Case Study Type 1 Dm
CASE STUDY—Type 1 Diabetes Mellitus
M.M., a 10 year old female, presents to the office with an approximate 10 lb. weight loss over the last few weeks, nausea, increased thirst and urination. She denies abdominal pain. Her father has had Type 1 DM for 14 years and one cousin was diagnosed with Type 1 DM at age 18 months.
1. What other history and PE exam would you perform? What further testing is required to confirm your diagnosis?
Physical exam reveals a thin, white female in no acute distress. Mucous membranes are dry. Rest of PE is normal. Lab studies reveal: Random blood sugar 411 (70-150mg/dl) BUN 24 (7-20) Sodium 129 (135-145) Chloride 93 (96-110) Potassium 5.4 (3.5-5.0) Bicarb 23 (21-28) CO2 23 (24-32) Serum Ketones Positive (Negative) WBC 11,600 (5,000-10,000) Hgb 13.7 (11-15)
2. What is your diagnosis and plan for this patient?
The child was admitted to the hospital for 24 hours and given sub-q insulin and oral fluids. Over the next 18 hours her blood sugars decreased to 140 mg/dl. Her last chem profile showed Sodium = 135, Potassium = 3.6, Chloride = 109, and CO2 = 25. She was seen by the dietitian and taught carbohydrate counting. Her discharge medication regimen was Humulin N Insulin 8 units in the morning with Humalog 3 units, Lunch—Humalog 3 units and Humulin N 4 units with 3 units of Humalog in the evening with addition of 3 units Humalog if pre-prandial Blood Sugars over 300 .
3. What is your nursing diagnoses for this patient? What teaching is appropriate during and after hospitalization for the newly diagnosed Type 1 patient?
The patient returned to the office the next day after discharge. She was using her father’s home glucose monitor 4 times/day and felt comfortable with technique. She was drawing up her insulin, but had not given a self-injection.
Blood sugars per monitor were:
FBS Noon Supper HS
9-20 311
M.M., a 10 year old female, presents to the office with an approximate 10 lb. weight loss over the last few weeks, nausea, increased thirst and urination. She denies abdominal pain. Her father has had Type 1 DM for 14 years and one cousin was diagnosed with Type 1 DM at age 18 months.
1. What other history and PE exam would you perform? What further testing is required to confirm your diagnosis?
Physical exam reveals a thin, white female in no acute distress. Mucous membranes are dry. Rest of PE is normal. Lab studies reveal: Random blood sugar 411 (70-150mg/dl) BUN 24 (7-20) Sodium 129 (135-145) Chloride 93 (96-110) Potassium 5.4 (3.5-5.0) Bicarb 23 (21-28) CO2 23 (24-32) Serum Ketones Positive (Negative) WBC 11,600 (5,000-10,000) Hgb 13.7 (11-15)
2. What is your diagnosis and plan for this patient?
The child was admitted to the hospital for 24 hours and given sub-q insulin and oral fluids. Over the next 18 hours her blood sugars decreased to 140 mg/dl. Her last chem profile showed Sodium = 135, Potassium = 3.6, Chloride = 109, and CO2 = 25. She was seen by the dietitian and taught carbohydrate counting. Her discharge medication regimen was Humulin N Insulin 8 units in the morning with Humalog 3 units, Lunch—Humalog 3 units and Humulin N 4 units with 3 units of Humalog in the evening with addition of 3 units Humalog if pre-prandial Blood Sugars over 300 .
3. What is your nursing diagnoses for this patient? What teaching is appropriate during and after hospitalization for the newly diagnosed Type 1 patient?
The patient returned to the office the next day after discharge. She was using her father’s home glucose monitor 4 times/day and felt comfortable with technique. She was drawing up her insulin, but had not given a self-injection.
Blood sugars per monitor were:
FBS Noon Supper HS
9-20 311