Question

Case Study Diabetes Mellitus Type I

5. You may work with a partner or group and hand in one case study for the group. Make sure all names are on the case study. Do not “divide and conquer” – work together.
5. All answers require a reference you ½ point will be deducted per question.
5. The Lewis text book is a good resource.  But also utilize your Maternal Child as well as your nutrition text. These may be helpful.

• Scenario

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 A_1c(HBA_1c) 8.8%, cholesterol 310 mg/dL, triglycerides 300 mg/dL, high-density lipoprotein (HDL) 25 mg/dL, low-density (LDL) 160 mg/dL and creatinine 0.9 mg/dL. Her body mass index is 37.6. Her blood pressure is 160/96. 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, medication nutrition therapy and exercise.

1. Identify the important content to review regarding glucose monitoring.

2. K.W. states her diet is mostly fast foods, and the foods cooked at home are high starch and fat. She says because of her work schedule, mealtimes often very form day to day. What is carbohydrate (CHO) counting and shy would this method work well for K.W.?

3. Identify important pints to be covered in a basic nutrition plan with CHO counting.

4. K.W. states that she currently does not exercise at all. What benefits will K.W. receive from participation in an exercise program?

5. What do you need to teach K.W. regarding safe exercise?

6. K.W. states she and her husband were planning to have another child in a year or two. She want to know if DM will affect the pregnancy. Pregnancy in a persons with DM is complex issue. What basic information can you share with K.W. today without overwhelming her?

7. What evaluative parameter could you use to determine whether your teaching with K.S. was effective?

• Case Study Progress:

K. W. calls the clinic several days later complaining of having the “flu”. She says that she has been nauseated and vomited once during the night. She sats she has had two loose stools. On questioning she states she does have a few hills and might have a low grade temperature but does not have a thermometer to check her temperature. She states she did not check her glucose level this morning or take her insulin because she has not eaten.

8. Describe the instruction that you need to give K.W. regarding the management of her illness and DM.

  

9. Write below how you would document the phone call with K.W. in progress note format.

Answer 1

Firstly, greet the patient with a smile on your face and introduce your identity and ask her how she feels?

Identify whether she knows about type 1 DM and its management.If she doesn't know educate her about DM in a simple language.

Diabetes mellitus is a group of conditions in which a person has high glucose (sugar), either because the body cannot make enough insulin to store glucose, or because it cannot utilize the produced insulin adequately. T1D is an autoimmune condition. The body’s immune system attacks the insulin-producing cells (beta cells) in the pancreas by mistake and destroys them. As these cells get destroyed and cannot produce sufficient insulin, the person with T1D develops high glucose in the blood. A person with T1D can eventually get sick and dehydrated if not diagnosed in a timely manner.

Secondly, make sure that whether she is following a DM diet,Carbohydrate counting and Physical exercise.If not explain her that by following DM diet and exercise will control her blood sugar levels,cholesterol levels and also your blood pressure.By doing exercise and folowing a diet plan we can avoid complications like kidney disease,heart disease,stroke,high blood pressure,eye disease and skin infections.

Moreover,provide a detail explanation about insulin and its action and how to take injection and value checking with the help of a glucose machine.

Injecting your insulin shot

To perform your insulin injection:

• Wherever possible, wash your hands with soap and water before injecting.
• Put a new needle onto your pen.
• Remove the caps of the pen needle.
• Hold the pen upright and perform an ‘air shot’. This requires dialling up at least 2 units and pressing the plunger to expel a test shot of insulin. This helps to clear any bubbles out of the needle. If you do not get a steady stream, repeat the air shot until you do get a steady stream of insulin coming out.
• Dial up your dose.
• Pick a soft fatty area to inject. Tops of thighs, belly, bum and triceps (triceps; the top and back of the upper arm, are not always recommended for children or thinner people).
• Some people may need to raise a fold of fatty flesh slightly between your thumb and fingers. If you are unsure about whether you need to do this, ask your health team.
• Put the needle in and keep the pen steady.
• Push the plunger relatively slowly to inject the dose.
• After the dose has been injected, hold the needle in for a good 10 seconds to help insulin get delivered and prevent any of the dose escaping out.
• Ensure that the used needle bin is deposited into a sharps bin.    

Emphasise the importance of checking frequent blood sugar levels and other investigations.

Atlast, make her realize that when we have diabetes, do your best to avoid getting flu,or influenza.The flu can put added stress in your body,which can affect your blood sugar levels and raise the chances of serious health complications and encourage her to use thermometer at home to monitor temperature.

At the end of the conversation make sure that she understood everything and also make a follow-up visit to monitor her improvements also,provide a details leaflet about type 1 DM for her better understanding.

PALEO DIET

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