Question

Nutrition

Case Study - Type 2 Diabetes Mellitus Mrs. Ellex is a 51-year-old African American female who works as a bookkeeper for an insurance company. Her father and brother have type 2 diabetes mellitus, and have had severe complications because of poor control of blood glucose She is 5' 4" tall and weighs 174 pounds with a medium frame. She has a history of obesity, hypertension, hypothyroidism, and frequent urinary tract infections, and is currently taking propranolol and levothyroxine Mrs. Ellex.complains of constant fatigue over the past two months and has lost 8 pounds, although she is thirsty and hungry and eats all the time. She is concemed that she may have another urinary tract infection because she has frequent urination and pain in her lower abdomen. Her physician orders some fasting blood tests and the results show the following glucose 380 mg/dl (normal 70-110 mg/dL) HA 76% (normal<6%), serum LDL cholesterol 270 mg/dl (normal 200 mg/dL), triglycerides 290 mg/dl. (normal 200 mg/dL). She is diagnosed with type 2 diabetes, and started on a 1200 kcal diet and glyburide. She is also scheduled to see the nurse, who is a Certified Diabetes Educator (CDE), at the end of the week for further counseling 4 points each, be detailed and specific in your answers 1. What symptoms of type 2 diabetes does Mrs. Eolley, manifest? Explain the pathophysiology of each of these symptoms 2. What is the relationship between being overweight or obese and type 2 diabetes? 3. Describe HbA and how is it used to monitor diabetes? 4 In view of her other laboratory results, what other dietary counseling will Mrs. Elles need (other than glucose)? List some specific diet changes needed due to these labs. 5. Mrs. Es family members suffer from some of the complications of uncontrolled diabetes. What are some of the chronic complications that she is at risk for developing?

Answer 1

1) Symptoms manifested by Folley were weight loss, thirst and hunger, fatigue, frequent urination.

Weight loss - due to insufficient insulin, body cells will not get enough glucose from blood to use as energy. So body will start burning fat and muscle for energy thus reducing body weight.

Increased thirst and frequent urination - due to increased glucose in blood,body cannot use sugar from food properly. This sugar collects in blood which cause thirst and also it cause kidney to overdrive to force extra sugar out.

Hunger - due to high blood glucose level, glucose from blood cannot enter cells due to insulin resistance thus cannot convert food in to energy. This lack of energy causes hunger.

Fatigue- high blood sugar level and low insulin level affects body's ability to get glucose from blood in to cells .thus affects body's ability to utilise glucose to meet energy needs thus causing fatigue.

2) Obese people have greater tendency of developing type 2 diabetes. Obesity causes increased level of fatty acids and inflammation leading to insulin resistance. This insulin resistance makes glucose to build up in body thus causing type 2 diabetes.

3) HbA1C is glycated heamoglobin.It is a form of heamoglobin linked to sugar.Most monosaccharides including glucose bind with heamoglobin when present in blood. When glucose build up in blood.it binds to heamoglobin. This test measures how much glucose is bound. RBC live for 3 months. So test shows average glucose level in blood for 3.months.

Normal value - below 5.7%

Pre diabetes- 5.7 to 6.4%

Diabetes - 6.4% or higher

HbA1C is reflective of how well sugar is controlled.

4) Diet regulations for hyperlipidemia should be advised.

Eat a diet low in saturated and trans fat. Do regular exercise.

Include fruits ,vegetables, beans, nursing, whole grains and fish to diet Add fiber rich foods ind diet..Include omega3 fatty acids,olive oil.Drink enough water.1

5) complications are cardiovascular complaints, diabetic nephropathy, neuropathy, diabetic retinopathy, foot problems, skin conditions.