A 48-year-old woman is admitted to the emergency room. Her family states she has
ID: 121874 • Letter: A
Question
A 48-year-old woman is admitted to the emergency room. Her family states she has been ill for 5 days with vomiting and diarrhea. She has been unable to take fluids for the past 2 days. She has no past major medical problems. Family history is positive for type 2 diabetes in her mother and sister. She takes no medications.
On physical examination:
BP 110/80, P 96, R 22, BMI 34
Skin: dry with decreased turgor
HEENT: oral mucous membranes are dry
Lungs: clear to auscultation
Heart: regular rhythm with no murmur
Abdomen: soft bowel sounds present, no masses
On admission, the following laboratory tests were done:
Fasting blood sugar 250
Total cholesterol 265
Triglycerides 185
High Density Lipoprotein 35
Urine
Specific gravity 1.028
Ketones positive
The physician made a diagnosis of type 2 diabetes.
1. Reviewing the above history, physical examination, and laboratory data, which of the findings support the diagnosis of type 2 diabetes?
2. This is a new diagnosis for the patient and the nurse in her teaching needs to describe the pathophysiology of the disease. Provide a description of the important information that should be included.
3. What are important dietary changes the patient needs to institute? Think about her BMI.
Explanation / Answer
1.Findings that support the type2 diabetes are-
Fasting blood sugar -250
Urine - ketones positive
2.In type-2 diabetes,there is a development of insulin resistance and impaired insulin secretion occurs.
Insulin is not able to bind with the special receptors so it becomes very less effective at the stimulation of glucose release and glucose uptake at the right time
Therefore increase level of insulin is required to maintain the normal blood glucose level .
3.Dietary modifications-
Avoid-
- Unhealthy fast foods with high calorie intake
- Processed meat
- Refined carbohydrates
-Sugary beverages
-Avoid the polished white rice and refined wheat flour as it reduces the nutritional content of the grains.
Foods to be taken-
- Eat freshly prepared foods
- intake of green vegetables ,dairy products should be included in the diet
- Daily intake of fresh fruits is also adviseable
- High Body Mass Index is a risk for developin type-2 diabetes.
- It is important to measure the BMI and waist circumference
-Restriction in the high calorie intake and regular exercise should be carried out to reduce the body weight and to control the diabetes
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