Running head: ILLNESS NARRATIVE – TYPE 2 DIABETES 1

Illness Narrative Type 2 Diabetes

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ILLNESS NARRATIVE ASSIGNMENT – TYPE 2 DIABETES 2

Illness Narrative Type 2 Diabetes

Introduction

Type 2 diabetes is one of the chronic diseases. It is a heterogeneous disorder that varies in

prevalence among the different ethnic groups. For instance, in the U.S. the most affected

populations include the Native Americans, more precisely the Asian Americans, Hispanic-

Americans and desert South westerners (America Diabetes Association, 2018). The illness is

characterized by higher levels of blood sugar. It is also referred to as adult-onset diabetes or type

2 diabetes mellitus. This is because it was previously prone to commence at the middle and late

adulthood stages of life. But, presently, the illness continues to affect more and more teenagers

and children. The following paper is an illness narrative following an interview with a patient,

Mr, Mike (62 years old and obese), who has been diagnosed with type 2 diabetes. The paper

looks at various elements and concludes by comparing the patient experience and the clinical

description.

Pathophysiology

The main pathophysiological features of the disease as discussed with the patient

following the interview include increased insulin resistance and impaired insulin secretion which

jointly will result to the development of the condition. In recent times, the patient was alerted by

his doctor it that with time, the functional pancreatic cell mass will decrease therefore making the

ailment a progressive disease. This confirms the studies carried out by Caramori, Luiza &

Michael (2017) which showed that some individuals like the Japanese possess several genes that

are susceptible to diabetes (350 genes in total). Nevertheless, several environmental factors on

top of these genetic factors all play a role in the onset of the disease. Consequently, the numbers

of patients are likely to increase to reflect the recent changes in lifestyle (Caramori et al., 2017).
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The patient mentioned about impaired secretion of insulin which from my analysis results

from lowered glucose responsiveness particularly the decrease in postprandial-phase secretion; a

very critical pathophysiological condition. Particularly, this if left untreated, glucolipotoxicity

will cause a decline in functional cell mass. This has linked the patient treatment of diabetes by

securing quality of life and lifespan which can be done by preventing progression of vascular

complications.

Etiology

The type 2 diabetes characteristic is insulin resistance and progressive decrease of the

pancreatic β cell insulin production. During very initial stages, the patient did not need

(something he claims his doctor advised) insulin because up to date there is no an autoimmune-

mediated damage of the pancreatic β cell.

More specifically, insulin resistance is whereby there is a production of insulin but it is

not used. The given quantity of insulin has no anticipated results. Being an obese diabetic patient

it could be that chronic inflammation which is closely linked to obesity has affected the proper

functioning of insulin receptors on the cells in the muscles, liver etc. The decrease in number of

insulin receptors consequently inactivates insulin receptors or affects signaling pathways of

insulin. On the same, when functional pancreatic β cell decline progressively is most likely due

to a decrease in the cell mass β resulting for apoptosis. The condition with this patient (65 years

old and obese) is attributed to insulin resistance itself, genetic susceptibility or aging. But, what

the author has come to notice is that the type 2 diabetes etiology is very complex and involves

both the lifestyles and genetic factors.

The genetic factor is where susceptible genes play a definite role in developing the

condition. According to Maritim (2014), this contribution seems to be very small. The effect
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occurs due to the common gene variants which create type 2 diabetes pre-dispositions that are

close to 5-10% (p.89). Therefore, unlike some of the inherited diseases, being homozygous for

this particular susceptibility is not a guarantee case of type-2 diabetes unless the crucial

environmental factors come into play like in this case. Mike is the only diabetic patient in his

family. In addition are the demographic or lifestyle factors. Maritim (2014) has stressed that

obesity is one major risk of developing type 2 diabetes, and therefore, the risk increases with

obesity. Particularly, excess adipose tissue is a state of chronic inflammation. Insulin resistance

will result from this inflammation in the adipose tissue or any other organ. Also, other risk

factors for the development of type 2 diabetes include metabolic syndrome, sedentary lifestyle

and age which could also apply to Mike.

Pathogenesis

Ordinarily, the pathogenesis of type 2 diabetes is the development of insulin resistance

which is attributed to compensatory hyperinsulinemia. For Mike, this is what followed the

gradual impairment of the beta-cell which would then result into hyperglycemia and a reduction

in insulin secretion. Hyperglycemia will cause extra inhibition of insulin secretion and even more

glucose toxicity (insulin resistance) further accentuating hyperglycemia. Hyperglycemia has a

general sign of tiredness and fatigues something that Mike mentioned. Hence, type 2 diabetes

development is a consequence of two abnormalities: deficient secretion of insulin and impaired

insulin action. Sadly, both impairments are worsened by hyperglycemia. Insulin resistance can be

compensated by normal beta cells. In that case, type 2 diabetes does not occur in absence of β-

cell abnormalities (Klaus & Andrea, 2015).

