Reference no: EM133445018
Case study
WD, 44 years old, has been experiencing fatigue for the past four months, which he attributes to being busy at work. Over the past two days, he has been urinating frequently and drinking more fluids than he usually does. He decides to go to the doctor.
The doctor completes a physical examination. WD has no history of unexplained fatigue or kidney problems. He does not smoke but enjoys about five glasses of wine per week. He has normal blood pressure, does not have a fever, there is no evidence of oedema, and his pulses are normal. His height is 173 cm, weight 89 kg and body mass index 29.7 kg/m2 (overweight but not quite 'obese'). He does not exercise regularly. His fasting blood glucose level is found to be 13 mmol/L (Question: Is this normal? conduct a normal search engine search for '13 mmol/L fasting blood glucose' to find out whether this is abnormal.). His father and one of his aunts have diabetes mellitus. WD is referred to an endocrinologist who makes a diagnosis of diabetes mellitus.
At the diabetes clinic, WD is provided with information about the disease, as well as a diet and exercise program. At the next consultation, he is still having trouble with fluctuating blood glucose levels and is told that his glycosylated haemoglobin level is elevated (Question: What is glycosylated haemoglobin?). He is prescribed oral hypoglycaemic therapy - the biguanide metformin and the postprandial agent acarbose.
Several months pass and WD appears to have better control of his daily blood glucose levels. However, a problem has arisen with hyperglycaemia developing overnight. He is prescribed an isophane insulin to address this problem.
Questions
1. Which type of diabetes mellitus does WD most likely have? Briefly explain why you ruled others out.
2. Describe the mechanisms of action of the oral hypoglycaemic agents prescribed for WD.
3. Describe the properties of isophane insulin and its pharmacokinetics.
4. Explain any specific safety issues associated with the combination of acarbose and insulin that would be of concern if the client is experiencing hypoglycaemia.