CASE STUDY 10

DIANA
DICHOSO
NAVARETE
TALAVERA
TIBILLO
SCENARIO
You are volunteering at a health fair being conducted at a local
community health clinic in a large metropolitan area. You are assigned
to work with an advanced practice nurse in diabetes management and
are assisting in the screening process for hyperglycemia and high
waist-hip-ratio. During the course of the day, you meet M.M., a 42-
year-old African-American woman, who you suspect has some type of
diabetes mellitus. A nursing history reveals the following findings:
Height 5’6”; Weight 210 lbs; WHR =1.12. Her VS are 192/146, 88, 18, 98.6o
F. M.M.’s mother, age 72, and two maternal aunts have type 2 diabetes
mellitus (DM). M.M. has smoked 1 and ½ packs/day of cigarettes for
over 25 years and admits she should get more exercise. Screening
glucose level (finger stick) is 310 mg/dL. On interview, M.M.’s only
complaint is increasing fatigue over the past month and mild nocturia.

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1. List major risk factors for type 2 DM. Identify risk factors that M.M. has.

RISK FACTORS Risk factors that M.M have

-Weight
-Vital signs hypertension
-Fat distribution 192/146
-Family history -42 yrs old African american
-smoking -Two maternal aunts and
-Race and ethnicity. mother have type 2 diabetes
-Age mellitus(DM)
-Smoked 1 and 1/2 packs/
-Prediabetes day of cigarettes
-Areas of darkened skin, -Screening glucose level 310
usually in the armpits mg/dL
and neck. -Height 5’6 Weight 210 lbs
- sendentary lifestyle WHR =1.12.

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2. What manifestation of type 2 DM is present in M.M.’s nursing history findings?

• Screening glucose level

(finger stick) is 310
mg/dL.
• Increasing fatigue over
the past month
• Mild nocturia
3. Differentiate between a screening plasma glucose, a fasting plasma glucose, a 2-hour postload glucose,
and Hb A1c. Identify the data used to arrive at a definitive diagnosis

fasting plasma glucose (FPG)

- The fasting plasma glucose (FPG)

test, also known as the fasting
blood glucose test (FBG) or fasting
blood sugar test, measures the
levels of glucose (sugar) in the
blood. Used to screen for diabetes,
it is a relatively simple, accurate,
and inexpensive test that exposes
problems with insulin functioning.

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2 hour postload glucose is a blood test

- 2 hour postload glucose

is a blood test to check for
diabetes, this test is done
to see how your body
responds to sugar and
starch after you eat a meal.

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Hemoglobin A1c

- Hemoglobin A1c is a
test for diabetes, the
hemoglobin A1c tells
you your average level
of blood sugar over the
past 2 to 3 months.

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 - Factors of the definitive diagnosis: Genes, since patient M.M's two
Factors of the aunts have type 2 DM. Her weight (210 lbs), her race/ethnicity since
she is African-american, high blood pressure (192/146), age (42) 40-
definitive diagnosis
45 years old is considered to be at risk for DM, she also admits that
she should get more exercise, physical inactivity, and last is she
smoked 1 and ½ packs/day of cigarettes for over 25 years

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4. During a brief physical assessment, the practitioner checks M.M.’s eyes with an
ophthalmoscope. Why?

•Fundoscopy or ophthalmoscopy is a test done

to examine the back of the eye and the inner
lining. The fundus consists of the retina, the
macula, the optic nerve, and blood vessels.
Fundoscopy allows the ophthalmologist to
detect retinal degeneration, detachment, and
other abnormalities of the blood vessels and
the optic nerve.  Fundoscopy is an important
screening test for diabetic patients to look out
for diabetic retinopathy.

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•One of the main complications in people
with diabetes and poor glycemic control is
diabetic retinopathy. In most people with
diabetes, improper management of
diabetic retinopathy is the main cause of
blindness. This calls for an aggressive
management with regular screenings. The
degree of retinopathy is highly correlated
with duration of diabetes, Blood glucose
levels, BP levels

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5. M.M. tells you she has a neighbor who had to start taking insulin for diabetes Weight gain is a normal side effect of taking
after she had “bad pneumonia.” Her neighbor is very thin. M.M. asks whether she insulin. Insulin helps you manage your body
will need insulin and whether she will lose weight like her neighbor. How would sugar by assisting your cells in absorbing
you respond to her? glucose (sugar). Without insulin, the cells of
your body are unable to use sugar for energy.
If you have type You’ll eliminate the extra glucose in your
1 diabetes, insulin therapy is vital for bloodstream through your urine or have it
replacing the insulin your body doesn't stay in the blood, causing high blood sugar
produce. Sometimes, people with type levels
2 diabetes or gestational diabetes need
insulin therapy if other treatments You may experience weight
haven't been able to keep blood glucose loss before you start insulin therapy.
levels within the desired range. The loss of sugar in your urine takes water
with it, so some of this weight loss is due to
water loss. Also, unmanaged diabetes
can make you extra hungry. This can lead to
eating an increased amount of food even
when you start insulin therapy.

WEIGHT
INSULIN
LOSS 12
6. M.M. tells you that she knows if she would just stop eating “sweet things” she would not have diabetes.
How would you correct her understanding of the disease using understandable terminology?

People with diabetes can still have sweets, chocolate, or other

sugary foods as long they are eaten as part of a healthful
meal plan or combined with exercise.

They consider a healthful meal plan to:

· have limited saturated fat

· contain moderate amounts of salt and sugar
· include lean protein, non-starchy vegetables, whole grains,
fruits, and healthy fats

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However, it is best to save sugary foods for an occasional
treat and enjoy them in small portions.

When choosing any food, it is essential for a person with

diabetes to understand how it can affect their blood
glucose levels. Knowing how to read the nutrition labels on
food packaging can make this easier.

