis, leading to wrong miss examination (Pervjakova et al., 2022). To overcome this, a patient must be subjected to more clinical tests to define the type of diabetes mellitus. Therefore, more tests were performed to measure the blood sugar level and assess the type 2 diabetes mellitus he was suffering from.
Prognosis
In the past, diabetes was prevalent among senior adults, making it known as a disease of the old. However, the medical trend is likely to change, with young people beginning to fall victim. Due to factors such as diet and increased junky foods, young adults are increasingly depicting diabetic signs such as obesity (Retnakaran et al., 2022). Soon, diabetes mellitus may become prevalent among children and young adults.
Treatment
Insulin
Various types of insulin are available for diabetes mellitus victims. Regardless of the type of diabetes one suffers from, insulin is critical as long as it involves a high sugar level. With Type 2 diabetes mellitus, the patient needed an insulin injection to help reduce and regulate glucose levels (Chefik et al., 2022). Insulin is administered by injection because the enzymes in the mouth can digest it (Pan et al., 2022).
Since the victim had demonstrated a high blood sugar level due to obesity and other physical symptoms, he needed an urgent insulin response to lower and regulate the sugar levels (Livadas et al., 2022). As a result, he was given rapid-acting to quickly correct the blood sugar composition by lowering the glucose level. In addition, the patient was given long-acting insulin to help regulate the glucose level in the long term. For long-term remedy, the victim was given an insulin pump attached to the skin and programmed to dispense specific amounts of insulin.
Oral Drugs
Having diagnosed the patient with Type 2 diabetes mellitus, it was medically evident that the victim’s insulin was incapacitated or inefficient in regulating the glucose level in the blood. It was, therefore, necessary to introduce a drug that helps produce more insulin and catalyzes the inefficient ones to regulate the sugar level (Dai et al., 2022). The patient was given oral antihyperglycemic therapy to lower the glucose level in the blood.
OHAs are administered orally because they cannot be digested by the enzymes in saliva in the mouth (Diaz-Santana et al., 2022). Owing to the A1C test result, which showed the glucose level stood at 8%, and the FPG test result, which depicted more than 126 mg/d, the victim’s sugar level had risen highly beyond normal, demonstrating the absence or inefficiency of insulin (Pai et al., 2022). Thus, he needed more OHAs to lower the amount of glucose in the blood and boost the insulin.
Monitoring of Glucose Level
Following the medical intervention, the patient was advised to monitor his blood sugar level to avoid further glucose accumulation in the body or worsening of the condition. Since the treatments would help to lower the sugar level immediately, it was the responsibility of the patient to conduct self-efficacy to monitor and maintain the sugar level at low all the time (Barbagallo, Veronese, and Dominguez, 2022). To achieve this, two programs of self-care were proposed, including;
Healthy Diet
The patient was advised to monitor his diet and avoid sugary foods. Since his blood sugar level was above normal, it was self-harming to continue consuming sugary meals. Therefore, a healthy diet with less sugar was to be maintained to reduce the glucose level (Bouchi et al., 2022). In addition, the victim was encouraged to include fruits, vegetables, and lean proteins in his daily diet. Legumes and whole grains were other options for the patient.
Healthy Lifestyle
The victim was advised to embrace a healthy lifestyle by engaging in regular physical exercise and avoiding harmful habits such as smoking, which are risk factors for diabetes. Regular exercise is critical for lowering sugar levels and burning excess cholesterol (Piotie et al., 2022). In addition, exercise will maintain healthy body mass and weight.
Follow-Up Outcomes
Clinician and Patient Assessment
After two weeks of treatment, the patient was followed up to monitor the progress. From the patient’s self-assessment, he confirmed that he was experiencing several improvements. First, the victim’s constant thirst had largely reduced. Secondly, the patient confirmed a reduced rate of urination and the urge. Third, the consistently dry mouth had become soft and hydrated, resuming its normal status.
In addition, the patient had started to experience decreased body mass, and their body weight was reduced by 7kg (Soetedjo et al., 2022). The patient was subjected to further clinical examination to measure the sugar level. From the test result, the victim’s sugar level had reduced from the initial 126 mg/d to a lower figure of 117 mg/d. The percentage from the A1C test indicated a figure below 6.5 percent.
Adherence to Interventions
Healthy Diet and Lifestyle
The patient observed a healthy diet and eating habits, including fruits, vegetables, and lean proteins in his meals. In addition, the individual avoids sugar by consuming sugarless tea and other sugar-free drinks (Yang, Li and Peng, 2022). Furthermore, the patient was exercising regularly by visiting the gym in the evening.
Discussion
According to many studies, diabetes mellitus is one of the most common diseases in America, with Type 2 being the most prevalent. The disease is caused by the inefficiency or resistance of insulin to regulate the sugar level, leading to high glucose concentration in the blood (Yokoyama et al., 2022). Types of diabetes mellitus can be diagnosed through physical examination by observing the physical symptoms. However, clinical tests are essential to assess the sugar level and the extent of the disease on the victim.
Based on the research, Type 2 diabetes mellitus is controllable through treatment and adherence to clinical recommendations such as a healthy diet and lifestyle (Chefic et al., 2022). The study teaches about healthy lifestyles and dietary habits to mitigate and manage diabetes mellitus (Sardu et al., 2022). The study can be used by relevant health bodies such as the Public Health Commissioned Corps to initiate national health programs and diabetes sensitization.
Gaps
The literature does not differentiate between Type 1 and Type 2 diabetes mellitus. Even though many sources discuss type 2 diabetes mellitus, they do not provide a clear distinction between the two types of diabetes mellitus, giving room for mix-up and confusion. Secondly, the studies do not explain the relationship between obesity and diabetes. Even though many diabetic patients are obese, not every obese person is diabetic, thus there is a need to provide the link and contrast between the conditions.
Conclusion
Type 2 diabetes mellitus is becoming a common problem in the U.S. with prevalence among the senior adult populations. The illness is characterized by insufficient or failure of insulin to regulate the sugar level in the blood. The victims of type diabetes mellitus experience a high glucose level in the blood, which manifests physically through various symptoms such as dry mouth, frequent urination, obesity, and numbness, among others.
To diagnose Type 2 diabetes mellitus, a victim must be subjected to physical examination and several clinical tests. If not managed, the disease can lead to complications such as cardiovascular issues, sexual dysfunction, kidney failure, and amputations. However, it can be managed by the right treatment and strict adherence to clinical recommendations through lifestyle changes.
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