Case Study: Angela is a 35-year-old woman diagnosed 2 years ago, with type 2 Dia
ID: 166034 • Letter: C
Question
Case Study: Angela is a 35-year-old woman diagnosed 2 years ago, with type 2 Diabetes Mellitus. She has 3 children whose birth weights were in the range of 4.5 to 5 kgms. The children now teenagers, show no signs of diabetes, and their weights are reported to be within normal limits despite their mother's fondness for cooking. Her husband, an underpaid construction worker is slightly overweight. Approximately 6 months ago, Angela was seen with a complaint of a series of infections that lasted longer than usual during the past 2 months. At the time she was measured as a 165 cm ( 5 feet 5 inches) and 71 kg (156 lb.) Her glucose tolerance test was positive. She was seen for follow up twice during the next month, each time showing hyperglycemia and glycosuria. At the second follow up, antidiabetic medication was prescribed, and she was referred for medical nutrition therapy (MNT). Angela did not keep this appointment or her subsequent medical appointment. She was not seeing again until 1 month ago, when she arrived to the emergency department with ketoacidosis. She responded well to treatment and was placed on a 1200 kcal diet and a mixture of intermediate and rapid acting insulin given in two injections a day. Her discharge plan included a referral for a MNT consultation session and diabetes education classes.
Identify any personal factors that may affect Angela's adherence to her treatment plan. Do you anticipate any problems?
If so, then how would you attempt to help her solve them?
Explanation / Answer
According to the information, it can be implied that the patient is suffering from insulin dependent Diabetese mellitus. From the case history of the patient, it can be ascertained that if the patient sticks to the treatment plan, she will definitely recover from the immediate problem of diabetic shock but a sustained anti-diabetic therapeutic might pose problems for the patient in long run. These problems include dependency of the patient on complete supply of insulin for regulation of blood glucose levels, loss in physiological endurance due to fluctuations in sugar levels and moreover insulin-related pathologies might also occur if a dose is missed.
This is because the patient is already shown to have multiple infectious episodes previously. This is a very strong signature of diabetes mellitus and deciphers insulin intolerance in some patients. Thus, inspite of relying completely upon external supply of insulin, the patient should be encouraged to naturally monitor and modulate her blood sugar levels by exercise, regular walks and control on her dietary intake. These practises along with light medication will help in improving her condition.