A Case Study Of A 57 Year Old Female Patient With Type 2 Diabetes Mellitus

A Case Study Of A 57 Year Old Female Patient With Type 2 Diabetes Mellitus

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The following is a case study of a 57-year-old female patient with Type 2 Diabetes Mellitus. She is 65 inches tall and weighs 242 pounds giving her a BMI of 40%. During her review of systems she reports she has been fatigued, having headaches and had increased thirst. The patient’s fasting blood sugars have been averaging 180-200 mg/dL. She is currently taking Metformin 500 mg by mouth twice daily with breakfast and dinner. The patient’s labs reveal a fasting glucose of 204 mg/dL and a HgbA1c of 8.4%. Her family history reveals type 2 diabetes in both parents and one brother as well as coronary artery disease in her father and paternal grandparents. The patient reports that she walks once or twice a week but overall is sedentary. She tries to watch what she eats but still consumes a large amount of carbohydrates and would not consider her diet well balanced. The patient works as a store clerk and has health insurance but no prescription coverage.
Pathophysiology
Type 2 diabetes is a multifactorial process that is linked to genetics, lifestyle, metabolic and environmental risk factors. It is characterized by hyperglycemia due to abnormal metabolism of carbohydrates, fats and protein. This altered metabolism is a result of decreased insulin secretion, increased resistance to insulin, and/or impaired insulin processing. (Carmichael, 2016). Chronically hyperglycemic states can result in both micro and macrovascular complications including retinopathy, nephropathy, neuropathy, coronary artery disease, stroke and peripheral artery disease (Carmichael, 2016). According to Carmichael (2016) insulin resistance is a contributing factor in endothelial dysfunction that leads to inhibition of platelet aggregation resulting in ...


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...ave prescription coverage through her health insurance. The patient should be educated about various programs and savings plans in her area. The patient could also be advised of at least one pharmacy in the area that gives low cost generics that would cover her simvastatin as well as free diabetic testing supplies and metformin. There is also a savings card available through the manufacturer for the Lantus that the patient could be assisted in obtaining. If the patient is still unable to afford the Lantus then alternative medications may be considered such as NPH insulin or a sulfonylurea (McColluch, Aug. 2016).
Conclusion
The goals of this patient’s treatment are to get her blood glucose under control and to get her HgbA1c below 7%. Reaching her glycemic goals will help to decrease her risk of cardiovascular events as well as other complications of diabetes.

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