¶ … Diabetes Mellitus Type II Diabetes is described as a condition that results from a chronic problem of hyperglycaemia that is brought about by insulin inaction in the body system. Diabetes type II is a condition that fronts the case for a range of diabetic problems characterised by some pathophysiological symptoms, including increased insulin resistance and impaired insulin secretion. The problems observed in the cell function and the deteriorating pancreatic conditions develop over a period of time. The root and development of diabetes type II is linked to the abnormal secretion of insulin, its action and endogenous output of glucose (EGO Type II diabetes affects over 6.4% of the world's population. This percentage represents over 285 million people the world over. It is expected that the number will increase to 7.7% (439 million) by the year 2030. The epidemic of Diabetes mellitus II (T2DM) as perceived by medical experts is an epidemic that is closely linked to obesity. It has been established that over 85% of patients with diabetes are obese or overweight. Further, it has been established that a lot of the treatments used for lowering glucose cause weight management complications. They lead to even more weight gain. The rise in the prevalence of diabetes and the accompanying comorbidities, plus the complications, exert a significant burden on the society and the available primary care facilities. Diabetes mellitus calls for controlling one's diet and a restricted calories intake. Patients are advised to cut down their consumption of fat and simple carbohydrates as they increase the consumption of fibre and complex forms of carbohydrates. There is also the need to engage in regular aerobics. It is an effective way of treating diabetes mellitus II as it reduces resistance to insulin and burns extra glucose. It is also observed that such regular exercise may lower blood lipids and help deal with stress effects. These two elements are important in forestalling complications and treating diabetes (Quillen & Kuritzky, 2015). Studies show that diabetes type II has a genetic link that relates to problems with the secretion of insulin and resistance. Some of the problems have been noted to be environmental. The latter set includes obesity, lack of exercise, overeating, stress and aging, which are evident in Tompkins' case. It is a condition that is brought about by a combination of genetic and environmental factors to a varying extent. Insulin resistance and impaired secretion contribute equally to the development of physiological conditions. Impaired insulin secretion is a condition that is manifested in decreased glucose responsiveness and is observed just before the onset of diabetes proper. The occurrence of impaired glucose tolerance, also referred to as IGT, is triggered by reduced glucose responsiveness in insulin secretion in the early stages and the accompanying decrease in insulin secretion after eating. A decrease in the secretion of insulin after meals leads to post-prandial hyperglycaemia. There is an excessive response observed in victims, such as Mr. Tompkins' diabetic condition. Such people show reduced insulin secretion in the early phase. Indeed, this phenomenon is an important feature in the development of diabetes cases. It is an essential element in the pathophysiological changes that diabetes victims experience. The impaired insulin secretion problem is noted as a progressive response. The impairment is characterized by the toxicity of glucose and lipotoxicity. If left untreated, the conditions are known to cause pancreatic secretion reduction (Kohei, 2010).

Diabetes type II is clearly evident in Mr. Tompkins's case. It manifests four main metabolic anomalies, i.e. insulin secretory dysfunction, impaired insulin action, obesity and a high rate of endogenous glucose output (Weyer, Bogardus, Mott & Pratley, 1999).

Case Study Symptoms

Increasing Dyspnea on Minimal Exertion (DOE)

Mr. Tompkins manifests an increased Dypnea on minimal exertion. This is a condition that is described as abnormal breathing that is elicited by a person, according to their fitness status. It is caused by a wide range of factors. It has multiple etiologies. It has also been established that pulmonary organ and cardiac organ systems are the most common causes of Dyspnea etiology

Dyspnea can easily be managed by the family physician. The diagnosis constitutes four basic categories, i.e. pulmonary, cardiac, non-pulmonary or mixed cardiac and non-pulmonary or non-cardiac. Dyspnea cases are caused by pulmonary or cardiac diseases and can easily be pointed out using a careful examination of the patient's history, along with a physical exam. Mr. Tompkins falls in this category, which further shows that Tompkins comes from a family with a diabetic history. There should be a screening spirometry, and electrocardiographs...