Morphologic Changes
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A patient may not be able to narrate the morphological changes. But, generally the

pancreas contains endocrine and exocrine compartment, with the former made up of the

pancreatic islet in it endocrine (ε, F, δ, α and β cells) together with enormous neural and vascular

supply. Within the islet, the morphological organization of these cells is critical for a normal

functioning of the endocrine. But, with the condition of type 1 and 2 diabetes, numerous

morphological changes take place in the pancreas. Mainly, it is the loss of β cells. The loss of

beta cells will as well takes place in cystic fibrosis-related diabetes, which therefore implies that

the exocrine abnormalities of the pancreas to a very big extent will affect the islet. In type 3

diabetes, the etiology linked to β-cell demise is even more complex. Inflammation, amyloid

depositions are some of the underlying mechanisms of losing beta-cells.

Clinical Manifestations

Type 2 diabetes symptoms have a very gradual appearance (Klaus & Andrea, 2015). In

fact, Mike stated that he did not notice these symptoms during the early stages of the disease.

But, with time he had these signs and symptoms, which include the following:

 Increased thirst and frequent urination: this is because when there is an excess

buildup of glucose builds up in the bloodstream, the body responses by extraction more

fluid from tissue cells. Consequently, the individual will fell more thirsty and drink more

water and urinate more

 Increased hunger: the illness makes the body cell unable to access enough glucose for

energy. Therefore, the organs and muscles will have very low energy and the patient will

feel more hungry that normal

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 Weight loss: Without insulin, the human body cannot burn fat because they require more

energy and instead protein in used. This will cause weight loss. Mike has lost more than

15 Kgs.
 Fatigue: With the lack of glucose the body will become tired. Fatigue interferes with day

to day life endeavors. He cannot walk for long distances or run.

 Blurred vision: Excess blood glucose could result in pulling fluid from the eye lenses

which causes swelling and temporary blurred vision. Mike cannot read with dim light or

without glasses sometimes.

 Sores and infection: The disease causes poor blood circulation which makes it even

longer for the patient to recover from infections. There could also be other nutritional

deficits. His wounds take time to heal like the one in his shoulder when he fell off the

bathtub.

Diagnosis

There are a number of tests that can be done to a person to determine whether they have

any form of diabetes. The test that was done to Mike was Glycated hemoglobin (A1C). This test

indicates the average level of blood sugar in a person. According to this test, normal blood sugar

levels should always be lower than 5.7 percent. If the reading is between 5.7 and 6.4, then

pediabetes attention is needed. Mikes scored initial 6.4 then 6.5. A level of 6.5 and above is an

indication that the condition of the patient is critical and immediate attention is required

(American Diabetes Association, 2017). The American Diabetes Association always advises that

routine screening is necessary for type 2 diabetes for patients who are 45 years and above (Klaus

& Andrea, 2015). This is mandatory for a patient in this category, and they are obese. However,

if the diagnosis of the patient yields normal results, then it is necessary to repeat the test after
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three years, though it is not mandatory. A healthy lifestyle is advisable to reduce the risks of

developing diabetes.

Clinical Course

Mike visits the hospital frequently on weekly basis. Two months ago he said he was

bedridden. A patient suffering from type 2 diabetes that have been presented to the hospital with

have higher burden of comorbidity. They will therefore require longer hospital stays, because

they are at risk of subsequent readmission. Modern treatment regiments include intense therapy

which has worked well with Mike. But, a careful evaluation of what best future strategy of

treatment should be undertaken like in the case of Mike. This is to take account of the patient’s

comorbidities including the renal function.

Summary-- Interviewee Experience with the Clinical Descriptions

In summary, the individual personal experience after being diagnosed with type 2

diabetes is a challenge. Most general reaction to the diagnosis was the concerns about the future

and anticipated life changes. For one, this follows the anticipated multifactorial treatment and

cardiovascular risk that the patient was to encounter. The reason for this is that Type 2 diabetes’s

clinical course is intense therapy. Intensive feeling also came with the anticipated lifestyle

changes such as inability to undertake some of the daily life tasks such as driving and reading

because the disease affected various organ systems.

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References

American Diabetes Association. (2018). Diagnosis and classification of diabetes mellitus.

Diabetes care 27.suppl 1: s5-s10. Accessed at:

https://care.diabetesjournals.org/content/27/suppl_1/s5

Caramori, M., Luiza, N. & Michael, K.M. (2017). Diabetes and nephropathy.Current opinion in

nephrology and hypertension. Journal of the American Dietetic Association 1.4: S119-

S213. Accessed at: https://www.dovepress.com/diabetic-nephropathy-ndash-

complications-and-treatment-peer-reviewed-fulltext-article-IJNRD

Klaus, C, & Andrea, K. (2015). Role of physical activity in diabetes management and

prevention.” Journal of the American Dietetic Association 108.4: S19-S23. Accessed at:

https://ses.library.usyd.edu.au/bitstream/handle/2123/12569/9781920899851_Chapter_16

.pdf;jsessionid=B9661E491F23E2BD7AD551C4FBEBEE1E?sequence=3

Maritim, A. C. (2014). Diabetes, oxidative stress, and antioxidants: A review. Journal of

biochemical and molecular toxicology 17.1: 24-38. Accessed at:

https://pdfs.semanticscholar.org/8789/be54f9980364005a13ccd80190451e8a3a48.pdf