Does A.M. have type 2 diabetes mellitus?
Scenario A.M. is a 52-year-old woman who has gained over 75 lbs (32 kg) over the past 30 years, after the birth of her 3 children. She has a sedentary job that requires sitting at a desk for most hours of the work day. When she is at home, she stays inside because she is afraid to walk by herself in her neighborhood. She lives alone, but her children live in the same city. She has a history of hypertension and states that she does not take her medications regularly. She came to the clinic today stating that she thinks she might have a urinary tract infection. Her weight is 255 lbs (102.5 kg). She is 5 feet, 4 inches tall (162.5 cm) and has a waist circumference of 41 inches (104 cm). Her abdomen is large, nontender, soft, and round. Her blood pressure is 160/104. You review fasting labs results that were drawn a week ago.
Chart View
Laboratory Results
Glucose 170 mg/dL (9.4 mmol/L)
Total cholesterol 215 mg/dL (5.6 mmol/L)
Triglycerides 267 mg/dL (3.0 mmol/L)
HDL 60 mg/dL (1.56 mmol/L)
LDL 116 mg/dL (3.0 mmol/L)
HbA1C 5.9%
1. What is BMI? Calculate A.M.’s BMI and identify her classification based on the results.
2. Does A.M. have type 2 diabetes mellitus? Explain your answer.
Case Study Progress A.M.’s urinalysis is clear, and upon examination she is diagnosed with a vaginal yeast infection. The health care provider discusses A.M.’s condition with her and tells her that in addition to the yeast infection, she has metabolic syndrome and reviews some treatment goals with her. In addition, the HCP reinforces the need for A.M. to take her blood pressure medication regularly. A.M. is visibly upset and has many questions.
3. What is metabolic syndrome? 4. Review A.M.’s history and assessment. What criteria for
metabolic syndrome does A.M. have, if any? 5. What other lifestyle habits will you ask A.M. about during
your assessment? 6. What health problems may result if metabolic syndrome
remains untreated? Select all that apply. a. Stroke b. Diabetes c. Breast cancer d. Heart disease e. Renal disease
Case Study Progress A.M. is given the following prescriptions:
Metformin (Glucophage), 500 mg BID Atorvastatin (Lipitor), 10 mg PO at bedtime Lisinopril (Zestril) 5 mg PO, 1 tablet every morning Fluconazole (Diflucan) 150 mg tablet × 1 dose
7. Explain the purpose of each medication ordered.
8. Which are potential side effects of metformin? Select all that apply.
a. Nausea b. Diarrhea c. Dizziness d. Constipation e. Abdominal bloating
Case Study Progress You take the time to talk to A.M. about her concerns and provide health promotion teaching that includes increasing regular physical activity, weight reduction, and eating a diet low in saturated fats. A.M. tells you she is willing to make changes but that this is a lot of information to take in at this time.
9. She asks, “Why do I have to take a drug for diabetes if I don’t have diabetes?” What is the appropriate answer?
a. “Metformin will prevent you from ever developing diabetes.”
b. “Metformin provides the insulin your body is no longer making.”
c. “Metformin allows you to eat whatever you want and your glucose levels won’t increase.”
d. “Metformin helps your cells to be less resistant to insulin, and, as a result, your glucose levels will decrease.”
10. Explain the role of insulin resistance with metabolic syndrome and metformin’s effect on insulin resistance.
11. Is A.M. at greater risk for coronary artery disease? Explain your answer.
12. A.M. asks you, “Won’t all these pills help me? Why do I need to change how I eat and exercise?” Explain the role of reducing risk factors as part of the treatment for metabolic syndrome.
13. After visiting with the dietitian, you review what A.M. has
learned. You ask her to tell you what food choices would be good for a low-fat diet. Which answer reflects a need for further education?
a. “I will eat more fruits and vegetables.” b. “I will try to eat more chicken and fish.” c. “I can eat red meat as long as I don’t fry it.” d. “I will eat more whole grains, such as whole wheat
bread.”
Case Progress A.M. is referred to a registered dietitian for nutrition education and decides to join the local YMCA for exercise. You teach her how to monitor blood glucose levels at home. She has an appointment to return to the clinic in one month. However, A.M. does not return to the clinic for her appointment. When you call to follow up with her, she agrees to come in a week later. At that time, she tells you that she did not do well with the exercise because it “hurts too much.” She said she tried eating a low-fat diet but that it was difficult to stick to it. She did not check her blood glucose regularly, but told you that when she did check them, her fasting levels were in the “140s to 160s.” Her weight is now 250 lbs (113 kg). She tells you that she feels so discouraged and that she will “never get better.”
14. What resources do you suggest for A.M. at this time?
Case Study Outcome During the next year, A.M. continued to miss appointments, and her weight increased to 272 lbs (123 kg). She was eventually diagnosed with type 2 diabetes mellitus, and at her last visit she asked her HCP about having weight loss surgery.