HITT250 Basic Pathophysiology and Pharmacology for Health

Describe the pathophysiology and pharmacological management for a person/client with type 2 diabetes mellitus. We would like you to show your understanding by making explicit the links between pathophysiology, clinical manifestations and pharmacological management of your person/client’s disease. Your answers to these questions will be used to grade the ‘coverage of subject matter’ and ‘accuracy of information’ sections of your assignment.

• You will need to create your own ‘person/client’ according to the following criteria*.

You must answer the 4 questions below:

Question 1

The following physiological processes are important for blood glucose control:

• Insulin synthesis and release
• Insulin binding to target tissues explain how they are different in your person/client in comparison to a healthy non-diabetic person.

 Question 2

The following are some consequences of long-term poorly controlled hyperglycaemia:

• Retinopathy
• Renal disease Explain why they may occur in your person/client.

 Question 3

The following drugs are used in the management of type II diabetes mellitus.

• Metformin
• Insulin

Choose ONE that is appropriate for your person/client. Discuss why it can be used by your person/client by referring to its mechanism of action.

Question 4

Answer both parts (a) and (b) (a) Insulin resistance can occur in a person with increased abdominal adiposity. Explain the pathophysiological basis for this. (b) Explain why HbA1c is used a measure of long-term control of BGL and how this measure will be useful in the management of your person’s/client’s disease.

Question 1:

Insulin synthesis and release

;">The synthesis of the insulin has a significant quantity in the beta cells of pancreas. The insulin mRNA can be translated as the single peptide while insertion in the endoplasmic reticulum, which generates the proinsulin. Fu, Gilbert and Liu (2013) mentioned that the proinsulin mainly is exposure to the particular endopeptidases that exercise C peptide. This help to generate mature form of the insulin.

Insulin binding to the target tissues

In case of type 2 diabetes, insulin resistance occurs due to the cellular alternation, which appears at the hepatic insulin level. The process of post binding occurs in the peripheral targeted tissues (Berry et al., 2013). In case of type 2 diabetes, the post binding defects appears in the peripheral tissues as the primary lesion.

Question 2:

Retinopathy

Retinopathy is the disease, which occur due the type 2 diabetes and results the loss of vision or impairment of vision. Due to the type 2 diabetes, Mr. Brown has the risk of total blindness. Therefore, it is necessary to treat the type 2 diabetes. Abnormal blood vessels grow inside the retina due to high level of blood sugar (Lovshin & Shah, 2017)).

Renal disease

Mr. Brown has a higher risk of renal disease that is kidney failure. As insulin is not produced in adequate amount, the regulation of blood glucose hampers. As a result, the kidney became affected and high-risk of kidney failure occurs (Coresh et al., 2014). In such condition, the patient needs to be careful about the weight, healthy eating, lifestyle, and medication to reduce the effect of diabetes mellitus.

Question 3:

Insulin and its mechanism of action

Insulin is one of the peptide hormones. It is produced from the beta cell of pancreas and helps in the regulation of fat and carbohydrate metabolism. Insulin activates the GLUT4, which helps the glucose uptake in the fat cells and muscle (Pernicova & Korbonits, 2014). When the insulin production reduces in the body, the glucose uptake level decreases while the symptoms of type 2 diabetes are seen. The insulin contains the single peptide that directs nascent polypeptide chain to endoplasmic reticulum. The formation of immature granules occurs during the transportation of proinsulin to trans- Golgi network.

Question 4:

a. Pathophysiology of insulin resistance

The insulin resistance has a major role in pathogenesis of the type 2 diabetes mellitus as well as metabolic syndrome. In skeletal muscle, the insulin resistance manifests primarily the reduction of insulin stimulated glycogen synthesis (Blázquez et al., 2014). This is the consequence of the decreased glucose transport.

b. Measurement of HbA1c

in the human body, the red blood cells can survive for 8 to 12 weeks before the renewal. Therefore, the glycated hemoglobin can be measured, which reflects the level of average blood glucose (Strack et al., 2014). This provides a long-term effect on the blood glucose control. However, the HbA1c is the biochemical marker, which helps in the management of type 2 diabetes mellitus.

References

Berry, D. C., Jacobs, H., Marwarha, G., Gely-Pernot, A., O'Byrne, S. M., DeSantis, D., ... & Croniger, C. M. (2013). The STRA6 receptor is essential for retinol-binding protein-induced insulin resistance but not for maintaining vitamin A homeostasis in tissues other than the eye. Journal of Biological Chemistry, 288(34), 24528-24539.

Blázquez, E., Velázquez, E., Hurtado-Carneiro, V., & Ruiz-Albusac, J. M. (2014). Insulin in the brain: its pathophysiological implications for States related with central insulin resistance, type 2 diabetes and Alzheimer’s disease. Frontiers in endocrinology, 5, 161.

Coresh, J., Turin, T. C., Matsushita, K., Sang, Y., Ballew, S. H., Appel, L. J., ... & Green, J. A. (2014). Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality. Jama, 311(24), 2518-2531.

Fu, Z., R Gilbert, E., & Liu, D. (2013). Regulation of insulin synthesis and secretion and pancreatic Beta-cell dysfunction in diabetes. Current diabetes reviews, 9(1), 25-53.

Lovshin, J. A., & Shah, B. R. (2017). Inadequate screening for retinopathy among recent immigrants with type 2 diabetes despite universal health care: A population-based study. Journal of Diabetes and its Complications, 31(4), 664-668.

Pernicova, I., & Korbonits, M. (2014). Metformin [mdash] mode of action and clinical implications for diabetes and cancer. Nature Reviews Endocrinology, 10(3), 143-156.

Strack, B., DeShazo, J. P., Gennings, C., Olmo, J. L., Ventura, S., Cios, K. J., & Clore, J. N. (2014). Impact of HbA1c measurement on hospital readmission rates: analysis of 70,000 clinical database patient records. BioMed research international, 2014