Many foods claim to be “sugar-free” or have “no added

sugar.” However, these foods can still contain calories and
types of carbohydrate that can impact a person’s blood
sugar levels.

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7. During the interview, the nurse takes M.M.’s BP and asks whether she’s ever been told she has
heart trouble (CAD). Explain why.

Mam if you weren’t been told ever that you have a heart
trouble(CAD), because you weren’t not diagnosed with this
disease, but there are higher risk you may develop heart
trouble(CAD) because there are study that a type 2 diabetic
patient has a higher risk to develop heart trouble, if you will
not follow the orders, medication and prevention that will
be given to you. Those are the information that I can give
you.

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8. Discuss two modifiable behaviors M.M. engages in that will aggravate the
pathologic effects of her type 2 diabetes mellitus.

- Physical inactivity and smoking.

Physical inactivity is a major risk factor
for developing type 2 diabetes. When
you have no physical inactivity, you gain
more weight. Smoking can cause insulin
resistance. Smokers like patient M.M has
30 to 40% chance of acquiring type 2 DM.
It can also lead to high blood sugars or
make it harder to manage blood sugars.

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9. In order of significance, what health problems related to type 2 DM should be addressed?

-Hearing impairment.
-Sleep apnea
-Dementia.

-Heart and blood vessel

disease
-Nerve damage
(neuropathy) in limbs
-Kidney disease
-Eye damage
-Skin conditions
-Slow healing

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10 . M.M. agreed to come to the clinic for help; her HbA1c was 13%. What does this tell you
about M.M.’s glucose control in the past few months?
- It shows that MM’s
glucose is POORLY
CONTROLLED

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11. Identify three content areas of diabetes education that are important for patients with newly
diagnosed diabetes. Identify three important learning objectives for each content area.

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 1.Change your diet
High blood pressure and high cholesterol can increase your risk of stroke.
You might be able to reduce your blood pressure and cholesterol levels by
making changes to your diet. Try the following nutrition tips:
• Lower your intake of salt and fats.
• Eat more fish in place of red meat.
• Eat foods with lower amounts of added sugar.
• Eat more vegetables, beans, and nuts.
• Replace white bread with bread made of whole grains.

BRAIN 2.Exercise
- Exercising five or more times per week can help reduce your risk of stroke.
Any exercise that gets your body moving is good exercise. A daily, brisk walk
can lower your risk of stroke and improve your mood in general.

3.Take your medication as prescribed.

Certain types of medication are especially important for lowering stroke risk.
These include blood pressure medications, diabetes medications,
cholesterol medications (statins), and medications to prevent blood clots,
such as aspirin and blood thinners. If you’ve been prescribed any of these
medications, continue taking them as prescribed by your doctor.
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 1.Physical Activity
- Regular exercise improves blood glucose control, lowers cardiovascular
disease risk factors, contributes to weight loss, decreases the risk of falls and
fractures, improves quality of life by improving functional capacity and sense
of well-being and prevents the development of type 2 diabetes mellitus in
individuals who are at high risk
- At least 8 weeks of exercise intervention has been shown to reduce HbA1c by
0.66% in patients with type 2 diabetes mellitus

2.Sleep
- All patients should be advised to sleep approximately 7 hours per night to
maintain energy levels and well-being

HEART - Evidence supports that 6-9 hours of sleep per night is associated with a
decrease in cardiometabolic risk factors
- Sleep deprivation causes aggravation of insulin resistance, hypertension,
hyperglycemia and dyslipidemia and increases inflammatory cytokines

3.Smoking Cessation 
- It has been found that smoking may have a role in the development of type 2
diabetes mellitus 
- For patients having difficulty with smoking cessation, nicotine replacement
therapy should be considered
- For more recalcitrant patients that cannot stop smoking on their own,
structured programs are recommended
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 1.Maintain a healthy weight. If you're at a healthy weight,
work to maintain it by being physically active most days
of the week. If you need to lose weight, talk with your
doctor about weight-loss strategies, such as increasing
daily physical activity and reducing calories.

2.Don't smoke. Cigarette smoking can damage your

kidneys and make existing kidney damage worse. If
KIDNEY you're a smoker, talk to your doctor about strategies for
quitting smoking. Support groups, counseling and
medications can all help you to stop.

3.Manage high blood pressure or other medical

conditions. If you have high blood pressure or other
conditions that increase your risk of kidney disease, work
with your doctor to control them. Ask your doctor about
tests to look for signs of kidney damage. 22
12. Discuss two recommendations you would make to individuals participating in the Health Fair
regarding primary prevention of diabetes

-Work out regularly

-Have nutritional meal
Vegetables- Ex: broccoli, carrots, greens, peppers,tomatoes,potatoes, corn, and
green peas

fruits—includes oranges, melon, berries, apples, bananas, and grapes

grains—wheat, rice, oats, cornmeal, barley, and quinoa

examples: bread, pasta, cereal, and tortillas

protein- lean meat, chicken or turkey without the skin, fish, eggs, nuts and
peanuts, dried beans and certain peas, such as chickpeas and split peas, meat
substitutes, such as tofu

dairy—nonfat or low fat milk or lactose-free milk if you have lactose

intolerance: yogurt, cheese

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13. Explain why blood glucose testing is recommended to
monitor glucose rather than urine dipstick testing.
Blood Glucose Test
Urine Dipstick Testing
In the past, urine tests for glucose were used to diagnose and
monitor diabetes. Now, they aren't as commonly used
anymore. In order to diagnose diabetes more accurately, a
doctor will typically rely on a blood glucose test. Blood
tests are more accurate and can measure the exact amount of
glucose in the blood.
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CASE TIMELINE

THANK YOU

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