NUTR-222 Texas A&M University – Leigh is a 68 year old Native American female in the emergency room for symptoms of dehydration. As the nurse takes her vital signs

QUESTION

Leigh is a 68 year old Native American female in the emergency room for symptoms of dehydration. As the nurse takes her vital signs, he calculates that her BMI is 29 kg/m².  A doctor orders blood work and a urinalysis to test Leigh’s blood glucose, HgbA1c and urinary ketones. Interestingly, the doctor notices that her blood glucose value is 934 mg/dL but her urine is negative for ketones. Her blood pressure was low at 92/55.  After viewing her results, her doctor asks her if she is suffering from any symptoms in the days and weeks prior to coming to the emergency room.  Leigh replies that she has been feeling OK, and she has not noticed any unusual symptoms until feeling weak, exhausted, and “out of it” today before being brought to the emergency room.  She also complained that she has been going to the bathroom more than usual lately and that her vision was blurry.  Leigh then asks what is wrong with her and if she can have a bottle of water as she is very thirsty.

When the laboratory results were available, the doctor noted that her HgbA1c results was 15%.  He told Leigh that she has type 2 diabetes (T2DM).

Other medical history for Leigh includes:  she had 3 pregnancies; she had gestational diabetes for her last pregnancy.  She also has high blood pressure, her gallbladder was removed 20 years ago, and she has sleep apnea.

Name the acute state that Leigh is suffering from (be specific; not dehydration).

According to the lectures, what are 4 clinical signs of the acute condition you answered in question 1?

What 3 treatments are used to treat the acute condition you answered in question 1?

Leigh is newly diagnosed with T2DM. What were the diagnostic criteria included in the case study used to make this diagnosis?

What were Leigh’s risk factors for developing T2DM?

What is the cause of hyperglycemia in those with T2DM?

What are the 3 possible general treatments for T2DM discussed in lecture? The treatments could be medical or nutritional.

What is the overall goal for someone with diabetes to reduce their risk for developing long term complications of diabetes? What are the other treatment goals for those with diabetes?

As Leigh is a newly diagnosed older adult, the simpler meal-planning method is more appropriate for her to learn to treat her disease. What is the name of this meal-planning method discussed in lecture?

Describe 3 characteristics of the meal-planning method you answered in question 9 (beyond that it is simpler and more flexible than other methods).

ANSWER

Understanding Leigh’s Acute Condition, T2DM Diagnosis, and the Simpler Meal-Planning Method

The acute state that Leigh is suffering from, in addition to dehydration, is hyperglycemic hyperosmolar state (HHS) or hyperosmolar hyperglycemic nonketotic syndrome (HHNS).

Four clinical signs of HHS/HHNS include

Severe hyperglycemia: Leigh’s blood glucose level of 934 mg/dL indicates extremely high blood sugar.

Dehydration: Leigh’s symptoms of weakness, exhaustion, and excessive thirst, along with her low blood pressure, suggest dehydration.

Altered mental status: Leigh’s feeling of being “out of it” could be attributed to the high blood sugar levels affecting her brain function.

Blurred vision: Leigh’s complaint of blurry vision is another common symptom of high blood sugar levels affecting the eyes.

The three treatments for HHS/HHNS are:

Fluid replacement: Leigh’s request for a bottle of water is appropriate, and she may require intravenous fluids to rehydrate her body (Ahsan & Tobing, 2008).

Insulin therapy: Administration of insulin is necessary to lower Leigh’s blood glucose levels.

Electrolyte management: Monitoring and correcting any imbalances in electrolytes, such as potassium, sodium, and phosphate, is crucial in the treatment of HHS/HHNS (Ahsan & Tobing, 2008).

The diagnostic criteria for Leigh’s diagnosis of type 2 diabetes mellitus (T2DM) include the following:

Fasting plasma glucose level: Equal to or greater than 126 mg/dL.

HgbA1c level: Equal to or greater than 6.5%.

Presence of classic symptoms of hyperglycemia (e.g., increased urination, excessive thirst, unexplained weight loss) with random plasma glucose level equal to or greater than 200 mg/dL.

Leigh’s risk factors for developing T2DM include:

Gestational diabetes during her last pregnancy: Gestational diabetes is a known risk factor for the development of T2DM later in life (O’Donovan et al., 2017).

Advanced age: Leigh being 68 years old increases her risk of developing T2DM.

Native American ethnicity: Certain ethnicities, including Native Americans, have a higher predisposition to T2DM.

History of high blood pressure, gallbladder removal, and sleep apnea: These conditions are associated with an increased risk of developing T2DM (O’Donovan et al., 2017).

The cause of hyperglycemia in individuals with T2DM is insulin resistance, where the body’s cells become less responsive to the action of insulin, resulting in elevated blood glucose levels. Additionally, impaired insulin production by the pancreas contributes to hyperglycemia in T2DM.

The three possible general treatments for T2DM discussed in lecture are:

Medical treatment: This includes oral antidiabetic medications, such as metformin, sulfonylureas, or thiazolidinediones, and injectable medications like insulin (Heald et al., 2018).

Nutritional therapy: Emphasizing a balanced diet, portion control, and carbohydrate counting can help manage blood sugar levels.

Lifestyle modifications: Encouraging regular physical activity, weight management, and smoking cessation are essential components of T2DM management (Heald et al., 2018).

The overall goal for someone with diabetes is to reduce their risk of developing long-term complications. This includes maintaining blood glucose levels within a target range, controlling blood pressure and cholesterol levels, and managing other risk factors such as obesity and smoking. Other treatment goals for those with diabetes include promoting overall well-being, preventing acute complications (e.g., hypoglycemia), and improving quality of life.

The simpler meal-planning method appropriate for Leigh to learn is called “carbohydrate counting” or “carb counting.”

Three characteristics of carbohydrate counting as a meal-planning method are:

Flexibility: Carbohydrate counting allows individuals to have more dietary freedom by focusing on managing their carbohydrate intake rather than strictly limiting specific food groups.

Precision: This method involves calculating the number of carbohydrates consumed in a meal or snack, enabling better control over blood sugar levels.

Personalization: Carbohydrate counting takes into account an individual’s unique dietary preferences, allowing them to choose a variety of foods as long as they stay within their prescribed carbohydrate limits. This approach encourages a more individualized approach to meal planning and promotes adherence to dietary recommendations.

References

Ahsan, A., & Tobing, M. H. (2008). Study of the Impact of Tobacco Consumption among the Poor in Indonesia. Demographic Institute FEUI. https://www.researchgate.net/profile/Abdillah-Ahsan/publication/281061163_Study_of_the_Impact_of_Tobacco_Consumption_among_the_Poor_in_Indonesia/links/55d2ea7408aec1b0429f00e2/Study-of-the-Impact-of-Tobacco-Consumption-among-the-Poor-in-Indonesia.pdf

O’Donovan, G., Chudasama, Y., Grocock, S., Leigh, R., Dalton, A. M., Gray, L. J., … & Wells, A. (2017). The association between air pollution and type 2 diabetes in a large cross-sectional study in Leicester: The CHAMPIONS Study. Environment international, 104, 41-47. https://doi.org/10.1016/j.envint.2017.03.027

Heald, A. H., Livingston, M., Malipatil, N., Becher, M., Craig, J., Stedman, M., & Fryer, A. A. (2018). Improving type 2 diabetes mellitus glycaemic outcomes is possible without spending more on medication: lessons from the UK National Diabetes Audit. Diabetes, Obesity and Metabolism, 20(1), 185-194. https://doi.org/10.1111/dom.13067

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