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January 6, 2017
The Nursing Shortage
January 6, 2017

Case Study Diabetes

Effect of Insulin on the Body

The hormone insulin is responsible to make glucose available in our body cells for metabolism. In case of absence or the resistance against insulin by our cells, the glucose level in our body starts to rise. More and more glucose fabricates in the blood by the conversion of glycogen and lipids, to provide glucose to the starving cells. Furthermore, some of the glucose starts to be excreted in urine. The breakdown of lipids produces fatty acids (ketone bodies) which decreases the blood PH and causes ketoacidosis, this is a life threatening condition (Marieb & Hoehn, 2007). Some other complications such as blindness, erectile dysfunction, kidney or heart problems, and neurological disorders can also occur (Canadian Diabetes Association, 2010).

Predisposing Factors for Type 2 Diabetes

The predisposing factors include sedentary lifestyle, unhealthy diet, smoking, lack of exercise, and being overweight or obese (Marieb & Hoehn, 2007). The client for this case study has a sedentary lifestyle, no physical exercise and fast food diet. Alvin is now loosing weight because his body fats and muscle proteins are being converted into glucose. This is to compensate for the increased demand for glucose that is unavailable because of insulin resistance or deficiency of insulin (Marieb & Hoehn, 2007). According to Canadian Diabetes Association (2010), people from Aboriginal, Asian, South Asian, and African backgrounds are at a greater risk for developing type 2 diabetes. After forty years of age, people usually decrease their social activities that might put them at a risk for developing type 2 diabetes.

Psychological Impact of Type 2 Diabetes

Type 2 diabetes has a great impact on quality of life and psychology of patients with diabetes. Diabetic patients cannot eat the food they enjoy the most. Such sudden changes in diet may cause frustration and depression to patients. The extra cost of medication can also be a problem and can cause stress for clients with type 2 diabetes. Not being able to eat as desired at family gatherings may be stressful for diabetic patients. Nonetheless, monitoring blood glucose everyday and fear of developing complications of diabetes would cause additional psychological problems for these clients and can also become nerve-racking (Canadian Diabetes Association, 2010).

Diagnostic Criteria for Type 2 Diabetes

Assessment data that supports diagnosis of Alvin’s type 2 diabetes are as follows: fatigue, polyurea (nocturea) excessive thirst (polydipsia), bilateral numbness of toes and fingers, family history of diabetes, and weight loss. The normal measure for random blood glucose is less than 11.1 mmol/L and HbA1c less than 7%. Alvin’s random blood glucose is 25.8 mmol/L which is far beyond the normal level. As for his HbA1c is concerned, 16.4% is also beyond the normal range. HbA1c provides the average blood sugar level for past three months which can be used to predict the risk for diabetes complications for Alvin (Lilly, Harrington, & Snyder, 2011).

Pharmacokinetics of Amaryl and Humalog Insulin

Amaryl is absorbed through the gastro-intestinal tract and metabolized in the liver where it is converted into an active metabolite to act at the beta cells of pancreas. Peak drug concentration in the blood can be achieved in 2-3 hours with a half life of 5-9 hours. About 90-95% of the drug is bound to protein and excreted in urine. If the liver is impaired the drug cannot be metabolized and might cause drug toxicity because it cannot be broken down to become bioavailable (Lilly et al., 2011).

Humalog insulin (lispro) is given subcutaneously 10 to 15 minutes before a meal and its action is rapid but shorter in duration (about 3-5 hours). This exogenous insulin does not have to go through the first pass effect and metabolism. The drug is filtered through the glomerulus but reabsorbed or destroyed at the proximal tubule and may be used for renal metabolism (Lilly et al., 2011).

Pharmacodynamics of Amaryl and Glucophage

Glimepiride (Amaryl) is a second generation sulfonyluea and an oral antihyperglycemic agent used for type 2 diabetes. The drug acts on the beta cells of the pancreas to increase production of insulin that enhances the availability of glucose into the cells, tissues, and organs for production of energy. Glimepiride also helps in the reuptake of glucose by the liver, adipose tissues, and muscles to be stored as glycogen. The increased availability of insulin in the blood prevents from gluconeogenesis by the liver. The only matter of concern with glimepiride is that it can cause hypoglycemia because of the over production of insulin (Lilly et al., 2011).

Metformin (Glucophage) The mode of action of metformin is quite different from glimepiride that it does not stimulate the beta cells of the pancreas to produce insulin. Metformin reduces gluconeogenesis by the liver, decreases glucose absorption from intestines, and glucose uptake by the liver, muscles, and adipose tissues. It increases insulin receptors sensitivity in the liver, muscles, and adipose tissues. This drug does not cause hypoglycemia because of its mode of action (Lilly et al., 2011).

