Case Study 76
* Fasting glucose: 184 mg/dL-above 99 mg/dL suspected diabetes mellitus among other etiologies * HbA1C: 8.8%-The American College of Endocrinology recommends and A1C less than 6.5%. An A1C of 8.8% would also indicate diabetes mellitus. * Total cholesterol: 256 mg/dL-total cholesterol above 200 mg/dL could indicate uncontrolled diabetes * Triglycerides: 346 mg/dL-levels above 150 indicate diabetes mellitus * LDL: 155 mg/dL-Increased levels of LDL indicates metabolic syndrome and increased risk of diabetes mellitus * HDL: 32 mg/dL- Decreased levels of HDL indicates metabolic syndrome and increased risk of diabetes mellitus * UA: +glucose, -ketones- glucose represents diabetes mellitus
2. Three methods for diagnosing DM.
1. Fasting plasma glucose ≥126 mg/dl
2. Symptoms of hyperglycemia and a casual plasma glucose ≥200 mg/dl. 3. 2 hour plasma glucose ≥200 mg/dl during an OGTT.
3. Three function of insulin.
* Allows cells to use glucose for energy.
* Stimulates lipogenesis
* Stimulates growth
4. Describe major pathophysiologic difference between type 1 and type 2 DM.
Type 1: Immune-mediated disease. The body’s own T cells attack and destroy pancreatic beta cells. There is a virtual absence of endogenous insulin.
Type 2: The pancreas usually continues to produce some endogenous insulin but the insulin that is produced is either insufficient for the needs of the body or is poorly utilized by the tissues, or both.
5. Risk factors for type 2 DM? Place a star or asterisk next to those that Y.L. exhibits.
* Weight *
* Fat distribution *
* Family history
* Race *
* Gestational diabetes *
6. What is the rationale for starting Y.L. on metformin and glipizide?
Oral agents are used for type 2 DM to improve the mechanisms by which insulin and glucose are produced and used by the body. The combination of glipizide and metformin helps the body cope with high blood glucose. Glipizide stimulates the release of insulin from the pancreas, directing your body to store glucose. Metformin has three different actions: it slows the absorption of glucose in your small intestine; it also stops your liver from converting stored glucose into blood glucose; and it helps your body use your natural insulin more efficiently.
7. What teaching do you need to provide to Y.L. regarding oral hypoglycemic therapy?
* Instruct Y.L. that oral meds will help keep blood glucose controlled and will help prevent serious long and short-term complications of diabetes. * Teach Y.L. that oral meds are used in addition to diet and activity as therapy for diabetes and that they should continue with their meal and exercise plans. * Y.L. should not take extra pill if overeating has occurred. * Teach about prevention, symptom recognition, and management of hypoglycemia. * Contact primary healthcare provider if periods of illness or extreme stress occur as Y.L. may need to add insulin to better control diabetes.
8. What potential benefits could Y.L. receive from encouragement to exercise?
* Better management of blood glucose levels
* Improvement of cardiovascular function
* Weight loss and weight control
* Improvement of general health.
9. Which of the symptoms that Y.L. reported today led you to believe she has some form of neuropathy?
* Her feet hurt and they “burn or feel like there are pins in them”.
10. What findings in Y.L.’s history place her at increased risk for the development of other forms of neuropathy?
* Poor blood glucose control: she has a history of gestational diabetes. * Being overweight
* High blood pressure
* Increased triglyceride levels
11. How would you educate Y.L. about neuropathy?
* Help Y.L. understand that maintaining proper blood glucose levels are important for...