Question

Mr. Gennaro is a 61-year-old Spanish-speaking man who presents to emergency room with his wife Dolores. Mr. Gennaro is also Spanish-speaking, but understand some English. Mr. Gennaro complains of nausea and vomiting for two days and symptoms of confusion. His blood glucose is 796 mg/dL. Intravenous regular insulin is prescribed and he is admitted for further evaluation. He will require teaching regarding his newly diagnosed diabetes.

He is a past medical history of coronary artery disease (CAD) and hypertension (HTN). Smokes one pack of cigarettes per day; tobacco use for 35 years. He also takes jerbero, and curandera.

Mr. Gennaro is newly diagnosed with diabetes. His hemoglobin A1c is 10.3%. Mr. Gennaro is slightly overweight. He is 5’10” tall and weighs 174 pounds. He reports no form of regular exercise. He does not follow a special diet at home. He states, “I eat whatever Dolores puts in front of me. She is a good cook.” Neither can recall how long it has been since these changes are Mr. Gennaro began. Dolores states, “it has been quite a while now. It just seems to be getting worse and worse.”

1. Discuss how culture may influence Mr. Gennaro’s diabetes management interpreting food choices diet and exercise and use of an alternative healthcare provider.

2. Discuss what Mr. Gennaro should be taught about how to manage his diabetes on days that he is ill.

3. Mr. Gennaro meets his friends at a local bar once a week for beer or two. What impact does alcohol have on diabetes? Should he discontinue the social activity?

Answer 1

1.Effect of culture in diabetes management with food choices, exercise and use of alternate health care provider:

Keeping the blood sugar levels within the range istthe most important part of diabetes management. That's because many things make the blood sugar levels change, sometimes unexpectedly. The factors include :

1.food - healthy eating is the key of healthy living with or without diabetes. But in diabetes, how foods affect your blood sugar levels is very important . It's not only the type of food you eat, but also how much eaten and the combinations of food types taken.

Coordinate the meals and medications-

Too little food in proportion to your diabetes medications especially insulin may result in very low blood sugar (hypoglycemia). Too much food may cause your blood sugar level too high (hyperglycemia).

2.Exercise-

Physical activity is another important part of diabetes management plan. During exercise, the muscles uses sugar (glucose) for energy. Regular physical activity also helps the body use insulin more efficiently.

These factors work together to lower the blood sugar level. The more strenuous the workout is the longer the effect lasts. But even light activities like housework, gardening or being on your feet for extended periods can improve your blood sugar.

3.Medication -

Insulin and other diabetes medications are designed to lower your blood sugar levels when diet and exercise alone aren't sufficient for managing diabetes. But the effectiveness of these medications depends on the timing and amount of the dose. Medications taken for conditions other than diabetes also can affect your blood sugar levels.

2.management of diabetes on days of sickness -

1.Continue taking your insulin and diabetes pills as usual.

2.Test your blood sugar every 4 hours and keep track of the results.

3.Drink extra calorie free liquids and try to eat normally.

4.Stay on track. Unless your doctor tells to make a change, keep taking the same diabetes medicines.

5.Check blood sugar and ketone levels often.

6.Pay special attention to nausea and vomiting.

7.Prevent dehydration.

8.Use over the counter (OTC) medicines wisely.

9.Get some rest.

3.Impact of alcohol on diabetes :

The liver normally releases stored sugar to counteract falling blood sugar levels. But if the liver is busy metabolizing alcohol, the blood sugar level may not be increased even if needed. Alcohol can result in low blood sugar shortly after you drink it and for as long as 24 hours afterward.

Alcohol can aggravate diabetes complications, such as nerve damage and eye disease. But if the diabetes is under control and the doctor agrees an occasional alcoholic drink is acceptable.

Don't drink alcoholic beverages on an empty stomach- if insulin or other diabetes medications is taken , be sure to eat before drinking or drink with a meal to prevent low blood sugar.