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8 Sep
2019

Read and Respond (Reaction Paper) Subject: – NO PLAGIARISM

Endocrine-Type 2 DiabetesDemographics:According to the Centers for Disease Prevention and Control [CDC] (2017), as of 2015, diabetes is the 7th leading cause of death in Americans and an estimated 100 million have the disease and 27% is the elderly population (Munshi, 2018). The World Health Organization (WHO) states the number of people dying of non-communicable diseases, such as diabetes, are dying at a relatively young age, 30 to 69 (WHO, 2019). The contributing factors of non-communicable diseases are alcohol abuse, tobacco use, environmental contaminants, lack of physical activity, and unhealthy diets (CDC, 2017). Of the population of T2D, 27% is the elderly population has diabetes mellitus. Most (90%) of these patients have type 2 diabetes.The elderly is at higher risk for complications from diabetes mellitus including risk for cardiovascular, cerebrovascular, peripheral vascular, and renal complications.PathophysiologyOlder adults are at high risk for the development of type 2 diabetes due to the combined effects of genetic, lifestyle, and aging influences. These factors contribute to hyperglycemia through effects on both b-cell insulin secretory capacity and on tissue sensitivity to insulin. The usual defects contributing to type 2 diabetes are further complicated by the natural physiological changes associated with aging as well as the comorbidities and functional impairments that are often present in older people (Lee and Halter, 2017).Hyperglycemia develops in type 2 diabetes when there is an imbalance of glucose production (i.e., hepatic glucose production during fasting) and glucose intake (i.e., food ingestion) as opposed to insulin-stimulated glucose uptake in target tissues, mainly skeletal muscle. Multiple factors in an older person contribute to such an imbalance of glucose regulation. Although resistance to peripheral insulin action contributes to altered glucose homeostasis, current evidence has found that the direct effect of aging on diabetes pathophysiology is through impairment of b-cell function, resulting in a decline in insulin secretion (Lee and Halter, 2017).Clinical manifestationsDiabetes type 2 presentations are similar to those of younger adult populations. Include polyuria,feeling tired, increased hunger or thirst, losing weight without trying, or having trouble with blurred vision. You may also get skin infections or heal slowly from cuts and bruises (Lee and Halter, 2017).For diagnoses of diabetes type 2 the Hemoglobin A1c >6.5% orFasting blood sugar >126 , 2 hour post prandial BS of >200 however this will require a 2ndconfirmation on another day (NIDDK, 2019).
Pre-diabetes BG rangeHemoglobin A1c 5.7-6.5%Fasting blood glucose 110-1252 hours postprandial 140-199 (NIDDK, 2019).
Morbidity and mortalityNumber of deaths: 83,564 Deaths per 100,000 population: 25.7. Cause of death rank: 7(CDC, 2017).
EvaluationMay need lifestyle modification such as weight loss, nutrition adjustments and increase physical activity. There may be a presence of atherosclerotic disease and comorbid conditions. Geriatric syndromes, such as cognitive and physical dysfunction, depression, and falls and urinary incontinence, are common in older people with diabetes and may have subtle presentations. Due to the effect of diabetes on physical function the risk of disability in performing activities of daily living is increased by twofold compared to those without diabetes. Diabetes is also associated with reduced muscle strength, poor muscle quality, accelerated loss of lower extremity strength, and muscle mass contributing further to physical limitation and frailty. Frailty can be defined as a condition in which an older person is coping just above the threshold of disability; therefore, any physical or psychological stress can lead to loss of independence and overt disability. Diabetes mellitus and insulin resistance increase the likelihood of accelerated aging process and the development of frailty. Diabetes complications may contribute to the worsening of geriatric syndromes, such as the increased risk of falls due to peripheral neuropathy or impaired vision caused by diabetic retinopathy. Unlike other chronic conditions, diabetes care is dependent on the patients’ ability to perform self-care tasks, which may be compromised by both cognitive and physical disability. For example, patients with cognitive impairment may not be able to recognize or treat hypoglycemia or remember and administer their insulin regime correctly. Also, patients with depression may have problems with medication or self-care compliance leading to persistent hyperglycemia and increased risk of diabetic complications (UpToDate, 2018).
