Name: Zain Ul Abideen Khan

Student ID: 52102109

Cardiovascular Physiology & Pharmacology

BM3501

SECTION A

1. Ronan is a 28-year-old male who has a BMI of 32 kg/m2 and who has been
diagnosed with Type II diabetes mellitus. He is a smoker and consumes at least a
litre of sugary fizzy drinks each day. His blood glucose is frequently uncontrolled and
is often > 10 mmol/l even when he has been fasting for an extended period of time.
His HbA1c value is 82 mmol/mol when the ideal value should be 48 mmol/mol.
Ronan sees the diabetic nurse and she recommends that he needs to start making
some major lifestyle changes and begin taking oral anti-diabetic medication to
quickly address his hyperglycaemia.
A. Briefly explain why persistently elevated blood glucose levels are harmful to
health, using specific examples to illustrate your points (40%).
B. Explain what types of lifestyle changes Ronan needs to undertake to improve
his condition (10%).
C. Discuss which types of oral antidiabetic medications might be options for
Ronan, using diagrams to illustrate their mechanisms of action (50%).
Answer:

A.Briefly explain why persistently elevated blood glucose levels are harmful to
health, using specific examples to illustrate your points.

Persistently elevated blood glucose levels, also known as hyperglycaemia, occur

when there is an excess of sugar (glucose) in the bloodstream.

Hyperglycaemia, a pathological condition characterised by persistent elevation of

glucose levels in the blood, may lead to various health complications.
Hyperglycaemia can lead to acute and chronic complications, which can have
negative effects on various organs and systems in the body.

The primary aetiology of diverse diabetic complications is chronic hyperglycaemia,

and its complications are given as follows:

1.Diabetic neuropathy is a condition characterised by impaired function of the

peripheral nerves. This may manifest as abnormal sensations such as tingling,
numbness, or heightened sensitivity to pain. If left untreated, it can lead to
complications such as infections, injuries, and ulcers that may necessitate
amputation.

2.Cardiovascular pathologies: Hyperglycaemia is known to be a contributing factor to

the development of atherosclerosis, thereby elevating the likelihood of myocardial
infarction, cerebrovascular accident, and peripheral vascular disease.

3.Diabetic nephropathy is a condition characterised by vascular damage to the renal

system because of hyperglycaemia. This leads to impaired renal function and
insufficiency.

4.Diabetic retinopathy is a condition characterised by compromised retinal

vasculature, which may result in partial or complete loss of vision.

5.Impaired immune function may result in heightened vulnerability to infections,

particularly those affecting the integumentary and urinary systems.

6.Impaired wound healing is a condition characterised by a compromised healing

mechanism, which renders individuals susceptible to diabetic foot ulcers and
vulnerable to infections.

7.Cognitive impairment may lead to an elevated susceptibility to Alzheimer's disease

and dementia.

To minimise the likelihood of complications, it is crucial for individuals diagnosed with

Type II diabetes, like Ronan, to incorporate lifestyle changes. These changes include
following a healthy diet, engaging in regular physical activity, and quitting smoking.
Additionally, it is important to strictly adhere to prescribed medications that aim to
regulate blood glucose levels.
B. Explain what types of lifestyle changes Ronan needs to undertake to
improve his condition.

The medical management plan for Ronan entails the implementation of diverse
lifestyle modifications to optimise his condition and improve his management of Type
II diabetes. The modifications encompass:
1. Ronan has been advised to comply with a dietary modification regimen that
prioritises the consumption of a nutritionally balanced diet that is low in
saturated fats, sugars, and simple carbohydrates.
2. In relation to weight management, it is pertinent to mention that Ronan's body
mass index (BMI) of 32 kg/m2 categorises him as having obesity. The
adoption of a well-balanced diet and regular physical exercise may have the
potential to improve insulin sensitivity and regulate blood glucose levels
through the facilitation of weight loss.
3. It is recommended that Ronan engage in at least 150 minutes of moderate-
intensity aerobic activity per week, which may include activities such as brisk
walking, swimming, or cycling, to maintain his optimal physical health.
4. It is crucial for Ronan's overall health to quit smoking, as it may help reduce
the risk of developing comorbidities associated with diabetes, such as
cardiovascular disease and cerebrovascular accidents.

C. Discuss which types of oral antidiabetic medications might be options for

Ronan, using diagrams to illustrate their mechanisms of action.

Following is the list of anti-diabetic drugs that are suitable for Ronan. Each class of
drugs has a different mechanism of action by which they maintain normal serum
glucose levels:   
 Figure 1

1. Metformin, a member of the biguanide class of medications, is commonly

prescribed as the first-line pharmacological therapy for patients with a
diagnosis of type 2 diabetes. The mechanism of action entails a decrease in
hepatic glucose production and an increase in insulin sensitivity in peripheral
tissues, ultimately resulting in an amelioration of glucose uptake and
utilization. As per the extant medical literature, Metformin does not exhibit any
correlation with weight gain and might even elicit a favourable influence on
weight reduction. Considering Ronan's BMI, this may confer a notable
advantage.

Figure 2
2. Sulfonylureas, namely glimepiride, glibenclamide, and glipizide, operate
through binding to the sulfonylurea receptor located on the membrane of
pancreatic beta-cells. The process of binding causes an increase in calcium
ion concentration, which in turn triggers the secretion of insulin by stimulating
insulin release. It is noteworthy that the medications have the potential to
cause weight gain and hypoglycaemia, both of which may pose a health risk
to Ronan.

Figure 3

3.SGLT2 inhibitors, such as dapagliflozin, empagliflozin, and canagliflozin,

are a pharmacological class employed for the treatment of diabetes mellitus.
The previously mentioned drugs operate through the inhibition of the sodium-
glucose cotransporter-2 (SGLT2) situated in the renal proximal tubule. The
glucose transporter in question is responsible for the retrieval of glucose that
has been filtered from the urine and returning it to the bloodstream. By
inhibiting SGLT2, these pharmacological agents induce an increase in
glucose excretion through the urinary system, ultimately resulting in a
reduction in blood glucose concentration. Furthermore, they have the potential
to modestly reduce body weight and demonstrate a low frequency of
hypoglycaemic episodes.