Type 2 Diabetes and Hypertension

The Pathophysiology of Type 11 Diabetes and Hypertension & How the Alterations of each Comorbid Disorder Impact Each Other 

Type 11 Diabetes 

The pathogenesis of type 2 diabetes entails resistance of insulin, abnormal insulin secretion, and the liver producing high levels of glucose. According to research professionals, the aptitude of insulin to obstruct hepatic glucose creation in type 2 diabetes and to arouse its uptake and utilization by muscle cells and adipose is weakened (Einarson, Ludwig & Danton, 2018). Type 2 diabetes defects seem to occur in the beta cells of lean patients. On the other hand, primary defects in overweight patients cause damage to the target cells. 

Hypertension 

The autonomic and central nervous systems play major roles in the regulation of blood pressure. The centrally placed presynaptic beta receptors arouse the production of norepinephrine while alpha 2 receptors obstruct its production. Stimulation of alpha 1 receptors in arterioles and venules results to vasoconstriction, while activation of beta 2 receptors causes vasodilation. Upon a drop in blood pressure, baroreceptors send an impulse to the brain, causing vasoconstriction and increased heartbeat (Leung et al., 2017). On the contrary, once blood pressure increases, baroreceptors send the brain an impulse decreasing heart rate and causing vasodilation. 

How Patient Factors and Socio-demographic Indicators Affect the Pathophysiology of the Disorders 

Pediatrics/Adolescents 

Greatest risk factors associated with this age group are inactivity and obesity. The greatest indicator for the existence of type 2 diabetes in adolescence is dark pigmentation of skin around creases and the flexural region. 

Hypertension is at hand in 20 per cent to 30 per cent of adolescents with type 2 diabetes. According to Copeland et al. (2013), children and adolescents need treatment by a specialist. They should be given treatment encompassing medical, nutritional therapy and exercise. 

Geriatric 

Diabetes 2 complications in the elderly develop at a faster rate due to poor glycemic control. This condition causes a decrease in their renal function. Therefore, it is prudent that health care workers introduce exercise programs for the elderly by minding their comorbid conditions. 

For hypertension patients, their blood pressure can be minimized via the introduction of low sodium diets as well as weight loss. Antihypertensive medications can be started at low doses and titrated slowly in elders (Leung et al., 2017). 

Pregnancy 

Pre-gestational diabetes presents before pregnancy and specialists treat it during pregnancy. On the other hand, gestational diabetes is intolerant of glucose during pregnancy and is treated after pregnancy. Gestational diabetes can be controlled by medical, nutritional therapy and proper diet for pregnant women. Failure to be effective, a patient is injected with insulin. 

Women detected with hypertension prior to pregnancy should maintain consuming antihypertensive agents during their gestation period. Important to note, Beta-blockers should be evaded in young pregnancy as they can cause fetal growth. 

Types of Health Assessments and Diagnostic Reasoning Applicable to Patients 

Language Barrier 

Providing care to a patient is difficult with strained communication, especially when doctors and patients do not speak the same language. Diabetic and hypertension patients find it difficult for trusting their physicians while doctors find difficulty activating their patients (Einarson, Ludwig & Danton, 2018). 

Ethnicity 

Blacks, Hispanics and Asians compared to whites have lower levels of health insurance coverage (Copeland et al., 2013). With such differences, black, Hispanic and Asian type 2 diabetes and hypertension patients understand that they cannot always receive the best medical attention. 

Compensatory Mechanisms Displayed by Patients 

Adaptive 

Type 2 diabetes and hypertension patients display adaptive responses in various ways. After testing positive for the ailment, they immediately commence treatment to regulate their blood glucose levels and blood pressure. They take precautions, like exercising and eating healthy meals. 

Maladaptive 

Hypertension and type 11 diabetes patients may display maladaptive responses through denial, avoidance and isolation. Once they undergo tests and become aware of their status, some refuse to commence treatment (Copeland et al., 2013). Others avoid taking medication and isolate themselves from people. 

Pharmacokinetics and Pharmacodynamics of Medications Considering Specific Patient Factors 

Sulfonylureas 

This oral hypoglycemic drug is used in the treatment of type 2 diabetes for rectifying derangements of lipid, carbohydrate and protein metabolism. When administering Sulfonylureas, physicians introduce first and second-generation agents in the lowest doses and titrate them as required to attain required blood glucose levels (Leung et al., 2017). However, one-third of people who have type 2 diabetes fall short of responding to this drug due to damaged beta-cell function, not a success to observe the appropriate diet, or when experiencing traumatic occurrences like the eruption of infections. 

