Diabetic Case study

L.M. is a 22 year old male that came to the hospital with his sister with complaints of decreased appetite. L.M. is cognitively impaired and his sister provides the information. She says that he is drinking cranberry and apple juice. Past medical hx is DM 2. L.M ask for some juice shows no signs of distress. L.M. only takes glipizide 5mg po bid; and he has not taken a does since he has not been eating.

Subjective data:

·       Glucose level at home is high and the machine is unable to read the blood glucose level.

·       Abdominal pain, mouth and tongue is appears dry.

 

Objective data

·       Vital signs: T - 97.7, pulse - 136, Respirations - 17, O² sat - 97%, weight 70.2 kg, height 61

 

Labs:

·       BMP

o   BUN - 39 H, Creatinine - 2.25 H, Glucose level - 1023 CH, Sodium - 144, Potassium - 6.6 CH

o   Chloride - 93 L, CO 2 - 18 L, Osmolality 348 H, Calcium -11.4 H, Albumin 5.3 H

o   Magnesium 3.4 H, Bilirubin 1.9H

·       CBC

·       Hemoglobin 17.8, Hematocrit 56.5 H

·       Drug screen is negative

·       Urinalysis

·       Specific gravity 1.027, pH 5.0, leukocytes- negative, nitrate-negative, protein-negative,

·       Glucose-3+, Ketones 1+

·       ABG

·       pH- 7.17 CL, pO² - 36 CL, HCO³ -14.2, Allen test positive

·       CT scan of abdomen impression: Short segment intussusception within the upper abdomen without evidence of obstruction.

 

L.M. is given 10 units of Novolin R and started on Novolin insulin gtt at 6units/hr and sent to the unit. His sister says he is DM type 2 and is confused to the treatment plan. She asks the nurse the following questions and demands answers before she would allow her brother to be given insulin.

1.    What is the difference between type 1 diabetes and type 2?

2.    What is the difference between DKA and HHS?

3.    Can he have water or sugar free beverages to drink?

4.    What other test should the physician order for him?

5.    What is the nurse monitoring to ensure he is being treated correctly, she demands the rationales to your answer?

6.    What is the result of the CT scan to his abdomen and will he have surgery?

7.    Is there any important information that is required for when he goes home?

1)Type 1 DM

- young onset

- non obese

- Body cannot produce insulin

- insulin injection

- cell starvation

 

Type 2 DM

-Older Onset 

- obese

- body resistant to insulin

- oral medication or insulin injection

- less insulin receptors/Defective

 

2)DKA

- Glucose: 250-600

- More on Type 1 DM

- more prominent Ketoacidosis

 

HHS

- Glucose: 600 - 1200

- More on type 2 DM

-Hyperosmolar state

- Ketones may be absent

 

3)As per Warwick, 2020

Safe to Drinks

1. Water

2. Unsweetened tea

3. Unsweetened coffee

4. Tomato or V-8 Juice

5. Sugar-free sports drinks

6. Sugar-free carbonated Beverages. 

 

4. Other Test:

- A1C test (Glycated Hemoglobin) 

- Fast Blood Sugar Test

- Glucose Tolerance Test

- Random Blood Sugar Test

 

5. Nursing Intervention:

- Assess for signs of Hyperglycemia

-weight Daily 

- Assess feet for temperature, pulse, color and sensation. 

- Assess bowel sounds by auscultation and note rwport of bloating and abdominal pain. 

- Report BP of more than 160mmHg. Administer hypertensive as prescribed. 

 

Rationale:

- increased thirst, hunger and Urination (3Ps of Diabetes: polydipsia, polyphagia and polyuria).

- To help adequency of Nutritional intake. 

- To monitor peripheral perfusion and neuropathy. 

- Hyperglycemia disrupts gastric motility in stomach and may affect choice of intervention. 

- Renal failure: creatinine greater than 1.5mg/dL

- Hypertension is commonly associated with diabetes. 

 

6. Hyperglycemia may result in intestinal dysmotility, potentially leading to intestinal intussuception in adult. 

 

7. Teach patient how to perform home glucose monitoring. 

- Instruct patient to avoid heating pads and always wear shoes when walking. 

- Educate correct rotation of injection site when administering insulin. 

 

Rationale:

- Blood glucose is monitored before meals and at bedtime. 

- Peripheral neuropathy is decreased sensation in the extremities. 

- it may result to lipoathrophy/lipohypertrophy. 

Step-by-step explanation

A1C test - measures average blood sugar level over pasr 2 to 3 month

Normal: 5.7%

Prediabetes: 5.7% - 6.4%

Diabetes: 6.5% above

 

Fasting Blood Sugar Test:

Usually fasting starts at 6 pm until the blood sample is taken. May depends on institution. 

Normal: 99 mg/dl or low

Prediabetes: 100 - 125 md/dl

Diabetes: 126 mg/dL or above. 

 

Glucose Tolerance Test:

Drinking a liquid contains glucose:

Normal result: Depends on how many grams of glucose are in the solution. 

Normal: 140 mg/dL (7.8mmol/L)

Prediabetes: 149 to 199 mg/dL (7.8 mmol/L to 11.0 mmol/L) 

Diabetes: 200 mg/dL (11.1 mmol/dL) 

 

Random Blood Sugar Test

Normal: 200 mg/dL.