Depression, Diabetes and Obesity
This is a case study on a 58-year-old male, Mr. H.Y. who worked at a supermarket and is now retired. He has a supportive wife who works full time and children who are all independent .He has a history of smoking, but quit 10 years ago and drinks alcohol twice a week. He is obese and a known case of diabetes for one year. He has gained 8 kg over the past four months, his blood glucose levels are uncontrolled. He denies feeling sad but doesn't like to take part in activities he once enjoyed, he feels tired and lethargic after doing any work, his sleep pattern is also disturbed. His drug history reveals that he is taking glyburide and multi-vitamins. He has scored 14 on his PHQ-9 score which indicates moderate depression. The patient has been diagnosed with depressive disorder not otherwise specified (DSM IV 311).
Mr H.Y has type 2 diabetes which is also known as non-insulin dependent diabetes. It is a metabolic disorder in which the beta cells of the pancreas do not produce enough insulin or there is resistance to the action of insulin on the cells of the body. (Kumar, et al., 2010). It affects 8.3% of the U.S. population. (CDC, 2011) . He has not been taking his medications for diabetes regularly. This increases his chances of developing complications of diabetes. He is also obese which is caused by various factors such as environmental, genetic, cultural, dietary habits, socioeconomic status, endocrine abnormalities, sedentary lifestyle, etc. In Mr. H. Y's case it is most likely due to his sedentary lifestyle, his lack of exercise, and depression. Obesity is prevalent amongst 35.7% of the U.S. population and one-fourth of obese patients are likely to develop depression (CDC, 2011) .Obesity can lead to the development of certain cancers, diabetes, coronary heart disease and may even lead to death.
The social and lifestyle determinants responsible for Mr. H.Y's condition are most likely him retiring from work at an early age due to his co-morbid conditions, more free time at hand, alcohol consumption, past history of smoking, full-time working wife and a chronic illness (diabetes).
DIAGNOSIS
According to the DSM IV, this patient has been diagnosed with Depressive Disorder Not Otherwise Specified as it does not meet the category of Major Depressive Disorder, Dysthymic Disorder, Adjustment Disorder With Depressed Mood, or Adjustment Disorder With Mixed Anxiety and Depressed Mood. It includes premenstrual dysphoric disorder, minor depressive disorder in which 2 to 5 of the symptoms of major depressive disorder are present for more than two weeks, recurrent brief depressive disorder, depressive disorder due to any underlying medical condition or substance abuse, post-psychotic depressive disorder of schizophrenia. (American Psychiatric Association, 2000)
To be able to be categorized as major depressive disorder, the patient must have more than one episode of at least five of the following symptoms for more than two weeks. These symptoms include feeling of emptiness, sadness, decreased pleasure in activities once enjoyed, significant weight loss or weight gain, disturbance in sleep pattern (insomnia or hypersomnia), fatigue, suicidal thoughts, feeling of guilt for no valid reason and slowing down of neurologic function and inability to concentrate. (American Psychiatric Association, 2000). Mr. H.Y. has denied feeling sad, has no feeling of guilt and does not have suicidal thoughts, but is suffering from all the other symptoms of depression.
Depression occurs in about 1 in 10 adults in the United States and is influenced by biological factors as studies show that there is a high incidence of depression amongst first degree relatives even if they have not been raised together. It is also influenced by environmental facts. Lack of support from family members, stress, financial problems, occupational problems are all situational factors that worsen a depressive disorder. (NANDA nursing, 2012).
TREATMENT
The treatment of diabetes entails tight glycemic control and lifestyle modifications such as exercise and a diet which is low in carbohydrates and high in protein. Pharmacologic treatment is essential in maintaining blood glucose levels. Sulfonylureas are drugs that stimulate the release of insulin from the beta cells of the pancreas. Meglitinides also stimulate their release of insulin from the pancreas, but they are short acting compared to sulfonylureas. Biguanides reduce the production of glucose by the liver and increase utilization of glucose in the peripheries thereby controlling blood glucose levels. Alpha glucosidase inhibitors delay the absorption of glucose and prevent a rise in glucose levels after a meal. Glitazones work by increasing insulin sensitivity of cells. Incretin mimetic agents reduce glucagon and stimulate the release of insulin. If all therapy fails insulin can be added to the diabetes drug regimen. Mr. H.Y should...
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