Diabetes type 2 assignment

[tommygangstarr]

Need some help guys ... desperately !!!

67 year old female with a hectic and stressful job has got diabetes mellitus type 2. Her daily bsl's have been increasing between 11 - 13 mmol/L. She also has a medical history of hypertension and angina. She doesn't smoke and plays golf about once a week and brish walking for an hour a day with her dog. Her current meds include aspirin 100mg daily, perindopril 4 mg daily, metoprolol 25 mg twice daily, sublingual nitrate as needed (on average once per mth), simvastatin 20 mg daily, metformin 850mg 3 times a day and gliclazide 120 mg twich daily with food. Her BP is 135/80mmHg, heart rate 64 bpm, weight 72 kg, height 168 cm (BMI 26kg/m2), waist circumference 78cm.

What i need help most is :

1. How do I provide a rationale for all aspects of her management regime. If her bsl continues to rise, how would her treatment regime change?

2. Would there be any need to modify her current lifestyle?

[Daytonite, BSN, RN]

you've got a lady here with hypertension and angina. it's not mentioned why she's also on an antilipidemic (simvastatin) so i'm guessing that her cholesterol is or was probably elevated at some point unless it is just being given prophylactically. although with angina, i would suspect she's got cardiac disease and the simvastatin is needed. the hypertension and angina are being treated (perindopril and metoprolo for hypertension and sublingual nitrate for angina). her diabetes is being controlled with metformin and gliclazide. for her height she might be a tad overweight and could probably stand to lose about 10 - 12 kg. this lady has most all the other complications that are connected with type ii diabetes.

you've got to ask why her blood sugars are rising. what causes blood sugars to rise? i would consider these rises to be kind of subtle. a couple of things come to my mind, but i suggest you also do a little checking on your own. (1) diet. is she eating foods that are higher in carbohydrate than usual? has her diet changed in some way? (2) blood testing. is she testing at proper times and at proper intervals since eating? (3) is she compliant about taking her gliclazide every time she eats? if she doesn't, it may affect her glucose level keeping it high (4) is it possible that she is developing a resistance to the gliclazide? is her diabetic condition worsening and she now requires an adjustment of her dosage of gliclazide? her current dose seems like a rather high dose to me. (5) it's possible that being under stress her blood sugars are showing that by being elevated. i would want to question her and look for any evidence of a potential infection since blood sugars tend to rise in the face of infection. for diabetic women, rule out bladder infections first and in this lady, perhaps, something cardiac. it also crosses my mind that with the heart disease and hypertension, some of the medications this lady is taking can have peripheral edema as a side effect. if she develops leg edema and then a skin cellulitis that could account for a rise in blood sugar--just a thought (6) it is also quite possible that her disease process is just proceeding along its normal course. no matter how much help her poor pancreas is given with the medications and a controlled diet and exercise, it is still headed on a course of failure. it may just be that her diabetic meds need adjustment or perhaps it's time to go to insulin.

http://www.fpnotebook.com/search.asp?qu=diabetes&ct=d%3a%5cusers%5csmoses%5cdb - this web page at family practice.com has many links to outlines of information on type ii diabetes. they will only be starting places and lists of items to start you off on your search.

hope this gives you something to start with.

[tommygangstarr]

Cheers! I'll start workin on it.