CASE STUDY 42

Aliza T. Varona
While seeing patients in your preceptor’s clinic, you have the opportunity to meet
and examine one of her long-time patients, a 52-year-old woman who presents for
her yearly physical examination. She has been fine and has no complaints today.
Her medical history is notable only for borderline hypertension and moderate
obesity. Last year her fasting lipid profile was acceptable for someone without
known risk factors for coronary artery disease. Her mother and older brother have
diabetes and hypertension. At prior visits, you see that your preceptor has coun-
seled her on a low-calorie, low-fat diet and recommended that she start an exercise
program. However, the patient says she has not made any of these recommended
changes. With her full-time job and three children, she finds it difficult to exercise,
and she admits that her family eats out frequently. Today her blood pressure is
140/92 mm Hg. Her body mass index (BMI) is 29 kg/m2. Her examination is
notable for acanthosis nigricans at the neck but otherwise is normal. A
Papanicolaou (Pap) smear is performed, and a mammogram is offered. The patient
has not eaten yet today, so on your preceptor’s recommendation, a fasting plasma
glucose test is performed, and the result is 140 mg/dL.
MOST LIKELY DIAGNOSIS
Type 2 Diabetes
Are insulin resistance and impaired insulin
secretion.

Resistance of insulin refers to a decreased

tissue sensitivity to insulin.

Intracellular reactions are diminished, making

insulin less effective at stimulating glucose
uptake by the tissues and regulating glucose
release by the liver.
NURSING INTERVENTIONS
Nutritional therapy/Diet

Nutrition, meal planning and weight control are the foundation of diabetes management.

To control total caloric intake to attain or maintain the reasonable body weight, control of
body glucose levels, and normalization of lipids and blood pressure to prevent heart disease.

Providing all essential food constituents (eg., vitamins, minerals) necessary for optimal
nutrition.

Meeting energy needs.

Recommended foods

Carbohydrates (45-60%)

Fats (<20%)

Proteins (0.8 - 1g/kg)

vegetables, lean protein (eggs, fish, nuts, and tofu), good foods (olives or avocados) and
fruit in moderation.
Meal plan!
Breakfast :

hard-boiled eggs,

low sodium cottage cheese,

sliced avocados,

fiber-rich smoothies with avocado, frozen berries and a banana,

low-fat yogurt

Eggs and vegetables fried in extra virgin olive oil.

Lunch & Dinner

baked or grilled chicken

Cauliflower rice with vegetables and tofu

Salmon

Salad with toasted nuts

Zucchini noodles

Pizza with cauliflower crust

Whole grain pasta with vegetables or fish

Eggplant lasagna
Snacks

nuts

Fruit

hummus and vegetables

String cheese

olives

Apples and peanut butter

Sardines
SAMPLE MENUS

Sample Lunch #1 Sample Lunch #2 Sample Lunch #3

2 sliced bread Hamburger bun 1 cup cooked pasta

2oz sliced turkey and 1oz low-fat 3 oz lean beaf patty 3 oz boiled shrimp
cheese
Green salad 1/2 cup of plum tomatoes
Lettuce, tomato, onion
1 tbsp salad dressing 1 tsp olive oil
1 tsp mayonnaise
1 1/2 cup watermelon 1 1/2 cup fresh strawberries
1 medium apple
Diet soda Ice water with lemon
Unsweetened iced tea

1 tbsp catsup, pickle, onions Garlic, basil

Mustard, pickle, hot pepper
FOODS TO AVOID
Processed foods ( prepackaged meals and salty snacks)

Sugar-rich foods (cakes, candies, pastries, cookies, sodas, and juices)

Starches, especially white bread or bagels

Alcoholic beverages

Potatoes (potato chips)

Other starchy vegetables

White pasta
EXERCISE

It lowers blood glucose levels by increasing the uptake of glucose by body muscles and by
improving insulin utilization.

Improves circulation and muscle tone

Useful in losing weight, easing stress, and maintaining a feeling of well-being.

Alters blood lipid concentrations, increasing levels of high-density lipoproteins and

decreasing total cholesterol and triglyceride level.
AEROBIC EXERCISES
Undertake at least 150min/week

Walking, cycling, swimming, Team sport, aerobic dance (Zumba), weightlifting

lifting, resistance band exercises, Calisthenics exercises (push ups, pull-ups, squats,
lunges, and abdominal crunches), and Yoga.
Monitoring glucose levels and ketones

Enable people to adjust their treatment regimen to obtain optimal blood glucose control.

This allows for detection and prevention of hyperglycemia and hypoglycemia and plays a
crucial role in normalizing blood glucose levels, which in turn may reduce the risk of long
term-diabetic complications.

Blood glucose monitoring is a cornerstone of diabetes management and self-monitoring of

blood glucose (SMBG) levels by patients has dramatically altered diabetes care.
PHARMACOLOGIC THERAPY

Diabetes medications

Metformin (Fortamet, Glumetza, others) - is generally the first medication prescribed for
type 2 diabetes. It works primarily by lowering glucose production in the liver and
improving your body’s sensitivity to insulin so that your body uses insulin more effectively.

Thiazolidinediones - makes the body tissues more sensitive to insulin.

DPP-4 inhibitors- help reduce blood sugar levels but tend to have a very modest effect.
QUESTIONS?