Question

Alan, age 75 is a white man admitted to the hospital following a cerebrovascular accident. He has a history of Type 2 Diabetes Mellitus, Hypertension, moderate obesity, and consumes 4 alcoholic drinks per day. Medication on admission are Lasix, Inderal, Hydrochlorothiazide, and Diabanese 500 mg orally twice a day. Alan comes to the clinic regularly, and at his last visit, he complained of blurred vision, polydipsia, polyuria, and a weight loss of 8 pounds in the past two weeks. He was admitted to the hospital with a diagnosis of a urinary tract infection and hyperglycemia. Physical examination revealed the following: • Height 5’11” • Weight 215 lbs. • Cholesterol 380 mg/dl • Triglycerides 300 mg/dl • Blood Pressure 160/82 mmHg • Blood Sugar 315 • Family History: Sister has had Type 2 Diabetes Mellitus for 10 years.

1. What are Alan’s blood glucose and lipid goals?

2. Identify the times of day Alan should check his blood glucose levels?

3. List the symptoms and clinical data that support treating Alan for hyperglycemia. What are the appropriate treatment strategies?

4. What effect does Alan’s daily alcohol consumption have on his blood glucose levels?

5. What long term complications would you expect if Alan’s blood glucose levels are not properly controlled?

Answer 1

1.The goal of Alan's blood glucose levels is to maintain it less than 140 mg /dL after having food and less than 110mg/dL without food or in a fasting state.

The goal of the cholesterol in the blood should be brought less than 200mg/dL.

2.Alan should check his blood sugar levels in the following times of the day

• Fasting (in morning) This gives knowledge how the last night dose works to control the blood glucose level and helps to adjust the dose.
• After breakfast: to know the level of glucose in the body after morning dose after food
• Before lunch and after lunch : to plan the amount of medication which has to be given before lunch and plan the dose for night. Also it helps to identify what type and quantity of food should be taken to keep the levels under target.
• Before dinner: to give the night dose
• At bed time: this helps to avoid hypoglycemia in the night time

3.The symptoms and clinical data which supports Alan for getting treated for hyperglycemia are

• Polydipsia
• Polyuria
• Weight loss
• Blurred vision

The appropriate treatment strategies is to stary insulin therapy to bring the blood glucose under control

4.Dailyalcohol consumption in a day to f in moderate quantity can increase the level of blood glucose because alcohol contains high carbohydrates in . At the same time if it is taken in a very large quantities it will increase the insulin production leading to severe drop in the blood glucose levels.

5.The long term effects which can be noted in the patient if the blood glucose is not kept under control are

• Retinopathy
• Nephropathy
• Neuropathy
• Organ damage (renal failure)
• Disease associated with cardiovascular system.