DM-II, Case study PDF

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case study diabetes type 2...

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Case Study 76 Diabetes Mellitus Type 2 1. Interpret Y.L.'s laboratory results. The elevated fasting glucose level and HbA1c level confirm the presence of DM. Glucose should not be present in the urine; its presence also suggests DM. The absence of ketones is consistent with type 2 DM. In type 1 DM, the presence of ketones indicates that the body is using fat stores for energy, a process which is rare in type 2 DM. YL’s elevated total and LDL cholesterol levels, elevated triglycerides, and low HDL cholesterol are consistent with values often seen in those with type 2 DM because of insulin resistance. 2. Identify the three methods used to diagnose DM. Fasting Plasma Glucose Test Oral Glucose Tolerance test Hemoglobin A1c 3. Describe the functions of insulin. Its primary role is to deal with the regulation of glucose in the body and maintain the energy rich molecule in proper amount. It converts glucose into glycogen which is then used as a reserve food and is stored in the muscles. It promotes the storage of fat in the hepatic cells. It facilitates the transport of glucose from the cell membrane to the fat cells. 4. Describe the major pathophysiologic difference between type 1 and type 2 DM. In people with type 1 diabetes, the immune system mistakes the body’s own healthy cells for foreign invaders. The immune system attacks and destroys the insulin-producing beta cells in the pancreas. After these beta cells are destroyed, the body is unable to produce insulin. People with type 2 diabetes have insulin resistance. The body still produces insulin, but it’s unable to use it effectively. Researchers aren’t sure why some people become insulin resistant and others don’t, but several lifestyle factors may contribute, including excess weight and inactivity. 5. Name six risk factors for type 2 DM. Place a star or asterisk next to those that Y.L. exhibits. Weight loss Glycosuria* Chronic fatigue* Increased thirst* Frequent urination* Feet hurt* 6. How can you incorporate Y.W.'s cultural preferences as you develop her education plan? YW’s primary language should be assessed. Her understanding of diabetes should be asked. In some Asian cultures it is believe that developing diabetes is fate or the result of spiritual failure. Assess how her culture affects her lifestyle and what religion she practices. She may fast periodically, causing swings in glucose levels, and may wish to incorporate Eastern medicine practices into her DM care. Also ask what her eating habits are. Her diet could be high in carbohydrates such as rice and pasta.

7. What is the rationale for starting Y.L. on metformin (Glucophage) and glipizide (Glucotrol)? These drugs are used when the level of sugar increases in the blood due to DM. In such patients, the body is unable to store the excess glucose formed in the body. Glucotrol stimulates the production of insulin from the pancreas. Glucophage slows down the absorption of glucose in the small intestine. 8. Outline the teaching you need to provide to Y.L. regarding oral hypoglycemic therapy. Because a hypoglycemic reaction can occur with glipizide, teach her the symptoms of hypoglycemic reaction, how to treat a reaction, and ways to decrease the chance of a reaction. Teach her the symptoms of hyperglycemia and what to do if it occurs. She should avoid OTC medications unless approved by the prescriber. She should be taught to monitor blood glucose before eating breakfast and dinner. 9. What benefits should Y.L. receive from encouragement to exercise? Doing exercise will utilize glucose as a form of energy, which will prevent the accumulation of sugar in the blood. Exercise stimulates the muscles and ensures the proper flow of blood. This will make the patient energized and avoid any symptom of getting fatigue or muscular weakness. 10. Which of the symptoms that Y.L. reported today led you to believe she has some form of neuropathy? She was complaining about pain in her toes and feet which was tingling and numbness. She was feeling dizziness and fatigue due to abnormal rise in blood pressure. She was experiencing a problem with frequent urination. 11. What other findings in Y.L.'s history place her at increased risk for developing neuropathy? Because she has a history of hypertension, hyperglycemia, is overweight and smokes, she is at risk for developing other forms of neuropathy. 12. What would you teach Y.L. about neuropathy? DM is a common cause of nerve damage or neuropathy. It can manifest as pain, tingling, pins and needles, or numbness. High glucose levels over time damage nerves and alter how they send signals. Treatment of neuropathy is aimed at symptom relief and/or prevention of progression. It is important to control glucose levels, to exercise, and to be diligent about good foot care.

13. Because Y.L. has symptoms of neuropathy, placing her at risk for foot complications, you realize you need to instruct her on proper foot care. Outline what you will include when teaching her about proper diabetic foot care. Inspect all surfaces of the feet daily for cuts, blisters, swelling, and red, tender areas. Wash feet daily and dry feet thoroughly. Avoid hot water. Wear properly fitting shoes, and inspect the shoes daily for cracks and loose lining. Avoid high-heeled shoes. Avoid walking barefoot. Moisturize skin daily. Cut toenails straight across and file sharp edges to match the contour of the toe.

14. What monitoring will Y.L. need regarding nephropathy and retinopathy? She would need to be monitored for changes in renal function. She should have regular dilated eye examinations by an ophthalmologist or a specially trained optometrist, beginning now and on an annual basis hereafter....