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Case Study
Type 2 Diabetes Mellitus

Y. L. makes an appointment to come to the clinic where you are employed. She has been complaining of (C/O) chronic fatigue, increased thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination. She tells you she as a vaginal yeast infection that she has treated numerous times with the over-the-counter (OTC) medication. She admits to starting smoking since going back to work full time as a clerk in a loan company. She also complains of having difficulty reading numbers and reports making frequent mistakes. She also says, “By the time I get home, and make supper for my family, then put my child to bed, I am too tired to exercise.” She reports her feet hurt, they often “burn or feel like there are pins in them.” She reports that, after her delivery, she went back to her traditional eating pattern, which is high in carbohydrates (CHO). In reviewing Y.L’s chart, you notice she has not been seen since the delivery of her child 6 years ago. You note that in her 26th week of pregnancy she was diagnosed with gestational diabetes mellitus (GDM). You also note that she is 5’3” and her pre pregnancy BMI was 25. Her father has type 2 diabetes mellitus and both paternal grandparents had type 2 DM. She has gained considerable weight; her current weight is 173 pounds. Today, her blood pressure is 152/97 mm Hg, and her plasma glucose is 291 mg/dl. Her primary care provider (PCP), which of course is a Family or Adult Nurse Practitioner, orders the following labs: urinalysis, hemoglobin A1C, fasting complete metabolic panel (CMP), CBC, fasting lipid profile, and glomerular filtration rate (GFR). The lab values are as follows: fasting glucose 184 mg/dl, Hb A1C 10.4, UA +glucose, -ketones, cholesterol 256 mg/dl, triglycerides 346 mg/dl, LDL 155 mg/dl, HDL 32 mg/dl, ratio 8.0. A subsequent fasting glucose is also elevated and Y.L is diagnosed with type 2 diabetes mellitus. After meeting with Y.L. and discussing management therapies, the PCP decides to start multiple-dose injection (MDI) insulin therapy and have the patient count CHO. Y.L. is scheduled for education classes and is to work with the diabetes team to get her blood glucose under control. You may use your text book and you must also use 2 additional references (not Wikipedia). List your references at the end. Refer to the rubric for guidance. Double space and make sure your name is on the attachment.

1.Identify the three methods used to diagnose DM.
The recommended screening and diagnostic test for diabetes is to measure fasting plasma glucose, oral glucose tolerance test, and use of the glycated hemoglobin A1c measurement (A1C). The American Diabetes Association provides criteria for diagnosing diabetes and are as follows: In nonpregnant adults: symptoms of diabetes and casual plasma glucose greater than or equal to 200 mg/dl, or fasting plasma glucose greater than or equal to 126 mg/dl, or 2-h plasma glucose greater than or equal to 200 mg/dl during an oral glucose tolerance test. Certain individuals should be screened more often (every 1-2 years) than others when they have any of these following issues: overweight (BMI greater than 25), history of gestational diabetes, history of vascular disease, first-degree relative with diabetes, high-risk ethnic group, previously found to have impaired glucose tolerance or impaired fasting glucose, and signs of insulin resistance, such has acanthosis nigricans, hypertension, dyslipidemia, or polycystic ovary syndrome. The patient Y.L. has many of these issues that qualify her for screening. She is overweight, (BMI 30.6),she is hypertensive, she has a history of gestational diabetes, her father has diabetes. Y.L. was diagnosed with DM with an A1C of 10.4, fasting glucose of 184 mg/dl, and a subsequent fasting glucose that was also elevated. 2.Explain Type 2 DM.

Type 2 DM has a complex pathology. Most individuals with Type 2 DM...
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