Question

For the past 2 or 3 years, Donna has always had fasting blood sugar levels in the 100-120 mg/dL range. When she presents in your clinic however, her fasting blood sugar is 137 mg/dL and her hemoglobin A1c is 8.3%. Donna’s 24-hr recall includes:

Breakfast: English muffin with 2 t. butter, 1 slice American cheese, 1 Jimmy Dean sausage patty, 20 oz. water

Snack: 1 large (4x4”) brownie

Lunch: chicken salad sandwich on 2 slices wheat bread with lettuce, tomato, and mayonnaise, 1 oz. BBQ chips, 12 oz. orange soda

Dinner: Lean Cuisine Alfredo Pasta with Chicken & Broccoli, 16 oz. sweet tea

Snack: 2 c. chocolate Haagen-Dazs ice cream

Donna is 58 years old, does not have a history of diabetes, is 5’2” and weighs 165#, and she is on medication for hypertension. She says she has tried to lose weight many times in the past and often has success, but she always gains it back. She reports that she eats a “fairly healthy” diet but just loves to bake and often indulges in sweets. She does not know much about diabetes, except that it requires you to give yourself shots—and she hates needles, saying “Don’t expect me to give myself a shot!”

What can you tell Donna about her current and past diabetes status? What lab values helped you to determine that, and what are the relevant cut-points? Describe some risk factors that Donna exhibits for developing diabetes.

If Donna’s hemoglobin A1c is 8.3%, what is her average blood sugar? How did you figure this out? How does that compare to her fasting blood sugar, and why is it different or similar?

Donna is so scared of needles that at any mention of diabetes, she immediately resists, saying, “Don’t expect me to give myself a shot.” What can you tell her about various diabetes treatments and the likelihood of her needing to give herself a shot? Will Donna need to use a needle for her diabetes management? What are some strategies she can implement to avoid this?

Explain why Type 2 diabetes often shows up later in life and how it differs from Type 1 Diabetes. How do the treatments for the two diseases compare?

What lifestyle changes would you recommend for Donna? What dietary recommendations would you make? Explain why you decided to focus on the behaviors that you did

Answer 1

1.At present Donna is prediabetic patient because her past 2-3 years fasting blood sugar is 100-120 mg/do.today my clinic her fasting blood sugar is 137 mg/FL and glycosylated hemoglobin is 8.3 percentage because her eats high calorie foods from last 24 hours. 2 lab value mostly decided diabetes are 1 blood sugar level both fasting and random,impaired glucose tolerance test and oral glucose tolerance test.3. cut of point -impaired fasting blood sugar more 88 to 110mg/dl and HbAc1is 5.7to6.4 percentage. 4 risks factor are - high body weight, inactivity , genetics susceptibility most of time idiopathic. Donna HbAc1 level is 8.3 mean her blood sugar levels is around 200 mg/dl it is different from current blood sugar levels because sugar is metabolism by body enzymes so blood sugar levels is low. She refused to insulin injections so give oral antdiabitics drugs like sulphonylureas ,meglitinide,biguanide, alpha glucosidase inhibitor,thiazolidinedions etc.or give insulin therapy by continuous subcutaneous insulin infusion by a battery driven pump.In latter life she show's type 2 diabetes because she is prediabetic and obese woman.type 2 is different from type 1 because in type 1 insulin producing beeta cells are distraction but type 2 only insulin resistance occur.tretment of type 1 is only external insulin therapy.type2 both insulin and oral antdiabitics drugs. Life style change occur like regular morning walk for 4 km , refused weight,diet modifications low calorie diet for a 3-4 step Diet.and focus to behavior change keep low blood sugar level by regular exercise and diet plan . Following physician diet plan.and regular check up.