Hypoglycemia and its Management

Hypoglycemia is a medical condition in which blood glucose level goes down abnormally, less than 2.8 mmol/L. Persons’ experiencing hypoglycemia may exhibit diaphoresis (excessive sweating), confused, irritable, tremors, and lately body temperature abnormally goes down and seizures. Patients’ with hypoglycemia should be treated timely because an uninterrupted glucose supply is required for the normal brain functions. Patients should also be taken care of to watch for falls due to hypoglycemic levels. It may increase the risk of falls and ultimately trauma. Some instant glucose should be provided to meet the brain’s need for glucose in order for the brain to survive and to perform effectively. These treatments include buccal tablets, gel forms, and other forms of monosaccharide. The use of disaccharides should be avoided because these are not readily available and have to break down into monosaccharide to be available for the action. The use of 50 % dextrose intravenous is used in hospital settings (Lilly et al., 2011).

Adverse Effects of Medication and Lifestyle Modifications

The adverse effects of Alvins’ antidiabetic medication are as follows: hypoglycemia, jaundice, hemolytic anemia, heartburn, nausea, gastric fullness, and sensitivity to sunlight. Alvin needs to check his blood sugar before taking his medication and making sure he takes it with food. He should consult his physician if conditions become worse or new symptoms arise such as, vomiting, diarrhea, and shortness of breath. The contraindications for his medication are such as, allergic response to drug therapy and his diet should not include alcohol as it reduces drug metabolism (Lilly et al., 2011).

Alvin is an auto mechanic and he needs to modify his lifestyle and dietary habits. He must spare time for physical activities, such as walking briskly daily to help him monitor his glucose level. Instead of eating large meals at once, eat in small portions and consume a diet low in carbohydrates or starches (Lilly et al., 2011).

Safe Administration of Drugs and CNO Standards

Patients’ safety and well-being is the prime objective of nursing care. Nurses should be knowledgeable about the clients and drugs being administered. They should perform three checks for safe administration of drugs to avoid medication errors. Nurses should follow 5 rights of drug administration. Nurses ought to assess the clients’ weight and age for proper drug dose. They must check for any adverse drug reactions, drug interactions, and drug allergies (Lilly et al., 2011).

Personal Learning and Humanizing Nursing Care

I believe that knowledge is the key to success. Nurses are responsible for patients’ health teaching and their well-being, which is possible only when nurses are knowledgeable about all the aspects of care. After completion of this assignment, my concepts are clear regarding diabetes and nursing considerations for administration of hypoglycemic agents. As nurses, we need to follow safe standards of drug administration to avoid medication errors.

The humanistic nursing theory considers all the aspect of care and takes clients as unique individuals with specific needs and wants. The effect of this disease or any disease as a matter of fact is not just a physical change but it changes the person psychologically as well. The changes in lifestyle and diet may bring depression and stress (Canadian Diabetes Association, 2010). Nurses can help patients plan meals, interrupt bad habits and encourage positive reinforcement with appositive attitude. Not being able to enjoy food one likes can become frustrating. Exercise also plays a major role in diabetes. Alvin must also adjust extra curricular activities in his schedule. This can only be carried out with recommended exercise regimen and encouragement from nurses and other healthcare providers (Kleiman, 2006).


Kleiman, S. (2006). Josepine Patterson and Loretta zderad’s humanistic nursing theory and its applications. In M. E. Parker (Ed.), Nursing theories and nursing practice (pp. 125-138). Philadelphia, PA: F.A Davis Company.

Lilly, L., Harrington, S., & Snyder, J. (2011). Antidiabetic Drugs. In B. Swart (Ed.), Pharmacology for Canadian Health Care Practice (pp. 589-616). Toronto: Elsevier Canada.

Marieb, E., & Hoehn, K. (2007). The Endocrine System. In S. Beauparlant (Ed.), Human Anatomy & Physiology (pp. 604-645). San Francisco: Pearson Education, Inc.

Type 2 Diabetes: Complications. (2010). In Canadian Diabetes Association. Retrieved from


These articles have been written by Nasir Ahmad BSc. (HONS) Nursing, a graduate from York University Toronto, Ontario, Canada. The writer of these articles authorize Peace In-Home Health Care Services Inc to use these articles on their website as an additional resource for their clients. However, any unauthorized copying or distribution of these articles will be dealt strictly by the laws of the state. Please contact author for any queries at 416-648-2717 or email: