NR 507 Week 6 Case Study; Pathophysiology & Clinical Findings of Type 2 Diabetes

Week 6 Case Study Template 3. Identify at least three subjective findings from the case that support the chosen diagnosis. Some subjective findings that support Type 2 DM are extreme thirst, insomnia due to frequent urination at night, weight loss, and fatigue. 4. Identify at least three objective findings from the case that support the chosen diagnosis Some objective findings that support Type 2 DM are fasting glucose: 132 mg/dl, A1C 7.2 %, OGTT 220 mg/dl, and breathing quality deep with fruity breath odor. Management of the Disease 1. Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each. A. Biguanides: Metformin (American Diabetes Association, 2022) B. GLP-1 RA: Semaglutide (American Diabetes Association, 2022) 2. Describe the mechanism of action for each of the medication classes identified above. A. Biguanides: Biguanides primarily target mitochondrial complex I in the respiratory transport chain (Di Magno et al., 2022). By inhibiting complex I, they reduce the consumption of oxygen, leading to cellular energy stress. This stress increases the AMP to ATP ratio inside cells, activating AMP Kinase (AMPK). AMPK is crucial because it regulates various cellular processes by phosphorylating key proteins. In diabetes, it affects hepatic CRTCs, while in tumors, it impacts mTOR pathways. These actions contribute to the therapeutic effects of biguanides, which include both their antidiabetic and potential anticancer properties (Di Magno et al., 2022). B. GLP-1 RAs: GLP-1 receptor agonists (RAs) enhance insulin secretion in response to high blood sugar levels and suppress glucagon secretion, which helps normalize blood sugar levels (Nauck et al., 2021). Additionally, they slow down stomach emptying after meals, preventing large spikes in blood sugar (Nauck et al., 2021). GLP-1 RAs also reduce appetite and promote weight loss. Short-acting GLP-1 RAs like exenatide and lixisenatide are less effective at lowering overnight and fasting blood sugar levels but maintain their ability to slow stomach emptying over time. Long-acting GLP-1 RAs such as liraglutide, dulaglutide, and semaglutide have more consistent effects on reducing overnight and fasting blood sugar levels and HbA1c when used alone or with other diabetes medications, but their ability to slow stomach emptying may decrease with prolonged use (Nauck et al., 2021). Week 6 Case Study Template References American Diabetes Association [ADA] (2022). Standards of Care in Diabetes-2023. https://www.portailvasculaire.fr/sites/default/files/docs/ 2023_ada_diabete_standards_of_care_in_diabetes_diab_care.pdf Di Magno, L., Di Pastena, F., Bordone, R., Coni, S., & Canettieri, G. (2022). The Mechanism of Action of Biguanides: New answers to a complex question. Cancers, 14(13), 3220. https://doi.org/10.3390/cancers14133220 Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of Type 2 diabetes mellitus. International Journal of Molecular Sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275 Nauck, M. A., Quast, D. R., & Wefers, J. (2021). GLP-1 receptor agonists in the treatment of type 2 diabetes – state-of-the-art. Molecular Metabolism, 46, 101102. https://doi.org/10.1016/j.molmet.2020.101102