Question

R.H. is a 62-year-old woman who comes to the clinic for a routine physical examination. She works as a banking executive and gets little exercise. She says she is “just tired.” She has gained 18 pounds over the past year and eats a high-fat diet. Her BP is 162/98, heart rate is 92, and respiration rate is 20. R.H. also complains of increased thirst and frequent nighttime urination. She denies any other weakness, numbness, or changes in vision

1.      What clinical manifestations of diabetes is she displaying?

2.      What diagnostic tests for diabetes would you expect the health care provider to order and why?

3.      The lab results show a low HDL, high Cholesterol and Triglycerides level and a Fasting glucose 130. What risk factors for diabetes does R.H. have?

4.      Which type of diabetes is R.H. at highest risk for developing and why?

5.      R.H. wants to know if she will have to take insulin daily. How will you respond? If your patient needs insulin what are some key points that you will include with your teaching?

6.      What are some good exercise strategies for R.H.?

7.      How can R.H. prevent hypoglycemia?

Answer 1

1. Increased thirst and frequent urination , tired.

2. HBA1C test .It shows the average blood sugar level for the past 2 to 3 months.

3. Weight .

Physical Inactivity.

High blood pressure.

Low level of HDL ( high density lipoprotein ).

High level of triglycerides.

4. Type 2 diabetes

Overweight , Inactivity , high blood pressure , low HDL , high triglycerides are more likely to develop type 2 diabetes.

5. Tell R.H that diabetes is a progressive disease and may require insulin injections to compensate decrease in insulin production.  

Patient teaching:-

Check the blood sugar regularly.

Inject insulin subcutaneously.

Inject correct dose at correct time.

Don't rub the skin immediately after the injection.

Avoid using the same site of injection.

6. Walking , cycling , swimming , aerobic dance , yoga.

7. Monitor blood sugar .

Adjust medication or eat additional snack if increase   the physical activity.

Take medication on time.

Don't skip meals .