TLA on Diabetes Mellitus

Case in Point—Marie-Claire: Managing New-Onset Type 2 Diabetes

Marie-Claire is a 36-year-old female who is a busy mother of two older teens. She loves sports and prides
herself on her appearance. She is thin and works out at the gym three nights a week. Marie-Claire has
noticed that she is drinking a lot more water than she normally would and is always hungry. She attributes
this to an unusually hot summer and to playing softball in the middle of the day. She has tried to curb her
appetite and finds it difficult to do. But she continues to lose weight, so she thinks everything is fine.
Marie-Claire had worked in human resources for a local recreational vehicle company, somewhat far
from home. Because of the distance from home, she applied and has been hired at a new company just 10
miles from her home. Before starting her position, she has a preemployment physical. The NP doing the
assessment listens to Marie-Claire and requests that she have a fasting blood sugar drawn. The results are
high, 290. After more testing, Marie-Claire is told she has type 2 diabetes (NIDDM). She is to report to a
dietitian within three days, bringing with her a diet history for those three days. She is started on
glipizide-metformin (Metaglip) for her blood glucose control.

ASSESSMENT

1. What do you know about Marie-Claire so far?

2. Using the rule of thumb in Chapter 16, what is Marie-Claire’s ideal weight? At 5 feet 6 inches
and 152 pounds, does Marie-Claire need to lose weight?

3. What are you looking for when reviewing her food diary?

DIAGNOSIS

4. Write a diagnostic statement for Marie-Claire.

PLAN/GOAL

5. What are reasonable, measurable goals for Marie-Claire?

IMPLEMENTATION

6. The dietitian recommends an 1,800-calorie diet for Marie-Claire. What distribution of categories
would you, as her nurse, select for milk, bread, meat, fat, vegetables, and fruit?
 7. After Marie-Claire learns the exchange system, what else does she need to do to manage her
diabetes?

8. What would the advantages of the carbohydrate-counting system be compared with those of the
exchange system?

9. How would the diabetes web sites http://www.diabetes.org and www.lilly.com help Marie-
Claire?

EVALUATION/OUTCOME CRITERIA

10. At her two-month follow-up visit with the diabetes team, what should Marie-Claire’s HgbA1c
be?

11. What should she be able to write out or describe?

12. What should her weight be?

13. Why would it be important to check her blood pressure and lipid levels?

THINKING FURTHER

14. Why is it important for all diabetic clients to maintain a normal blood glucose level?

15. What are the potentially serious health consequences of diabetic clients not controlling their
diabetes?

RATE THIS PLATE

Marie-Claire has seen a diabetes educator and decided that carbohydrate counting would be the easiest
way to plan her menus. What do you think of her lunch? On an 1,800-calorie diet plan, Marie-Claire is
allowed four carbohydrate choices per meal.

Sandwich made of:

2 slices 100% whole wheat bread
3 oz sliced roast beef
1 Tbsp reduced-fat mayonnaise
2 slices tomato
2 large pieces of leaf lettuce
1/4 cup raw mini carrots
1 oz baked potato chips
1/2 cup sugar-free chocolate pudding

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