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. 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 insulins?

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 glargine (Lantus) and lispro (Humalog) insulin regimen.

3. Identify important content to be included under pharmacologic therapy?

4. What specific points would you include regarding managing insulin therapy? Select all that apply:

1. Store unused insulin in the freezer.
2. The insulin can be used if it is yellow but not expired.
3. Administer the lispro (Humalog) within 15 minutes of eating.
4. Ideally, the glargine (Lantus) should be administered at bedtime.
5. Always administer the injections in the same easy-to-reach location.
6. The current insulin vial or pen o lispro (Humalog) can be kept at room temperature for one month.
7. Two injections will be needed to administer lispro (Humalog) and glargine (Lantus).

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

6. 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.?

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

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

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

10. 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?

11. 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.

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

  

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

Answer 1

Lispro dissociate rapidly resulting in more defined peak and shorter duration of action.it can be given before or after meal. A better control of meal time glycemia,postprandial hypoglycemia , reduction of HbA1c is achieved

Glargine dissocites slowly . Low blood levels of insulin are maintained for upto 24 hours.a smooth peakless effect is maintained, it is injected at bed time, it does not control meal time glycemia.it is injected separetely because of acidic ph.

All the above points apply.

She has to change her diet, avoid fast foods and high glycemic index foods such as potatoes, sugar tea . Etc

She has to take SMALL MEALS AT FREQUENT INTERVALS, AND A NIGHT SNACK TO AVOID HYPOGLYCEMIA IN LONG NIGHTS.

for pregnancy she has to consult a gynecolgist and a endocrinolgist, a diabetic mother usually have a large baby at 9 months pregnancy.

She has been doing well after changing her meals and lifestyle modification ,she has been advised how to keep control on blood sugar levels, and advised about  follow ups