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Type 2 Diabetes Case Study - page 2
Keywords: Daibetes, case study, Diabetes Melltitus, NIDDM patient history
By Einstein10 on 30/12/2009
Level: Foundation Degree
Page Number: 2 of 6 pages: 1 2 3 4 5 6Chimera’s Physical Exam
Examination Result
Weight 112 kg; height 165 cm
Body Mass Index (BMI); 41.1 kg/m2
Fasting capillary glucose 152mg/dl
Blood pressure Lying. Right arm 154/96 mmHg;
Sitting. Right arm 140/90 mmHG
Pulse 88 bpm; respiration 20 per minute
Eyes Pupils equal and reactive to light, corrective lenses, no arteriolovenous nicking, no retinopathy
Thyroid Nonpalpable
Lungs Clear to auscultation
Heart Rate and rhythm regular. No murmurs or tachycardia
Neurological assessment No vibratory sense to the forefoot, no ankle reflexes, sensation above ankle is present (peripheral neuropathy)
Lab Results
Table 4. 10 8 Chimera’s Lab Results
Test Result
Glucose (fasting) 159mg/dl (normal range: 65-109mg/dl)
Creatinine 0.9 mg/dl (normal range: 0.5-1.5mg/dl)
Blood Urea nitrogen 21 mg/dl (normal range: 7-30mg/dl)
Sodium 139 mg/dl (normal range: 135-146 mg/dl)
Potassium 3.9 mg/dl (normal range: 3.5-5.3mg/dl)
Lipids Total cholesterol: 173 mg/dl (normal range: <200mg/dl)
HDL cholesterol: 46mg/dl (Normal range: ≥40mg/dl
LDL cholesterol: 93mg/dl (normal range: <100mg/dl)
Triglycerides: 167mg/dl (Normal range: <150mg/dl)
Cholesterol-to-HDL ratio: 4.1 (Normal: <5.0)
AST (Aspartarte aminotransferase) 19 IU/l (normal: 0-40 IU/l)
ALT (Alkaline transaminase) 24 IU/l (normal: 5-40 IU/l)
ALP (Alkaline phosphatase) 64 IU/l (normal: 35-125 IU/l)
HbA1C 7.8 % (normal: 4-6%)
Urine microalbumin 43 mg (normal: <30mg)
Assessment
Based on the patients medical history, physical and laboratory results she is assessed by the physician as follows:
• Uncontrolled type 2 diabetes
• Obesity ((BMI); 41.1 kg/m2)
• Hyperlipidemia
• Peripheral neuropathy (based on neurological assessment)
• Hypertension
• Elevated urine microalbumin level (possible nephropathy)
Treatment
After the assessment the clinician decided that a first line of medication should control Chimera’s glucose control, her hypertension and reduce her weight. Chimera was referred to a dietician for advice of food intake and exercise. Her diet history revealed increased amount of carbohydrate in high portions and minimal or no daily exercise as well as regular red wine. The dietician advised her to cut her meal portions and to reduce her carbohydrate intake by replacing it with foods high in fibre and starch alongside keeping her red wine to a minimum. He also recommended that she did 15-20 minutes exercise daily, even if it be a brisk walk in the park. Furthermore, a nurse helped Chimera in educating her in self-monitoring in blood glucose (SMBG) as well as showing Chimera how to use a blood glucose meter. 10
Below is a summary of the medication that Chimera’s clinician could have used/did use.
Table 5. 2 6 Drugs used to lower blood glucose/Drugs used for Chimera
Drug Effectiveness to patient’s condition/Complication
Thiazolidinediones like rosiglitizone and pioglitizone are effective in combating insulin resistance but can increase the weight of the patient so cannot be used in this case
Sulphonylurea or Meglitinide are effective in combating postprandial-elevations associated with carbohydrate intake but can increase the weight of the patient so cannot be used in this case
Glyburide was prescribed
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