Type 2 diabetes

Melanie Johnson is a 63 year old woman who has been admitted to your surgical ward for the drainage of a
Bakers Cyst. She was diagnosed with Type 2 Diabetes Mellitus (T2DM) 6 months ago, during a routine workup
for surgery. She takes no specific medication for her diabetes, and has been told by her GP to ‘watch what she
eats’. She was devastated to discover her diagnosis of T2DM, as she was aware of the risks due to her family
history. She has not returned to her GP since her initial diagnosis. She has no other past medical history of
note. Melanie says tearfully “I have been trying to eat right and exercise, but I can’t walk because of the pain in
my knee and I was feeling down and eating ice cream. I have hardly eaten anything in the last week because I
am trying to lose weight and get my blood sugar down”.
Her mother and older sister were both diagnosed with T2DM in their early 50’s.
Melanie tells you she has had the Bakers Cyst for about 2 years. It has been increasing in size over the last 8
months, restricting her movements. The planned surgery is drainage followed by two follow up cortisone
On Admission at 0800 – her blood glucose level (BGL) was 22.9 mmol/L; HbA1c: 11%. She has been fasting
since midnight. She notes that she is feeling quite “stressed” about the surgery. On admission the following
were recorded:
Height: 167cm
Weight: 105kg
Blood Pressure: 140/80 mmHg
Pulse rate: 95 beats/min
Respiratory Rate: 22 breaths/minute
Temperature: 36.7 ºC
SpO2: 97%

Part 1 Questions (1000 words)
Melanie is distressed that her blood glucose level is elevated and asks you for help in understanding her
diabetes. She tells you that she has a friend who is very overweight, eats lots of cake and hardly ever
exercises, and he does not have diabetes.
1. Describe the pathophysiology of T2DM with links to Melanie’s case. Include in your answer
risk factors for T2DM, the pathogenesis of T2DM, possible complications of T2DM and
outline the 3 levels of treatment options for T2DM. (600)
2. Differentiate between T2DM and T1DM (at least 6 differences). (100)
3. Identify at least 2 reasons Melanie’s BGL is high on admission. Discuss how each reason you identify effects
BGLs. (300)

Part 2 Questions (700 words)
The surgery is successful and Melanie comes to see you in the outpatient clinic for cortisone injections
(Kenacort-A 40). She has been commenced on metformin (APO-Metformin Tablets) and glipizide (Minidiab
Tablets) to help control her diabetes. Her blood test on this visit were BGL 8.8 mmol/L; HbA1c: 8%.
1. Discuss the three medications Melanie is on. Include in your answer the action, complications/side
effects and nursing considerations linked to Melanie’s situation. (500)
2. Discuss the two blood results, one from prior to surgery and one from the clinic visit of Melanie’s BGL
and HbA1c. What are they? What do they measure and why have they changed? (200)

Part 3 Questions (300 words)
While Melanie is waiting to see the doctor, she starts talking to you about her condition. She asks if she has
insulin dependent diabetes or early onset diabetes. She is also unsure of how to use her BGL machine and BGL
1 Discuss why the terms insulin dependent diabetes mellitus/ non insulin dependent diabetes
mellitus and early onset/mature onset are misleading. (100)
2 You need to teach Melanie how to use her BGL machine. Discuss the “teach back” method
for patient education (include evidence from peer reviewed sources). Discuss how you
would use this method to teach Melanie how to use her BGL machine. (200)

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