The biggest complication of using sulfonylureas is hypoglycemia. In the elderly, it causes risks like isolation or financial constraints when undertaking treatment. Copeland et al. (2013) states that in younger patients, hypoglycemia is related to abuse of alcohol or overexertion. Expectant women could lose their fetuses, and all patients using this drug are advised to consider using sun protection. 

Beta-Adrenergic Blockers 

Beta-blockers minimize blood pressure by jamming central and peripheral beta receptors that cause reduced cardiac production and sympathetic hemorrhage. This drug contains agents like metoprolol succinate and nebivolol that are safer for patients. 

Victims should shun Beta-blockers with asthma except in low doses, sinus bradycardia, overt cardiac failure, chronic obstructive pulmonary disease, or third-degree heart block (Copeland et al., 2013). Beta-blockers are preferable in the treatment of hypertension in patients with coronary heart disease. Overuse could result in dizziness, nausea, fatigue and the development of congestive heart failure. 

How Potential Interactions between Medications Prescribed to Treat Comorbid Patient Conditions Justify the Selection of the Medications 

Sulfonylureas 

The agent is useful in the treatment of type 11 diabetes. It binds to receptors on beta cells resulting in the closure of adenosine triphosphate (ATP)-dependent potassium channels. With the opening of the calcium channels, cytoplasmic calcium increase, therefore, arousing the production of insulin (Einarson, Ludwig & Danton, 2018). Physicians believe that these drugs contain extrapancreatic effects on the liver, adipose cells and muscles. Therefore, they are ineffective for use in type 1 diabetes patients. When used singlehandedly, they have a great impact on blood sugar more so in lean and insulinopenic patients. 

Beta-Adrenergic Blockers 

Beta-blockers are agents useful in the treatment of hypertension. They mostly bind to beta 1 receptors and are cardioselective since they do not block beta 2 receptors. The agents include atenolol, bisoprolol and leprossor. They are safer than non-selective beta-blockers for patients with asthma, peripheral heart disease and chronic obstructive pulmonary disease (Leung et al., 2017). However, with higher doses, selective beta-blockers lose cardio selectivity and could as well exacerbate an already existing ailment. Therefore, physicians should be aware of selecting correct doses of beta-blockers for patient administration. 

How Drugs May Impact Various Body Systems in Patients and Measures to Reduce Negative Effects 

Sulfonylureas 

This agent should not be used to treat pregnant women with cases of type 11 insulin because they are likely to terminate the fetus. Instead, glyburide could be the option for treatment of pregnant women unable to use insulin. Similarly, nursing mothers should not ingest sulfonylureas as it is excreted in human milk, and is harmful to the baby. 

Beta-Adrenergic Blockers 

Some beta-blockers have partial beta-receptor agonists that minimize the heartbeat of hypertension patients. Similarly, beta-blockers may reduce activity involved with the progression of heart failure. Therefore, physicians should caution patients not to discontinue therapy abruptly as it could result in myocardial infarction, unstable angina or death. 

How to Educate Patients on Disorders Considering Age, Developmental Level 

Young people prefer using technology to be it in their social or educational lives. Therefore, educating them about diabetes and hypertension could not be much easier through watching a DVD or reading on the internet (Copeland et al., 2013). They could also learn about the different levels of the disease through the same channel. Older people tend to have emotional, mental and physical impairments. Therefore, physicians should consider using visual materials and hands-on methods when teaching the physically impaired about disorders. For those with emotional problems, they can use close family members to pass vital information. 

References 

Copeland, K. C., Silverstein, J., Moore, K. R., Prazar, G. E., Raymer, T., Shiffman, R. N., ... & Flinn, S. K. (2013). Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents. Pediatrics, 131(2), 364-382. 

Einarson, T. R., Acs, A., Ludwig, C., & Panton, U. H. (2018). Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovascular diabetology, 17(1), 83. 

Leung, A. A., Daskalopoulou, S. S., Dasgupta, K., McBrien, K., Butalia, S., Zarnke, K. B., ...& Gelfer, M. (2017). Hypertension Canada's 2017 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Canadian Journal of Cardiology, 33(5), 557-576.