Case Study

Alert and oriented X 3, 80 year old pleasant, Caucasian male with a diagnosis of type 2 diabetes mellitus.
Other Medical Diagnoses: HTN, hypercholesterolemia, obesity, atrial fibrillation, GERD, COPD, depression
Past Medical History: Pneumonia and hip fracture from fall. History of smoking a pack a day for 30 years.
NKA
Clinical History: Mr. Smith sustained a fall and hip fracture at home 5 weeks ago, developed pneumonia during his hospital stay, and
was admitted to the nursing home 2 weeks ago.
Clinical Symptoms: Mr. Smith states that he is experiencing sadness related to the recent loss of his wife, as well as placement in a
long term care nursing home. He states that he feels fatigued and naps during the day, and has difficulty staying asleep at night.
Diet: ADA
Blood sugars have ranged from 50 to 375 daily
Recent Labs: 1 week ago
FBS 145
HbA1C 8.2%
Cholesterol 220
Urinalysis is positive for glucose
Vital Signs:
B/P 140/86, T 98.4, P 110, R 16
Medications:
Flovent 110 MDI - 2 puffs BID
Albuteral MDI - 2 puffs Q4H PRN SOB
Lipitor 20 mg qd
Lisinopril 20 mg qd
Omeprazole 20 mg qd
Digoxin 0.125 mg qd
Zoloft 50 mg qd
Monitor BS TID and prior to administering insulin.
Give Humulin R U-500 Insulin 500 unit/ml Inject 16 units by SQ route TID before breakfast, lunch, and at HS. If Blood Sugar is below
120 give only 4 units. If blood sugar is below 70, hold insulin and notify MD.
Questions
1. Explain how the patients other medical diagnosis and medications can have an effect on blood sugar levels.
2. Discuss the patients co-morbidities and risk factors that have caused and are exacerbating his type 2 diabetes mellitus
diagnosis.
3. Explain why the patients blood sugars might be erratic throughout the day and HS.
4. What clinical complication could be causing the erratic blood sugars?
5. Explain what pertinent information you would present to the MD.