Case study # 1,
Y.L. makes an appointment to come to the clinic where you are employed. She has been complaining of chronic fatigue, increased thirst, constant hunger, and frequent urination. She denies any pin, burning, or low-back pain on urination. She tells you she has a vaginal yeast infection that she has treated numerous times with 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 says, “By the time I get home, and make supper for my family, them 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.
In reviewing Y.L.’s chart, you notice she has not been seen since the delivery of her child 6 years ago. She has gained considerable weight; her current weight is 78.5 Kg, she is 160 cm (5’3”) tall. Today, her blood pressure is 152/97 mm Hg, and her plasma glucose level is 16.1 mmol/L. Her family physician orders the following diagnostic tests: urinalysis, HbA1c, fasting BG (blood glucose), fasting lipid profile (cholesterol, LDL, HDL and triglycerides). Lab results are as follows:
Fasting BG: 10.2 mmol/L
Urinalysis: positive glucose, negative ketones
Total cholesterol: 7.3 mmol/L
LDL: 240 mmol/L
HDL: 49 mmol/L
Triglycerides: 2.9 mmol/L
A subsequent fasting BG is also elevated and Y.L. is diagnosed with DM type 2
After meeting with Y.L and discussing management therapies the physician decides to start multiple dose injection of insulin therapy and have the patient count carbohydrate intake. Y.L. is scheduled for education classes and is to work with the diabetes team to get her BG under control.
1. Identify the...