Management according to UpToDate (2018):Goals are similar to those of the younger adult populationControl blood sugars- but avoid hypoglycemia, know that intensive tight control may contribute to frailty, confusion, falls, and confusion in the elderly. Elderly have a higher risk for hypoglycemiaKnow and reduce the risk of atherosclerotic and microvascular disease- reduction of risk through tight blood sugar control takes many years and may exceed life expectancy. Prevention of atherosclerotic and microvascular disease via lipid and blood pressure control has shown to be more beneficialControl lipids: goal: LDL 70-189,Control Blood pressure: goal: 120-140/70-80Smoking cessationAnnual eye carePodiatry care as indicatedControl nutritionWeight loss on an individual basisExerciseMonitoring of blood glucoseMonitor for albuminuria and kidney diseaseHealth maintenance interventions: ASA daily, Immunizations- influenza, zoster, pneumococcalCaregiver Education
Post 2MeAm
DemographicsAnemia is the reduction of red blood cells in a person’s circulating blood. In other words, anemia is a disorder where a person’s blood does not carry enough oxygen to the rest of their body. Anemia can be caused by; (1) impaired red blood cell production, (2) blood loss, (3) increased erythrocyte destruction and (4) A combination of all three previous factors. Anemias are usually classified by their causes like anemia of chronic disease, or by the changes that affects their size, shape, or hemoglobin content of the erythrocyte.PathophysiologyRed blood cell production takes place in the bone marrow where it is controlled by stromal network, cytokines and hormone erythropoietin producing reticulocytes. These reticulocytes remain in the bone marrow for 3 days before they are released into circulation (Epocrates, 2019). When a person has anemia, it decreases the number of red blood cell transporting oxygen and carbon dioxide impairing the body’s ability for gas exchange. Depending on the cause of anemia if pernicious anemia it is related to lack of intrinsic factor which helps in the adsorption of dietary vitamin B12 which is necessary for nuclear maturation and DNA synthesis in red blood cells. Intrinsic factor deficiency could be genetic or an autoimmune process directed against gastric parietal cells (like autoimmune gastritis) (McCance & Huether, 2014). Folate deficiency anemia is caused by impaired DNA synthesis secondary to folate deficiency resulting in megaloblastic cells. And iron deficiency anemia can be caused by lack of dietary intake and or excessive blood loss with thalassemia anemia being an inherited disorder depending on place of origin.Clinical PresentationPatients with anemia may present with depending on the kind of anemia1. Dyspnea2. Brittle fingernails3. Fatigue,4. Impotence/Priapism (prolong erection as seen in sickle cell patients which happens to be an emergency situation)5. Burning sensation on tongue6. Cheilosis7. GlossitisMortality/MorbidityAnemia killed 5,382 people in 2017. In 2016 anemia accounted for 2.8 million physician office visits of people presenting with anemia as a primary diagnosis and 526,000 people that presents to the emergency department with a primary diagnosis of anemia (CDC, n. d.).EvaluationTests to evaluate anemia; hemoglobin less than 12 for women and less than 13 for men/hematocrit, MCV size (may be normal or reduced microcytic/macrocytic), MCHC (may be normal or reduced), WBC and differential (it may be elevated depending on the cause), MCH, RDW, Peripheral blood smear, reticulocyte count, TIBC, Transferrin saturation, serum ferritin, serum iron, serum B12, serum folate and hemoglobin electrophoresis.ManagementManagement of anemia includes identifying the root of the problem and fixing it. If anemia of chronic disease, treat the underlying disorder. If iron deficient give iron supplement like oral iron e.g ferrous sulfate or IV iron infusion. Blood transfusion in severe cases of blood loss/low hemoglobin level when the benefits outweighs the risks. Erythropoiesis-stimulating agents (ESAs) to be used when anemia impacts the quality of life. And folate supplement (Epocrates, 2019).

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