Endocrine Disorders

NU641 Case Study Week 14 – Diabetes Mellitus

Rosais a 55-year-old moderately obese Hispanic woman (body mass index is 29). She was referred to you when her gynecologist noted glucose on a routine urinalysis. She subsequently has an FPG of 190 and 200 mg/dL on two separate occasions. She is thirstier than usual and has more frequent urination. She also complains of decreased energy over the last several months and numbness and tingling in her left lower extremity.

Family history:

·       Sister, mother, and maternal grandmother have diabetes.

Social history:

·       Nonsmoker, drinks alcohol socially (one drink about three times a month), and does not exercise.

Review of systems:

·       20 lb weight gain over the past two years, has some blurred vision, has had two urinary tract infections in the past year, and has frequent vaginal yeast infections.

·       Gestational diabetes in last two pregnancies.

Physical exam:

·       Unremarkable except blood pressure of 150/90

·       Height: 5 feet 2 inches

·       Weight: 200 lb

·       Laboratory results: FPG 200 mg/dL, HbA1C 10%, LDL 160 mg/dL, HDL 35 mg/dL, total cholesterol 248 mg/dl and triglycerides 266 mg/dL

Allergy:

·       NKDA

Diagnosis: Type 2 Diabetes Mellitus

1. List specific goals for the treatment for Rosa.

2. What dietary and lifestyle changes would you recommend for Rosa?

3. What drug therapy would you prescribe? Why?

4. What is the goal for the FPG? Postprandial glucose? HbA1C?

5. Discuss specific education for Rosa based on the prescribed therapy.

6. List one or two adverse reactions for the therapy selected that would cause you to change the therapy.

7. If the HbA1C after three months on the prescribed therapy is 8.8%, what would be the next line of therapy? Provide rationale for your answer.

8. What over-the-counter or herbal medicines might be appropriate for Rosa?

9. Describe one or two drug–drug or drug–food interactions for the selected agent.