Case Study 1 Mr GM. 58 years old. Diagnosed inn 2015 with T2DM during acute hospital admission following an unconscious collapse. Staff where he lives reported a 10-day period of being off his food...

Case Study Of A Patient With Type 2 Diabetes and Complex Co morbidities
The purpose of this study is to significantly discover the issues associated with the evaluation, management and intervention and of a person diagnosed with complex diabetes that has been managed by multi-disciplinary team members. This paper considers the case of Mr. GM. a 58-year-old man with health needs after diagnosed with type 2 diabetes. The case study also explores the physiology , anatomy and pathophysiology of types 2 diabetes.
Mr. GM. was admitted to hospital after an unconscious collapse in the year 2016 . His son who lives with him also reported the signs of lethargy, polyuria, polydipsia all typical symptoms of diabetes. . He also suffered from persistant diarrhoea and vomiting leading to dehydration. On inquiring he reported to have a history of Schizophrenia. He also suffered morbid obesity with BMI of 45.1 kg/m2. Blood tests for blood sugar revealed HbA1C of 12% (108mmol/mol) and a fasting blood glucose of 14mmol/L. Other findings detected normal level of Serial troponin, normal blood pressure and negative antibodies for Type 1 diabetes. The laboratory data also showed ketones which was 4 mmol/L and blood osmolarity of 352mOs/kg. The presence of high ketones and osmolarity indicated him suffering from diabetes ketoacidosis. Urinalysis demonstrated evidence of infection. Mr GM. also reported of taking medication for his mental health which was Quetiapine with Sodium Valproate
Diabetes is a type of metabolic disorder identified by high sugar level in blood. Chronic hyperglycemia is known to have long lasting effect and damages to different organs in the body, mainly kidneys, heart, nerves, blood vessels and eyes Symptoms of hyperglycemia comprises polyuria, polydipsia, abrupt loss of weight, and partial loss of vision. Severe consequence of untreated and high sugar also causes ketoacidosis or the nonketotic hyperosmolar syndrome (DeFronzo et al, 2004). Untreated diabetes for very long can also lead to severe complications such as nephropathy, retinopathy, peripheral nerve damage, loss of sensation in foot, foot ulcer with high risk of amputations, genitourinary, gastrointestinal, sexual dysfunction and cardiovascular symptoms (Sapra & Bhandari, 2021). Diabetic patient also have higher risk of acquiring cardiomyopathy, peripheral arterial, and cerebral vascular diseases Defect in metabolism of lipoprotein and hypertension are also observed in diabetic patient (Mellitus, 2005).
Diabetes Mellitus has several subtypes including type 1 Diabetes Mellitus, type 2 Diabetes Mellitus, gestational diabetes, and prediabetes. The most important types of Diabetes Mellitus are Type 1 and Type 2 diabetes. Type 1 Diabetes Mellitus also known as juvenile diabetes which is a chronic childhood disease that affects children and young people, while Type 2 Diabetes Mellitus is found in adults , middle-aged and elderly people with constant hyperglycemia due to wrong food choices and sedentary lifestyle. The pathogenesis for both the types of diabetes are unlike, and each type of diabetes has different diagnosis, and treatments (Goyal & Jialal 2018).
There are two main subtypes of endocrine cells present in the islets of Langerhans in the pancreas. One is known as insulin-producing beta cells and the other one is known as alpha cells that secrets glucagen. The number of beta and alpha cells frequently varies their level of secretions on the basis of presence of sugar and its amount in the environment. There should be a balance between glucagon and insulin without which the level of sugar in the blood becomes unsuitably off-center. In diabetes, insulin is either deficient or has impaired function leading to hyperglycemia (Sapra & Bhandari, 2021). Type 2 diabetes is a condition where cells are not able to use glucose competently for energy. This takes place when the cells in the body becomes insensitive to insulin and the glucose level in blood  gradually becomes very high (Sapra & Bhandari, 2021).
HbA1c and Fasting glucose levels diagnostic testing are helpful in the sooner detection of Type 2 Diabetes. In the case of borderline, glucose tolerance test can be used to estimate both serum response and fasting glucose levels to an oral glucose tolerance test (Sherwani el al, 2016). The condition that frequently appears before Type 2 Diabetes Mellitus is known as Prediabetes . Prediabetes can be monitored by checking the value of fasting blood glucose level which should be between 100 to 125 mg/dL (Sherwani el al, 2016).
On the basis of American Diabetes Association diabetes can be diagnosed through - HbA1c level which is 6% or; the level of a fasting plasma glucose which should range from 126 mg/dL or value higher than this, two-hour plasma glucose level should have a reading level of 11.1mmol/L or more for 75-g oral glucose tolerance test; random plasma glucose level should have a reading from 11.1mmol/L or higher than this in patient with polyuria, polydipsia, onserving abrupt weight loss, polyphagia or hyperglycemic crisis. The American Diabetes Association recommended screening of adults from the age of 45 years or more older despite of risk, where as United States Preventative Service Task Force recommends assessing patient from the age 40 to 70 years who are also overweight (Sapra & Bhandari, 2021).
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