Case Description
You visit White Horse Farm to give William Jones his fortnightly depot injection of Zuclopenthixol Decanoate 200mg. While you are there his mother collapses and starts vomiting approximately 500 mls of coffee ground liquid. You call an ambulance and she is taken in to the ED. She was admitted to the ward with a provisional diagnosis of bleeding peptic ulcer. She is to remain nil by mouth, continue with IV fluids and newly prescribed proton pump inhibitor (IV), please monitor 4 hourly and review.
Background:
- Jean is still very active and works on the farm 3 days a week.
- Jean has had Type II diabetes for 40 years.
Medication:
- Metformin 500 mgs twice a day (35 years)
- Glipizide 2.5 mg orally once a day 30 mins before breakfast (20 years)
- Aspirin 75 mg/day (15 years)
- Simvastatin 10 mg at night (15 years)
Case Analysis
Type 2 diabetes mellitus is a disease accompanied by chronically elevated blood glucose levels. This diagnosis develops as a result of the reaction of insulin with the cells of the body. This mechanism subsequently affects the functioning of the pancreas, which cannot produce enough insulin. The main accompanying symptoms of this disease are intolerance to physical activity and sleepiness. Subsequently, this can manifest itself in a sedentary lifestyle and excessive weight gain. Rather often in the course of second-degree diabetes, visual impairment due to the malfunctioning of the blood vessels of the eyes is noticed. This affects the patient’s ability to work with documents or study, moreover, many scientists have noted memory disorders in diabetics. The hormone insulin triggers the transport of glucose from the blood to the cells.
But in type 2 diabetes, insulin resistance develops – when muscle, fat and liver cells become less sensitive to the orders of this hormone and therefore cannot absorb glucose easily. As a result, excess sugar accumulates in the blood. If diabetes is left untreated, glucose gradually damages many body systems, especially the nervous and circulatory systems. This is why people with type 2 diabetes have a higher risk of cardiovascular disease. Fat cells release many hormones and inflammation-inducing bioactive molecules (Kuball and American Diabetes Association, 2018). Scientists suggest that if there is too much adipose tissue, the substances it secretes begin to interfere with insulin’s ability to do its job. In most cases, calculating your body mass index (BMI) can help you know if you are obese. To find it out, you need to divide your weight in kilograms by the square of your height in meters. It is usually a good indicator of how much body fat a person has.
The causes of type 2 diabetes are not yet fully understood. It is believed that in most cases, the disease occurs in people with a genetic predisposition, who have additional risk factors. Over the course of life, the heart and brain will suffer the most from insulin deficiency. Without carefully maintaining their function, there is a risk of stroke, heart attack, or arrhythmia. Since, in Jean’s case, second-degree diabetes was diagnosed as a result of working on a farm, it could be argued that the heart is particularly stressed (Kuball and American Diabetes Association, 2018). Because of the frequent heavy lifting or cardio-loads typical of this kind of work, the blood vessels need to pump a large volume of blood. However, due to the lack of insulin, the walls of the arteries become thickened, and the capacity of the blood flow decreases. This creates a significant risk for arrhythmias and heart attacks afterward.
In everyday life, farm work is likely to be perceived by patients as more difficult than by healthy people in similar conditions. Jean experiences more fatigue per unit of time than people who do not have a bathing diagnosis. This will also affect the psychological state of the patient; moreover, diabetics are characterized by some behavioral changes, that over time become an integral part of life. First, one can observe overeating as a consequence of dissatisfaction with the quality of life. This further increases the risk of obesity in the future. Second, the emotional sphere of diabetics is characterized by constant anxiety.
Diabetes is often psychosomatic in nature, making the nervous system particularly vulnerable to external stimuli. Moreover, the difficulties of life due to this diagnosis create a chronic stress background, which, without proper psychological support, can form mental disorders. The latter most often manifests in the form of neurotic, asthenic, and depressive syndromes (Kuball and American Diabetes Association, 2018). In addition to a purely psychological condition, these conditions arise as a consequence of intoxication or oxygen deprivation, which accompany hypoglycemia and create changes in the functioning of the nervous system. Researchers note that the most rastrotransmitted psychological effects of type 2 diabetes in the long term are mild cognitive impairment and dementia.
This is due primarily to organic abnormalities in the vascular system of the brain, affecting the quality of memory and thinking. Often it is accompanied by other disorders of consciousness, including amnesia or delirium. This means that in the direct diagnosis of patients, it is necessary to detect all possible preconditions for the formation of cognitive disorders (Kuball and American Diabetes Association, 2018). It is important to monitor memory impairment, confusion, or difficulty in formulating ideas over time. For each diabetic, it will be helpful to use various questionnaires and tests that allow doctors to identify these impairments early on.
Diabetics exhibit a variety of mood disorders in everyday life. Scientists have noted such manifestations in 20 percent of patients (Kuball and American Diabetes Association, 2018). At the same time, depression, especially in the chronic form, although possible, is quite rare. The most widespread manifestation of disorders in the emotional sphere is mixed conditions, aggravated by affective symptomatology. Patients exhibit depression, joylessness, passivity, and frozenness. Anxiety disorders often begin in diabetics in the form of apprehension and vague negative expectations. The patient is constantly afraid of potential catastrophic events that may occur because of the diagnosis. In rare cases, anxiety attacks may lead to panic attacks, but in everyday life, they are most often expressed in a person who is highly anxious, irritable, and fidgety (Kuball and American Diabetes Association, 2018). Conditions of this nature observed in a patient for more than 6 months require therapeutic intervention.
The risk of an eating disorder in the case of diabetes should not be overlooked. The above-mentioned obesity is a consequence of a variety of malnutrition scenarios. Patients commit eating excesses, showing an inability to stop eating (Kuball and American Diabetes Association, 2018). Furthermore, night eating syndromes, hedonic eating, and other forms of overeating may be formed. In some cases, eating disorders in diabetics take the form of anorexia nervosa and bulimia nervosa (Kuball and American Diabetes Association, 2018). However, such cases are in the minority. It is important for diabetics to stay in contact with a nutritionist or dietitian even if they do not show signs of an eating disorder because the risk of developing one remains high.
From a social point of view, there are also many preconditions for the emergence of an unstable state. By comparing himself with others, the patient comes to an unfair conclusion about his inferiority, which is often fueled by bullying in adolescence. As a consequence, the individual develops complexes, feelings of emotional abandonment, and guilt. In everyday communication, this may manifest as withdrawal or aggression toward others. Consequently, diabetics tend to be unsuccessful in building social contacts. Without proper psychotherapy, these patients have unstable self-esteem, which often becomes an obstacle to networking and career building (Kuball and American Diabetes Association, 2018). Diabetes cannot help but have an impact on Jean’s immediate environment. Relatives have to monitor constant access to medications, monitor the condition, and be there when help is needed. This creates some risks for a healthy family atmosphere, as the focus of attention is kept on the person with the diagnosis. It is not uncommon in such cases for parents or siblings to stop paying attention to their personal lives and interests.
Reference List
Kuball, E. and American Diabetes Association (2018). Managing type 2 diabetes. Hoboken, New Jersey: John Wiley & Sons, Inc.