C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for a number of “female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.
Case Study Questions
- In which race and ethnic groups is DM more prevalent? Based on C.B. clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis.
- If C.B. develop a bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.
- What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?
- Race and Ethnic Groups with Higher Prevalence of DM: Diabetes Mellitus (DM) is more prevalent in certain race and ethnic groups, including:
- Native Americans, such as the Winnebago Indian tribe to which C.B. belongs
- African Americans
- Hispanic/Latino Americans
- Asian Americans
- Pacific Islanders These groups have a higher risk of developing DM compared to the general population.
- Signs and Symptoms Compatible with Diabetes Mellitus Type 2: Based on C.B.’s clinical manifestations, the signs and symptoms compatible with a diagnosis of Diabetes Mellitus Type 2 include:
- Elevated fasting blood sugar level (141 mg/dL)
- High cholesterol level (225 mg/dL)
- Thirstiness (polydipsia)
- Increased frequency of urination, particularly at night (nocturia)
- Unexplained weight gain (65 pounds since her last pregnancy, 15 pounds in the last 6 months)
- Weakness and numbness in the left foot, difficulty flexing the foot (possible peripheral neuropathy)
- Expected Glycemia Values in Bacterial Pneumonia: In the case of bacterial pneumonia, stress on the body can lead to an increase in blood sugar levels. This occurs due to the release of stress hormones like cortisol and catecholamines, which can raise blood glucose. Therefore, it is expected that C.B.’s glycemia values would be higher if she develops bacterial pneumonia in the right lower lobe.
- Initial Therapy Recommendations for C.B.: a) Non-pharmacologic therapy:
- Weight management: C.B. should be encouraged to adopt a healthy lifestyle with a focus on weight loss through a combination of dietary changes and regular physical activity.
- Diet modifications: A balanced diet with a focus on portion control, reduced intake of processed sugars and carbohydrates, and increased consumption of fruits, vegetables, and lean proteins should be recommended.
- Physical activity: Regular exercise, such as brisk walking or aerobic exercises, should be encouraged to improve insulin sensitivity and overall health.
- Smoking cessation: If C.B. is a smoker, quitting smoking is crucial, as smoking can worsen diabetes complications.
b) Pharmacologic therapy:
- Since C.B.’s symptoms and history indicate Diabetes Mellitus Type 2, she may require pharmacologic intervention to manage her condition effectively.
- Oral antidiabetic medications, such as metformin, are commonly prescribed as a first-line therapy for Type 2 diabetes. These medications help control blood sugar levels and improve insulin sensitivity.
- The exact choice and dosage of medication should be determined by a healthcare professional based on C.B.’s specific health status, including kidney function and other factors.
It is important for C.B. to consult with a healthcare professional for a comprehensive evaluation, diagnosis, and personalized treatment plan for her specific needs and conditions.