Question

Y.L., a 34-year-old Southern Asian woman, comes to the clinic with complaints of chronic fatigue, increased
thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination. She tells you she has a vaginal yeast infection that she has treated numerous times with over-thecounter medication. She works full time as a clerk in a loan company and states she has difficulty reading
numbers and reports, resulting in her making frequent mistakes. She says, “By the time I get home and
make supper for my family, then put my child to bed, I am too tired to exercise.” She reports her feet hurt;
they often “burn or feel like there are pins in them.” She has a history of gestational diabetes and reports
that after her delivery she went back to her traditional eating pattern, which is high in carbohydrates.
In reviewing Y.L.'s chart, you note she last saw the provider 6 years ago after the delivery of her last
child. She has gained considerable weight; her current weight is 173 pounds. Today her blood pressure
(BP) is 152/97mm Hg, and a random plasma glucose level is 291mg/dL. The provider suspects that Y.L. has
developed type 2 diabetes mellitus (DM) and orders the laboratory studies shown in the chart.

1. Interpret Y.L.'s laboratory results

2. Name six risk factors for type 2 DM. Place a star or asterisk next to those that Y.L. exhibits.

3. Outline the teaching you need to provide to Y.L. regarding oral hypoglycemic therapy

Answer 1

1. Interpretation of laboratory reports:

  weight - 173 pounds

Which can be considered as overweight.

Blood pressure- 152/47

Which means she is hypertensive.

Classification	systolic BP	Diastolic BP
Normal	<120	<80
Prehypertension	120- 139	80-89
Stage l HTN	140-159	90-99
Stage ll HTN	>=160	>=100

Random blood sugar - 290mg/dl

Which means she is diabetic.

( Normal below 200mg/dl)

2. Risk factors include:

● Obesity(BMI >25kg/m^2)*

● Habitual physical inactivity

● Hypertension (blood pressure >140/90 mmHg)*

● Family history of diabetes(i.e, parent or sibling with type 2 diabetes)

● polycystic ovary syndrome acanthosis nigricans

● History of GDM or delivery of baby >4kg (>9lb)*

3. Patient counseling points include:

● OHA's are comparitively safe drugs. However some patients may develop loss of appetite, nausea, vomiting, abdominal pain, cramps, malaise, diarrhoea or weight loss.

● Do not skip the meals while taking OHA's because it can leads to hypoglycemia.

Symptoms of hypoglycemia are;

Sweating

Weakness and confusion

If hypoglycemia occurs, fruit juice or chocolates can be ingested. Carry toffies in bag.

● Follow regular eating patterns and check blood sugar at regularly.