These will provide crucial information. Gas exchange and normal respiration physiology is a complex process; dyspnea is more complex. The wider diagnosis of Dyspnea as mentioned earlier constitutes four stages. The cardiac causes could be left, right or congestive heart from both ventricles, with the result being systolic dysfunctions, coronary disease of the artery, myocardial infarction that may be recent or remote, dysfunction of the valves, caerdiomyopathy, diastolic dysfunction, septal hypertrophy (asymmetric), ventricular hypertrophy that causes diastolic dysfunctioning, arrhythmias and pericarditis. Pulmonary triggers include restrictive and obstructive processes. Asthma and chronic obstructive pulmonary disease (COPD) are the most obstructive triggers. Obesity and chest wall or spine deformities, interstitial fibrosis pneumoconiosis, collagen and vascular disease and granulomatous disease ailment constitute common restrictive causes of dyspnea. Mixed pulmonary and cardiac disorders are common triggers of dyspnea. These causes include: pulmonary emboli and trauma as Tompkins case shows, cor pulmonale, pulmonary hypertension and deconditioning.
Dyspnea condition may also manifest as a somatic signal of psychiatric problems, including anxiety disorder and consequent hyperventilation. Checking the history, to determine if it is well captured, is a great way to pick important clues. If the history does not exist or provide much information, then the option is a proper diagnosis in most cases. The differential diagnosis can be narrowed down by a range of factors, including the number of pillows a patient needs during sleep, chest pain complaints, how smooth the sleep sessions are, exertion during the day or at night and tolerance to exercise, among others. Other important factors include: the history of tobacco usage, allergies from the environment, occupation lifestyle, congestive heart failure, coronary artery disease, valvular complications and asthma condition (Morgan & Hodge, 1998).

Tompkins family shows a history of diabetes. There is even an incident of death as a result of diabetes type II. Comprehensive family history to check lung problems, pulmonary infections, diabetes and bronchitis, among others, should be checked. Dyspnea can, usually, be easily diagnosed, if a careful study of the history and physical exam points out common pulmonary or cardiac etiologies. There is need to conduct specific diagnosis in order to confirm the condition or even assist in the therapeutic management. Peripheral edema is a common cause of confusion for many clinicians. It is a common finding in the investigation of a host of diseases. There is need, therefore, to conduct a systematic and rational checking of the patient with edema to ensure a cost effective diagnosis of the problem and the consequent treatment.

The Case of Swelling in His Legs

This paper rechecks the pathophysiological causes of the formation of edema as a means for understanding the complexities of edema formation in specific disease conditions, including the resultant implication for its treatment (Morgan & Hodge, 1998).

The Case of His Lower Legs Being Red, Warm to the Touch, and Mildly Painful

Mr. Tompkins shows that his legs and feet are swollen. These are typical of peripheral edema. They are a result of the accumulation of fluids in the tissues of the said parts. It is not ordinarily painful. Swelling is clearly seen in the lower parts of one's body, owing to gravity. Although the swelling is a common occurrence among older people, and may not necessarily signal a serious problem, it is always safer to do a medical check up to establish the cause of the swelling. Sometimes, it may be indicative of a more serious underlying health complication. For Mr. Tompkins, overweight issues and usage of certain medicines for controlling blood pressure are the more likely causes of the swelling. Leg tissue inflammation, which may in turn be a result of injury or some ailment, may even be caused by rheumatoid arthritis or an inflammatory disorder. Mr. Tompkins feels some pain as is the case in such conditions. The lower parts of his legs are warm to the touch and feel remotely painful (Mandal, 2016).

1. Blood sugar tests show that Mr. Tompkins' blood sugar is abnormally high at 190 in the morning, and 290 before dinner. The blood sugar test is an easy exam that uses blood samples obtained from a vein puncture using a finger stick. Diabetes is the condition that results from excessive blood sugar in one's body. Such a scenario leads to a myriad of complications that can lead to death, if not carefully treated and/or managed. Some of the common complications that emanate from high blood sugar include: blindness; also known as restinopathy, or even the failure…