Concern of worsening fatigue

Case 2:
A 48-year old female presents to her physician with concern of worsening fatigue over the past months.
She reports feeling tired out all the time and unable to concentrate. Nothing seems to make it better, not even rest. She has not seen a physician in a number of years other than for routine OB/gyn care and reports having gradually put on 40-50 lbs. over the past 10 years. (Current weight 253; height 65.5 inches)
She undergoes an oral glucose tolerance test and based on that data (and other laboratory values) she is diagnosed with type 2 diabetes. Further testing shows she is also hypertensive and has hyperlipidemia.
What is the metabolic connection between type 2 diabetes and hyperlipidemia? Be specific in your discussion and include relevant enzymes related to lipid metabolism.
Circulating levels of which lipoproteins would be consistent with a diagnosis of hyperlipidemia? Be specific and include rationales for why some lipoproteins may be elevated and others not.
This individual is prescribed metformin to help manage her blood glucose levels. Describe the proposed mechanisms by which metformin reduces blood glucose levels and increases beta-oxidation. Be sure to include a discussion of AMP Kinase in your answer.

 

Sample Solution

Diabetes mellitus is the most frequent endogenous cause of fat metabolism-disorder. In diabetics the risk for arteriosclerosis is significantly higher and the clinical significance of hyperlipidemia should be estimated more serious as in non-diabetics. The predominant abnormality of fat metabolism in diabetes is hypertriglyceridemia due to an increase of triglyceride-carrying lipoproteins, the chylomicrons and the very-low-density lipoproteins. In type I-diabetics the decisive pathogenetic factor for hypertriglyceridemia is the impaired degradation of VLDL and the reduced chylomicron-clearance, caused by decreased activity of the lipoproteinlipase.

Section I: INTRODUCTION TO THE STUDY Introduction The country is encountering a basic deficiency of medical care suppliers, a lack that is supposed to increment in the following five years, similarly as the biggest populace in our country’s set of experiences arrives at the age when expanded clinical consideration is vital (Pike, 2002). Staffing of emergency clinics, facilities, and nursing homes is more basic than any time in recent memory as the huge quantities of ‘gen X-ers’ start to understand the requirement for more continuous clinical mediation and long haul care. Interest in turning into a medical caretaker has disappeared lately, likely because of the historical backdrop of the extraordinary and requesting instructive cycle, low compensation, firm and extended periods of time, and fast ‘wear out’ of those rehearsing in the calling (Wharrad, 2003).

A complex oversaw care climate in this country is restricting the dollars accessible to be spent on nursing care. Numerous wellbeing callings, particularly nursing, have the standing of ‘eating their young’ as opposed to offering compelling coaching to develop future medical services suppliers. Because of these variables, the quantity of medical attendants has diminished and businesses regard themselves as understaffed and seeking able work force. Before 2001 the decay had been apparent for a considerable length of time (Sadler, 2003). Nursing schools, public pioneers, medical services pioneers and the overall population is impacted by the absence of Registered Nurses (RNs) accessible.

As the populace ages, the assumption is that a rising number of RNs will be required essentially to keep up with the ongoing degree of medical care. Furthermore, the momentum ecological and political worries of expanding pandemic sickness, event of synthetic and catastrophic events, and expanding dangers of war, requires critical expansions in the medical services labor force (Jefferys, 2001). The public nursing lack and factors that increment the interest for expanding the nursing labor force notwithstanding public, state, and nearby debacles make the potential for a general wellbeing emergency. Nursing programs have endeavored to satisfy need for medical attendants by expanding enlistment and campaigning effectively for expansions in program subsidizing by schools and states for understudies.

Tragically, the issue of nursing understudy weakening hampers the best endeavors of nursing programs and irritates the public lack of Registered Nurses in the United States (Ofori, 2002). In 2003, the National League for Nursing revealed a positive vertical pattern in the nursing labor force supply in any case, the American College of Healthcare Executives (2006) detailed that in 2005, 85% of emergency clinic directors decided medical clinics needed more enlisted medical attendants to fulfill patient consideration needs. The United States Bureau of Labor insights showed by 2014, more than 1.2 million new and substitution nursing positions would be expected to meet the public medical services needs (Ramsburg, 2007).

Various broad endeavors to diminish weakening have been made by nursing programs including reinforcing affirmation methods and executing maintenance programs. Unfortunately, the issues of weakening keep on continuing nursing schools the nation over. Admission to a nursing program is serious and numerous potential understudies are denied confirmation every semester. Steady loss from nursing programs influences not just the particular understudy who is acknowledged to a nursing program and ineffective, yet in addition the understudy denied confirmation that might have been effective. Steady loss rates are expensive to understudies, nursing projects, and medical services the same by diminishing the quantity of likely alumni from schools of nursing and adding to the nursing lack. Many examinations feature the a lot higher than wanted whittling down rates for nursing understudies

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