Question

Mr. F. was diagnosed with type 2 diabetes mellitus at age 46. At that time, he was overweight, enjoyed foods with high carbohydrate and fat content, and led a sedentary life. His family history indicated that his mother and his brother had diabetes. Weight loss, appropriate diet, and exercise were recommended to reduce blood glucose levels.

1. List the factors contributing to diabetes mellitus in this case.

At age 50, Mr. F. noticed that his vision was cloudy, particularly in one eye. Cataracts were removed from both eyes.

2. Describe a cataract, and explain how diabetes promotes cataract formation.

3. Glyburide (DiaBeta) was prescribed at this time. Describe the action of this drug.

At age 56, a blister developed on the heel of one foot, which did not heal. An ulcer formed and persisted. Finally the foot was placed in a cast for 13 weeks to promote healing.

4. Explain several factors contributing to the delayed healing in Mr. F.

5. Why was it necessary in this case to remove the cast and replace it each week?

Peripheral neuropathy with total loss of sensory function had developed in both feet. Motor function was not directly affected. Orthopedic shoes were ordered and arrangements made for a podiatrist to provide regular foot care.

6. Why is it essential that Mr. F. examine his feet carefully each day?

At this time body weight had again increased substantially and blood pressure was elevated. Fosinopril (Monopril) was prescribed, along with recommendations for weight loss and regular exercise.

7. Describe the usual manifestations of hypertension.

At age 60, routine monitoring during a workout at the health club indicated atrial fibrillation. During consultation, the cardiologist also noted his blood pressure was very high.

8. State the purpose of the following medications prescribed at this time (see Chapter 18): fosinopril (Monopril), atorvastatin (Lipitor), amlodipine (Norvasc), warfarin (Coumadin), and sotalol (Sotacor).

Since that time, continued regular exercise and dietary modification have maintained weight at recommended levels. Blood pressure is within normal range, HbA_1c is below 7, and atrial fibrillation is controlled.

9. What does this HbA_1c value mean?

10. Why does Mr. F. bruise easily? What precautions would be advisable at this time?

11. Briefly review the effects of diabetes over time in this case.

Answer 1

1. List the factors contributing to diabetes mellitus in this case are,

• Overweight
• Family History
• Age
• Inapropritae Diet

2. A Cataract is a clouding of the lens of the eye which leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double vision, halos around light, trouble with bright lights, and trouble seeing at night.

The lens of the eye gets oxygen and glucose from the aqueous humor, which is the fluid that fills the front of the eye. If someone doesn't have control over their glucose levels - such as someone with diabetes - the sugar levels can rise, causing the lens to swell.

3.Glyburide appears to lower the blood glucose acutely by stimulating the release of insulin from the pancreas, an effect dependent upon functioning beta cells in the pancreatic islets.

4. Diabetes affects wound healing in a variety of ways, including: Reduced circulation – High blood glucose levels can cause the blood vessels to constrict, which reduces blood flow to the extremities and diabetic nephropathy.

7. Manifestations of Hypertension

• severe headache
• fatigue
• confusion
• chestpain
• irregular heartbeat
• blood in urine.
• difficult in breathing

8.  fosinopril (Monopril) - to treat hypertension

atorvastatin (Lipitor) - used to reduce the bad cholesterol or to treat hypercholesterolemia.

amlodipine (Norvasc) - used to treat hypertension and coronary artery disease.

warfarin (Coumadin) - to treat pulmonary embolism

sotalol (Sotacor) - used to treat primarily atrial fibrillation

9. HbA1c is your average blood glucose (sugar) levels for the last two to three months. A high HbA1c means you have too much sugar in your blood. This means you're more likely to develop diabetes complications, like serious problems with your eyes and feet.

10. Precautions are,

• Eat Healthy
• Stay Active
• Check Glucose Level Regularly
• Never Miss A Dose Of Medication
• Examine Your Feets Everyday.