Diabetes Management Case Study

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Questions and Answers

What is the most likely cause of the patient's blurry vision?

  • Diabetic retinopathy due to prolonged hyperglycemia (correct)
  • Cataracts forming from prolonged insulin use
  • Hypertension causing optic nerve damage
  • Chronic kidney disease related to diabetes

What does a glycosylated hemoglobin level of 9.1% indicate for this patient?

  • Effective use of oral hypoglycemics
  • Good diabetes control
  • Possible insulinoma
  • Poor diabetes control (correct)

Which of the following laboratory findings indicates the presence of diabetic nephropathy?

  • Serum creatinine of 1.8 mg/dL
  • Estimated glomerular filtration rate of 45 mL/min/m2
  • Urine albumin-to-creatinine ratio of 460 mg/g (correct)
  • Total cholesterol of 225 mg/dL

Considering this patient's current medication regimen, which medication does not directly address her diabetes management?

<p>Atorvastatin (C)</p> Signup and view all the answers

What could be a potential complication of the patient's insulin therapy if blood glucose levels fluctuate?

<p>Both hyperglycemia and hypoglycemia (A)</p> Signup and view all the answers

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Study Notes

Patient Profile

  • 46-year-old female with a 22-year history of type 1 diabetes mellitus.
  • Managed with both long-acting and rapid-acting insulin therapies.

Insulin Therapy

  • Current insulin regimen: Insulin detemir (long-acting) and insulin lispro (rapid-acting).
  • Reports fluctuations in blood glucose levels and episodes of hypoglycemia despite insulin adjustments.

Vision Changes

  • Experiencing slight blurriness in vision over the past 6 months, indicative of potential diabetic complications.

Vital Signs

  • Blood pressure: 145/85 mm/Hg, which is above normal range, indicating possible hypertension.
  • Pulse rate: 78 beats per minute, normal resting rate.
  • Oxygen saturation: 99% on room air, indicating adequate oxygen levels.

Laboratory Findings

  • Glycosylated hemoglobin (HbA1c): 9.1%, suggesting poor long-term glycemic control.
  • Serum creatinine: 1.8 mg/dL, indicating possible renal impairment.
  • Estimated glomerular filtration rate (eGFR): 45 mL/min/m², confirming chronic kidney disease.
  • Urine albumin-to-creatinine ratio: 460 mg/g, highlighting significant proteinuria as a complication of diabetes.
  • Total cholesterol: 225 mg/dL, slightly elevated and could contribute to cardiovascular risk.

Current Medications

  • Insulin therapy (detemir and lispro) for diabetes management.
  • Atorvastatin included for cholesterol management.

Summary of Conditions

  • Patient presents with complications of diabetes: poor glycemic control, renal impairment, and potential diabetic eye disease.
  • Requires comprehensive management including insulin adjustments, monitoring for cardiovascular risk, and addressing diabetes-related complications.

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