1- Why did Maria’s physician prescribe mealtime insulin? 2- What is the proposed
ID: 82526 • Letter: 1
Question
1- Why did Maria’s physician prescribe mealtime insulin?
2- What is the proposed mechanism of action for metformin?
3- Why would you recommend regular physical activity for Maria?
4- What causes the numbness and tingling in Maria’s feet and fingers?
5- Calculate Maria’s BMI, %UBW and %IBW
CLINICAL CASE STUDY Dinner: Maria P is a 65 ar old, non-smoker Hispanic female who is coming to see Her blood glucose levels are 2 CU 16 O anagement by an diabetes. she of urination during in her feet and and her fingers, and frequent uncontrolled as evidenced occasionally in the day interviewing her and review After no HS sna Food aller Previous ing her health record, you learn the following about Did not high school through middle school Vitamins occupation: Not employed outside the home, babysits infant grandchild on vitam a daily basis Household Members: Lives with her husband and with one of her four Tx Plans adult children Ethnic Background: Latin American, born in Mexico, emigrated to US in 1980 1. Referr with a Religious Affiliation: Catholic Language. Native Spanish, speaks English has difficulty reading English 2. Phys Patient History: Weighed more than 9 lb at birth a. rap Maria was diagnosed with T2DM. 10 or 15 years ago and her diabetes Pre meal management history is as follows breakfa Type of Treatment: Nutrition therapy plus oral diabetes medication and lunch 15 long-acting insulin at bedtime (HS) 2 dinner Medications: Meds: glargine 80 units at Hs, metformin XR 1000 mg BID Correct i enalapril 10 mg daily, simvastatin 40 mg daily, levothyroxine 75 mog daily evel 50 Family history: Mother had type 2 diabetes, 12 year old grandson recently diagnosed with prediabetes Medical History type 2 diabetes, hypertension, hyperlipidemia, hypothy roidism, episodic migraines (last occurrence 2012) Nutrit Physical exam shows the following: Weight: 201 lbs 1) Why Height: 5'2" inches med Temp: 98.6 F 2) Whi BP: 143/88 mm Hg Heart rate; 80 bpm Labs: A1C9.8%, TSH 8r FT4 0.3; Total cholesterol 144 mg/dL, LDL 116 mg/ 4) Wh dL, HDL 54 mg/dL, Triglycerides 545 mg/dL, BUN 14 phy Self monitoring of blood glucose record shows: 5) Ide Aggregate mean: 218 mg/dL, Standard deviation: 48 (n 68) over last 30 days 6) Wh Frequency 2 x/day Fasting (6 AM): 173 mg/dL, Standard deviation: 35 (n 21 Pre breakfast (9 AM): 248 mg/dL, Standard deviation: 30 (n Prelunch: (1 PM): 193 mg/dL, Standard deviation: 47 (n Nutri Predinner (6 PM): 195 mg/dL, Standard deviation: 33 (n 7) De 9): 260 mg/dL, Standard deviation 34 (n Bedtime (n 13 Range: 69 mg/dL to 304 mg/dL Nutrition History Genera: Good appetite, with wide consumption of foods and beverages native to the region in Mexico where she was born. She plans and prepares meals for the household Performed a 24-hour diet recall Breakfast: coffee with milk and sugar (several spoons Sweet bread 3 to 4 pieces Lunch: chicken and vegetable soup corn tortillas (4-6), home-prepared fruit juice (1-2 x 16 ounce glass)Explanation / Answer
Ans 1. As her blood suger level was increasing with numbness in her feet and fingers and also frequent urination day and night, Maria’s physician prescribe mealtime insulin. Managing blood sugar with mealtime insulin can help lower your A1C (a measure of blood sugar control over 2 to 3 months) when taken with a long-acting insulin. In fact, in 1 study of people with type 2 diabetes, after 1 year of long-acting therapy, 8 out of 10 people were not at A1C goal of less than 6.5% and needed to add mealtime insulin to help them reach their target A1C goal.
Ans.2 It can lower blood glucose in several ways. It acts by countering insulin resistance, particularly in liver and skeletal muscle.
Ans 3.Regular physical activity improves your body's sensitivity to insulin and helps manage your blood glucose (sugar) levels.
Ans-4. People with diabetes can, over time, develop nerve damage throughout the body.Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs.
About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes.
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