Question

For the past 2 or 3 years, Leah 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%. Leahs’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

Leah is 58 years old, does not have a history of diabetes, is 5’2” and weighs 165lbs, 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!”

1. What can you tell Leah 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 Leah exhibits for developing diabetes.

2. If Leah’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?

3. Leah 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 Leah need to use a needle for her diabetes management? What are some strategies she can implement to avoid this?

4. 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?

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

Answer 1

Hi Leah I have checked your blood glucose report and it is little higher than the normal. of course it was normal in your previous report. Your fasting blood sugar level is 137 mg/dl. It was 100-120 mg/dl for the past 2-3 years. A fasting blood sugar level less than 100 mg/dL is normal. A fasting blood sugar level from 100 to 125 mg/dL  is considered prediabetes. If it is 126 mg/dL or higher on two separate tests, you have diabetes. As your blood sugar value is 137 mg/dl you have diabetes Mellitus.

Another important test is HbA1c what’s known as glycated haemoglobin.The hemoglobin A1c test tells you your average level of blood sugar over the past 2 to 3 months. This is something that’s made when the glucose (sugar) in your body sticks to your red blood cells. Your body can’t use the sugar properly, so more of it sticks to your blood cells and builds up in your blood.   For people without diabetes, the normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher chance of getting diabetes. Levels of 6.5% or higher mean you have diabetes. As your value is 8.3% it is confirmed that you have diabetes.

Risk factor To develop diabetes for Leah is the high calorie intake. Recommended calorie intake according to her age is 2100 Kcals per day. her calorie intake according to her diet is approximately 2457 which is one of the risk factor. another risk factor is her weight. For her height the recommended weight is 104-135 lbs. but she is 165 which is considered to be obese. so over weight is another risk factor.

To calculate the estimated blood sugar value from Hb A1c we use the formula directly, using a calculator: 28.7 x HbA1c — 46.7 = eAG (in mg/dl). HbA1c value of Leah is 8.3. so 28.7x8.3-46.7= 191.51 mg/dl.

Diet and exercise alone were once the standard diabetes therapies for early type 2 diabetes. diabetes can be easily controlled with some oral drugs like Metformin. Metformin works by decreasing your liver's production of glucose (sugar) and increasing the body’s sensitivity to insulin. If metformin doesnt work other drugs like Sulfonylureas, Meglitinides can be used. To avoid injectable insulin she have to do regular exercise and follow strict diet along with the medications.

Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin. Exactly why this happens is unknown, although genetics and environmental factors, such as being overweight and inactive, seem to be contributing factors. so it shows up late in life.

Life style modifications recommended for Leah

• Taking two and a half hours each week of moderate intensity physical activity or one hour and 15 minutes of high intensity exercise.
• Losing weight gradually to achieve a healthy body mass index
• Replacing refined carbohydrates with wholegrain foods and increase intake of vegetables and other foods high in dietary fibre
• Reducing the amount of saturated fat in the diet