Martha Marconie is a 40 year old mother of 3 teenage children who works as a cou

Question

Martha Marconie is a 40 year old mother of 3 teenage children who works as a counselor in a job placement bureau. The children’s birth weight ranged from 9-1/2 - 11 lbs. As teenagers they show no sign of diabetes, and their weights at present are within normal range. Her husband, a truck driver, is overweight but not obese. Recently she noticed that she was having difficulty reading street signs, and, thinking she needed new glasses, made an appointment with her ophthalmologist. Refractive changes and premature cataracts were found, and her ophthalmologist, suspecting diabetes, referred her to an internist. On examination, the internist found no evidence of neurologic, cardiovascular or renal impairment. Her blood pressure was 130/68, height 165 cm (5’ 5”), weight 93 kg (205 lbs.). Glucose test values (GTT) were 300 mg/dl at 1 hour, 248 mg/dl at 2 hours and 195 mg/dl at 3 hours. Serum cholesterol was 250 mg per dl and triglycerides 200 mg/dl. History, physical examination and laboratory studies confirmed the diagnosis of NIDDM. She was counseled on a 1200 kcal weight reduction plan, along with an exercise program, urine testing, record keeping, and the importance of personal hygiene and avoiding infection. She was to return for follow-up and further counseling in two weeks. At this appointment she still showed hyperglycemia and glysuria, at which time a hypoglycemic agent was prescribed. A second appointment was scheduled for 2 weeks later. She did not show up for her second appointment or a subsequent medical appointment. A month later she was seen in the Emergency Room with the complaint of several infections that would not clear up. She was admitted for treatment. On discharge she was again referred to a diabetes educator for individual counseling and group education classes. Study questions Based on the information given: 1.What factors in Mrs. Marconie’s history do you think contributed to her becoming diabetic? 2.Why are obese people more susceptible to diabetes? 3.List 3 chronic complications of NIDDM. 4.Based on the results of Mrs. Marconie’s laboratory results and examination, what nutritional problems can be identified? What other factors should determine the type of diet counseling she should receive?

Explanation / Answer

1.

From information given here we know that Martha is class 1 obese according to her Body Mass Index, which is 34.11kg/ M2. She has hypercholesterolemia normal bellow 200mg/dL), and increased Triglyceride( normal bellow 150mg.dL).

She works Job placement bureau and is overweight, so she definitely do not exercise at all.

She has NIDDM (Type 2 diabetes mellitus) which due to abnormality in insulin quality not quantity of insulin and also the responsiveness of insuline receptors to the insulin. Obesity, hypercholesterolemia, increased triglyceride, high blood glucose level, sedentary life style, all these affects the rsponsiveness of insulin receptors( insulin resistance).

2. As I have already mentioned that in type 2 diabetes , there is insulin resistance. Obesity is associated with increased nonesterified fatty acids, glycerol, hormones, cytokines, proinflammatory markers, and other substances that are involved in the development of insulin resistance. Recent studies has shown that obesy induce stress on endoplasmic reticulum of individual cells of human body. Impaired Endoplasmic Reticulum function due to obesity has been linked to insulin resistance mechanism.

3. Chronic complication of NIDDM:

1. Cardiovuscular complications: Atherosclerosis leadig to ischemic stroke

2. Renal complication due to impaired of micro-circulation of body.

3. Diabetic retinopathy.

4. Martha has Hypercholesterolemia, Increased triglyceride, Retinal dmage due to poor nutrition to retina as a result of impaired micro-circulation.

5. Along with calorie recommendation, there should be recommendation for:

1. Not to take any poly-saturated fatty acids like mustard oil, butter, mergarin, peanut butter etc.

2. To take anti-oxidant to reverse nuronal dmamage. Stop smoking & alcohol if there is.

3. Avoid high sugar diet.

4. Avoid taking high protein diet to avoid damage in kidney bed.

5. To take adequate water to maintain circulation as normal as possible.

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