Segment 2 Endocrine Clinical Scenario Patient information: 12 year old female wi
ID: 3513171 • Letter: S
Question
Segment 2 Endocrine Clinical Scenario
Patient information: 12 year old female with excessive thirst, frequent urination, and weight loss.
Background: Veronica Donny, a 12-year-old girl in previously good health, has noticed that, in the past month, she is increasingly thirsty. She gets up several times a night to urinate, and finds herself gulping down glassfulls of water. At the dinner table, she seems to be eating twice as much as she used to, yet she has lost 5 pounds in the past month. In the past three days, she has become nauseated, vomiting on three occasions, prompting a visit to her pediatrician.
Following her visit to the pediatrician, Veronica undergoes a diabetic care training program, learning how to self-inject insulin subcutaneously and check her blood-glucose level at home with chemstrips. In addition, she learns the importance of carrying candy and glucagon with her at all times as well as eating the right amounts of food at the right times each day.
What dangers confront Veronica as she gives herself insulin artificially on a daily basis?
Why must she carry candy and glucagon with her at all times?
Veronica is started on the following schedule of insulin dosing:
· morning dose = 8 units of NPH insulin and 4 units of regular insulin
· supper dose = 4 units of regular insulin
· bedtime dose = 5 units of NPH insulin
· total dose per day = 21 units
Three days later, she returns to the doctor's office for a review of her blood-glucose readings and a measurement of her fasting blood-glucose level, which is found to be 95 mg/dl. Most of her glucose readings during the day have been in the low- to mid-100 range. Her glucose levels before supper, however, are in the upper 200s.
C.How might you adjust Veronica's insulin-dosing schedule to bring her pre-supper glucose levels down?
Veronica returns to her pediatrician three months later for a re-check, and is found to have a glycosylated hemoglobin level (Hb A1C) of 9.5%.
D. What is glycolsylated hemoglobin? What is the normal range for glycosylated hemoglobin?
E.What does Veronica's Hb A1C level indicate that a one-time direct measurement of blood glucose doesn't indicate?
The years progress, and Veronica has considerable difficulty controlling her diabetes. She has been told that she has "brittle" diabetes, a form of the disease marked by wide swings in blood-glucose levels despite the best efforts at control. Veronica is advised by her physician that she is at risk for developing certain complications of diabetes.
F. What are the possible long-term complications of her disease?
G. Veronica is advised that she must take very good care of her feet, never walking barefoot. Why is this important?
Explanation / Answer
veronica is suffering from type 1 diabetes mellitus.
A-Veronica gives herself insulin artificially on a daily basis because insulin is required to maintain blood glucose levels at normal level and via GLUT 4 insulin helps glucose to enter inside adipose and striated muscles.
B- she must carry candy and glucagon with her at all times because candy contain sugars as carbohydrate which maintain all time steady state glucose concentration and glucagon helps by maintaining glucose level normally, glucagon prevent blood glucose level dropping to be very low. hence maintain blood glucose.
C-.we adjust Veronica's insulin-dosing schedule to bring her pre-supper glucose levels down by adding 4 unit of nph insulin in supper dose and decreasing 4 nph insuline morning dose.
D and E- glycolsylated hemoglobin is HBA1C is a form of haemoglobin that bound to glucose, its normal level is less than 5.6% and it represent the 8 to 12 week status of blood glucose it represents how well the diabetes is controlled it give great range of glucose level idea about diabetes control well or not. single time glucose give idea for that instant but hba1c give idea of glucose level for past 8 to 12 wks. so its better to be measured.
F- type 1 DM complications are - diabetic retinopathy ,nephropathy, neuropathy cardiac stroke, heart diseases, foot diseases , vision impaired, hearing impairment.
G- veronica is advised that she must take very good care of her feet, never walking barefoot this important because in diabetic neuropathy along with blood vessels vasculitis leads to develop of diabetic ulcers and they are painless becoz of neuropathy so its better to avoid any injury to foot