Nursing
Case Study
Type 2 Diabetes Mellitus
Y. L. makes an appointment to come to the clinic where you are employed. She has been complaining of (C/O) chronic fatigue, increased thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination. She tells you she as a vaginal yeast infection that she has treated numerous times with the over-the-counter (OTC) medication. She admits to starting smoking since going back to work full time as a clerk in a loan company. She also complains of having difficulty reading numbers and reports making frequent mistakes. She also says, “By the time I get home, and make supper for my family, then put my child to bed, I am too tired to exercise.” She reports her feet hurt, they often “burn or feel like there are pins in them.” She reports that, after her delivery, she went back to her traditional eating pattern, which is high in carbohydrates (CHO).
In reviewing Y.L’s chart, you notice she has not been seen since the delivery of her child 6 years ago. You note that in her 26th week of pregnancy she was diagnosed with gestational diabetes mellitus (GDM). You also note that she is 5’3” and her pre pregnancy BMI was 25. Her father has type 2 diabetes mellitus and both paternal grandparents had type 2 DM. She has gained considerable weight; her current weight is 173 pounds. Today, her blood pressure is 152/97 mm Hg, and her plasma glucose is 291 mg/dl. Her primary care provider (PCP), which of course is a Family or Adult Nurse Practitioner, orders the following labs: urinalysis, hemoglobin A1C, fasting complete metabolic panel (CMP), CBC, fasting lipid profile, and glomerular filtration rate (GFR). The lab values are as follows: fasting glucose 184 mg/dl, Hb A1C 10.4, UA +glucose, -ketones, cholesterol 256 mg/dl, triglycerides 346 mg/dl, LDL 155 mg/dl, HDL 32 mg/dl, ratio 8.0. A subsequent fasting glucose is also elevated and Y.L is diagnosed with type 2 diabetes mellitus.
After
Type 2 Diabetes Mellitus
Y. L. makes an appointment to come to the clinic where you are employed. She has been complaining of (C/O) chronic fatigue, increased thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-back pain on urination. She tells you she as a vaginal yeast infection that she has treated numerous times with the over-the-counter (OTC) medication. She admits to starting smoking since going back to work full time as a clerk in a loan company. She also complains of having difficulty reading numbers and reports making frequent mistakes. She also says, “By the time I get home, and make supper for my family, then put my child to bed, I am too tired to exercise.” She reports her feet hurt, they often “burn or feel like there are pins in them.” She reports that, after her delivery, she went back to her traditional eating pattern, which is high in carbohydrates (CHO).
In reviewing Y.L’s chart, you notice she has not been seen since the delivery of her child 6 years ago. You note that in her 26th week of pregnancy she was diagnosed with gestational diabetes mellitus (GDM). You also note that she is 5’3” and her pre pregnancy BMI was 25. Her father has type 2 diabetes mellitus and both paternal grandparents had type 2 DM. She has gained considerable weight; her current weight is 173 pounds. Today, her blood pressure is 152/97 mm Hg, and her plasma glucose is 291 mg/dl. Her primary care provider (PCP), which of course is a Family or Adult Nurse Practitioner, orders the following labs: urinalysis, hemoglobin A1C, fasting complete metabolic panel (CMP), CBC, fasting lipid profile, and glomerular filtration rate (GFR). The lab values are as follows: fasting glucose 184 mg/dl, Hb A1C 10.4, UA +glucose, -ketones, cholesterol 256 mg/dl, triglycerides 346 mg/dl, LDL 155 mg/dl, HDL 32 mg/dl, ratio 8.0. A subsequent fasting glucose is also elevated and Y.L is diagnosed with type 2 diabetes mellitus.
After