Diabetes
Connie Rodrigues, a 47-year-old overweight woman, has gradually increasing dyspnea and mild chest discomfort on exertion, fatigue, and weight gain. She has no children and is not now pregnant. Further history reveals a family history of diabetes.
Answer the following questions about Ms. Rodrigues and diabetes.
1. In addition to questions about her chest discomfort, what other assessment questions should you ask Ms. Rodrigues? Why?
2.Ms. Rodrigues has polyuria, paresthesias in her feet, an itching rash in her groin, and blurry vision. Why is it important to measure her blood pressure and the pain and vibration sensation in her hands and feet?
3. Her nurse practitioner ordered blood tests for glucose and HbA1C. What do you expect these values to be if Ms. Rodrigues has type 2 diabetes?
4.What information does HbA1C provide that the blood glucose level does not?
5.Ms. Rodrigues’s evaluation reveals Candida infection and mild coronary artery disease. Why does diabetes increase the risk of infection?
6.Which physiological mechanisms contribute to peripheral neuropathy in type 2 diabetes?
sample answer: Diabetes
Connie Rodrigues, a 47-year-old overweight woman, has gradually increasing dyspnea and mild chest discomfort on exertion, fatigue, and weight gain. She has no children and is not now pregnant. Further history reveals a family history of diabetes.
Answer the following questions about Ms. Rodrigues and diabetes.
1. In addition to questions about her chest discomfort, what other assessment questions should you ask Ms. Rodrigues? Why?
I would ask Ms. Rodrigues if she had been previously diagnosed with pre-diabetes, if she has had fasting blood glucose levels between 100 and 125, in order to establish if we can go ahead with the diabetes diagnosis. Ask her if she has a high trygyceride level greater than 150 in order to establish the cause of her weight increase. Triglyceride are fats which are produced by the body though they may come from the foods we consume. Ask her if she participates in regular exercise to find out the cause of her weight gain. Ask her if she has smoked before in order to assess her smoking behavior and establish the cause of her weight gain. This will also establish a ground for discussing the hardest topics such as addiction to smoking and any other drugs and find out presence of diabetes.
2.Ms. Rodrigues has polyuria, paresthesias in her feet, an itching rash in her groin, and blurry vision. Why is it important to measure her blood pressure and the pain and vibration sensation in her hands and feet?
Knowing the correct blood pressure helps one establish the correct diagnosis for a diabetic patient. Diabetes type 2 can make you have a blurry vision. Diabetes eye disease causes vision loss and blindness among diabetes patients. Diabetes type 2makes patients feel hungry, thirsty urinate more and have blurry vision.
3. Her nurse practitioner ordered blood tests for glucose and HbA1C. What do you expect these values to be if Ms. Rodrigues has type 2 diabetes?
According to research, people with type 2 diabetes with the ability to reduce their HbA1c level by 1% are likely not to suffer from cataracts by 19%, heart failure by 16% and amputation or death to peripheral vascular disease y 43% since Ms. Rodrigues has all this symptoms, her values could be HbA1c of 86 mmol/mol and 13mmol/L for average blood Glucose respectively (American Diabetes Association,1966).
4.What information does HbA1C provide that the blood glucose level does not?
HbA1c measures the most recent blood sugar level (glucose). It returns accurate average measurement of average blood glucose. The amount of glucose combining with protein is directly proportional to amount of sugar in the body. Measuring glycated hemoglobin helps reflect on average blood glucose levels over the 8-12 weeks duration for which red blood cells can survive (World Health Organization, 2011) . Compared to blood glucose level HbA1c provides longer term trend of blood sugar levels. Blood sugar level refers to the concentration of glucose in the blood at the moment of test. Fast glucose test only shows the current glucose levels.
5.Ms. Rodrigues’s evaluation reveals Candida infection and mild coronary artery disease. Why does diabetes increase the risk of infection?
Diabetes mellitus is associated with increased infectious diseases among many patients. This is because of the hyperglycemic environment that weakens the immune system. All organs and systems are affected by the infections. The infections include gastrointestinal and urinal dysmotility, decreased antibacterial activity of urine and depression of antibacterial system. Diabetes mellitus is often associated with high infection ratesdue to reduced Tcell-mediated immune response and impaired neutophil function. Candiadiasis is caused but the Candida fungi which is found everywhere in the environment. It affects the groin areas and depends on the body immune system to protect against infection. When weakened by diabetes, one is prone to attack by the fungi.
6.Which physiological mechanisms contribute to peripheral neuropathy in type 2 diabetes?
Neuropathy is a common complication of diabetes. This is often as a result of hyperglycemia which is a metabolic reaction that causes peripheral nerve injury by increasing flux of the polylol pathway. Oxidation stress, Excessive release of cytokines and activation of protein kinase C are common physiological mechanisms contributing to peripheral neuropathy. The long axons are vulnerable to attack due to environmental causes or malnutrition axonal support (Baron, 2006).
References
American Diabetes Association. (1966). Diabetes (Vol. 15, No. 7-12). American Diabetes Association.
Baron, R. (2006). Mechanisms of disease: neuropathic pain—a clinical perspective. Nature Reviews Neurology, 2(2), 95.
World Health Organization. (2011). Use of glycated haemoglobin (HbA1c) in diagnosis of diabetes mellitus: abbreviated report of a WHO consultation.
