Gary has diabetes type 2. Nurse Martha has taught him about the illness and evaluates learning has occurred when the client makes which statement?
A. "My cells have increased their receptors, but there is enough insulin."
B. "My peripheral cells have increased sensitivity to insulin."
C. "My beta cells cannot produce enough insulin for my cells."
D. "My cells cannot use the insulin my pancreas makes."
Correct Answer: D. “My cells cannot use the insulin my pancreas makes.”
With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it. T2DM is an insulin-resistance condition with associated beta-cell dysfunction. Initially, there is a compensatory increase in insulin secretion, which maintains glucose levels in the normal range. As the disease progresses, beta cells change, and insulin secretion is unable to maintain glucose homeostasis, producing hyperglycemia.
Option A: There is a decrease, not an increase, in receptor sites with type 2 diabetes. Most of the patients with T2DM are obese or have a higher body fat percentage, distributed predominantly in the abdominal region. This adipose tissue itself promotes insulin resistance through various inflammatory mechanisms, including increased FFA release and adipokine dysregulation.
Option B: Peripheral cells have a decreased, not an increased, sensitivity to insulin. The beta cells continue to produce insulin with type 2 diabetes. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in T2DM.
Option C: Type 1 diabetes mellitus (T1DM) accounts for 5% to 10% of DM and is characterized by autoimmune destruction of insulin-producing beta cells in the islets of the pancreas. As a result, there is an absolute deficiency of insulin.
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