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Mini Case Study: Donna's Diabetes
For the past 2 or 3 years, Donna has always had fasting blood sugar levels in the 100-120 mg/dL range. When she presents in your clinic however, her fasting blood sugar is 137 and her hemoglobin A1c is 8.3%. Donna is 58 years old, does not have a history of diabetes, has a height of 5'4" and weighs 165 lbs and she is on medication for hypertension. She says she has tried to lose weight many times in the past and often has success, but she always gains it back. She reports that she eats a "fairly healthy" diet but just loves to bake and often indulges in sweets. She does not know much about diabetes, except that it requires you to give yourself shots—and she hates needles!
1) What can you tell Donna about her diabetes status? What lab values helped you to determine that, and what are the relevant cut-points?
2) If Donna's hemoglobin A1c is 8.3%, what is her average blood sugar? How does that compare to her fasting blood sugar, and why is it different or similar?
3) Donna is so scared of needles that at any mention of diabetes, she immediately resists, saying, "Don't expect me to give myself a shot." What can you tell her about various diabetes treatments and the likelihood of her needing to give herself a shot?
4) Explain why Type 2 diabetes often shows up later in life and how it differs from Type 1 Diabetes. How do the treatments for the two diseases compare?
5) What lifestyle changes would you recommend for Donna? What dietary recommendations would you make? Explain why you decided to focus on the behaviors that you did.
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In this solution, we discuss a case of type II diabetes mellitus, along with pathogenesis and treatment options including behavioral modification and medication.
1. Read this report from American Diabetes Association to learn more about the diagnosis of diabetes mellitus (DM): http://care.diabetesjournals.org/content/38/Supplement_1/S8.full. According to this guideline, Donna fulfilled at least 2 criteria for diagnosis of DM, which are Hb A1c of >6.5% and fasting plasma glucose > or equal to 126 mg/dL. You can probably tell Donna that she is diabetic, and intervention is highly recommended. Of note, her BMI (calculated from her weight and height) is 28.3, which falls in the overweight range and putting her at risk for developing type II diabetes (which she probably has).
2. The formula to calculate estimated average plasma glucose (eAG) from Hb A1c is "Average Plasma Blood Glucose (mg/dl) = (HbA1c * 35.6) - 77.3" If Donna's Hb A1C is 8.3%, her eAG is 192 mg/dL. This number represents the average level of plasma glucose ...
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