Case Study 81 DM1 Jordan Northup PDF

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Jordan Northup Case Study 81 DM Type 1 You work in the diabetes mellitus (DM) center at a large teaching hospital. The first patient you meet is K.W., a 25-year-old Hispanic woman, who was just released from the hospital 2 days ago after being diagnosed with type I DM. Nine days ago, K.W. went to see the physician after a 1-month history of frequent urination, thirst, severe fatigue, blurred vision, and some burning and tingling in her feet. She attributed those symptoms to working long hours at the computer. Her random glucose level was 410 mg/dL. The next day her laboratory values were as follows: fasting glucose 335 mg/dL, hemoglobin A1C (HbA1c) 8.8%, cholesterol 310 mg/dL, triglycerides 300 mg/dL, high-density lipoprotein (HDL) 25 mg/dL, low-density lipoprotein (LDL) 160 mg/dL, ratio 12.4, and creatinine 0.9 mg/dL. Her body mass index is 37.6. Her blood pressure (BP) is 160/96 mm Hg. She was admitted to the hospital for control of her glucose levels and the initiation of insulin therapy with carbohydrate (CHO) counting. After discharge, K.W. has been referred to you for comprehensive education. You are to cover four basic areas: pharmacotherapy, glucose monitoring, medical nutrition therapy (MNT), and exercise. 1. K.W. was started on sliding scale lispro (Humalog) four times daily and glargine (Lantus) insulin 30 units at bedtime. What is the most significant difference between these two insulin therapies? The difference is their onset, peak, and duration. Lispro is a fast-acting insulin that acts within 15 minutes, a peak effect of ½ to 1 hour, and a duration of 3 to 4 hours. Patients on lispro are taught not to take it until they sit down or at most 10 minutes before eating. The short duration necessitates frequent administration. Glargine (Lantus) is basal insulin with no peak effect and a longer than 24-hour duration of action. The risk of hypoglycemia is minimal. Its long duration allows for once daily injection. 2. K.W. says she knows people who “only take 2 shots” because they are on NPH and regular insulin and wants to know why she can't do that. Explain the advantages of using the glargine (Lantus) and lispro (Humalog) insulin regimen. The most effective treatment, with the best glycemic control, is one that closely mimics normal insulin production of the body, using lispro, before meals and a long-acting basal background insulin one to two times daily. Other advantages to this treatment include less weight gain and less nocturnal hypoglycemia because glargine insulin provides long acting efficacy. 3. What specific points would you include regarding managing insulin therapy? Select all that apply. a. Store unused insulin in the freezer. b. The insulin can be used if it is yellow but not expired. c. Administer the lispro (Humalog) within 15 minutes of eating. d. Ideally, the glargine (Lantus) should be administered at bedtime. e. Always administer the injections in the same, easy-to-reach location.

Jordan Northup f. The current vial of lispro (Humalog) can be kept at room temperature for 1 month. g. Two injections will be needed to administer lispro (Humalog) and glargine (Lantus). 4. Identify important content to review regarding glucose monitoring. • Teach the importance of monitoring glucose levels at home. It allows the maintainence of target glucose levels, detecting/preventing hypoglycemia, and evaluating response to diet and activity. • Teach how often and when to monitor blood glucose levels before and after meals, at bedtime in order to assess the efficacy of this treatment. Keep a log of glucose levels; the Physician will use this to adjust the treatment. • Assist in selecting a glucometer that meets her needs. • Teach how to properly take a blood glucose sample. 5. K.W. states that she currently does not exercise at all. What benefits will K.W. receive from participating in an exercise program? The benefits of exercise are from regular aerobic activity. Exercise helps control DM by increasing the number of insulin receptor sites which increases the effectiveness of insulin treatment. Other positive health effects of regular exercise include lower weight and reduced body fat, improved strength and dexterity, and better cardiovascular health. 6. What do you need to teach K.W. regarding safe exercise? • Check blood glucose before exercise. Avoid exercise when fasting glucose levels are >250 mg/dL with ketones present. Use caution if glucose levels are more than >300 mg/dL with no ketosis. She should eat more carbs if her glucose levels are...