diabetes - Nursing Case Study

Pathophysiology

• Primary mechanism: Insulin resistance. Body's cells do not respond properly to insulin and cannot easily absorb glucose from the bloodstream. Result: pancreas produces more insulin to overcome resistance, leading to hyperinsulinemia.

• Secondary mechanism: Beta cell dysfunction. Over time, pancreas cannot keep up with the increased insulin demand. Insulin production decreases, leading to insufficient glucose uptake and high blood glucose levels, defining diabetes.

• Key complication: Hyperglycemia. Prolonged high blood glucose can damage blood vessels and nerves, leading to complications like heart disease, stroke, kidney disease, vision problems, and neuropathy.

Patient Profile

Demographics:

52-year-old male, office worker

History:

• Key past medical history: Hypertension

• Current medications: Lisinopril 10mg daily for hypertension

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Excessive thirst and frequent urination

• Key symptoms: Increased thirst, urination, and mild fatigue, no significant weight loss

• Vital signs: Blood pressure 130/80 mmHg, pulse 72 beats per minute, respiratory rate 16 breaths per minute, body temperature 98.6 degrees Fahrenheit, blood glucose level 180 mg/dL

Section 1

Initial assessment findings:

The patient was alert and oriented but reported feeling mildly fatigued and extremely thirsty. On physical examination, there was no evidence of dehydration such as dry mucous membranes or poor skin turgor. The patient's weight was stable, with no reported significant weight loss. Neurological examination was unremarkable, with no signs of neuropathy such as numbness or tingling in the extremities. The cardiovascular exam revealed a regular rhythm with no murmurs, rubs, or gallops. The patient's blood glucose level was elevated at 180 mg/dL, which is above the normal range of 70-120 mg/dL, indicating hyperglycemia.

New diagnostic results:

The patient underwent a fasting glucose test, which revealed a blood glucose level of 128 mg/dL, above the normal range and suggestive of diabetes. An HbA1c test, which measures the average blood glucose level over the past 2-3 months was also conducted. Results showed a level of 7.2%, which is above the normal range of 4-5.6%, confirming the diagnosis of diabetes. His kidney function tests including serum creatinine and blood urea nitrogen were within normal limits, indicating that there is currently no significant renal impairment. His lipid profile showed borderline high LDL cholesterol of 130 mg/dL, indicating a potential risk for cardiovascular disease.

Section 2

Change in Patient Status:

Over the next few days, the patient reported continued feelings of thirst and began to experience increased urination, which are common symptoms of diabetes. He also reported mild blurred vision, another potential symptom of diabetes. His blood glucose levels remained elevated, averaging 150 mg/dL, despite dietary modifications. However, he did not display any signs of severe hyperglycemia such as confusion, abdominal pain, or shortness of breath. His vital signs remained stable with blood pressure at 120/80 mmHg, pulse rate 72 beats per minute, and respiratory rate 16 breaths per minute.

Response to Interventions:

The patient was started on a low dose of Metformin, a first-line medication for the treatment of type 2 diabetes. The healthcare team also provided him with diabetic education, emphasizing the importance of regular exercise, a balanced diet, and monitoring his blood sugar levels at home. He was encouraged to limit his intake of sugary drinks and maintain a healthy weight. Following these interventions, the patient's average blood glucose levels began to decrease, reaching 130 mg/dL. The patient reported feeling less thirsty and the frequency of urination decreased. His vision also improved. He expressed understanding of the disease process and the importance of medication and lifestyle modifications in managing his condition.

Section 3

New Complications:

Approximately two weeks after the initiation of Metformin, the patient began to report occasional episodes of light-headedness and shakiness, especially if he had missed a meal. He also noted that these symptoms seemed to coincide with feelings of fatigue and excessive sweating. These symptoms suggested that the patient might be experiencing hypoglycemia, or low blood sugar, a common side effect of Metformin. The healthcare team advised him to monitor his blood glucose levels more frequently, especially before meals and when experiencing these symptoms.

On one occasion, his blood glucose level dropped to 65 mg/dL, confirming the suspicion of hypoglycemia. His vital signs were stable, with blood pressure at 120/80 mmHg, pulse rate 68 beats per minute, and respiratory rate 16 breaths per minute. The healthcare team emphasized the importance of regular meals and snacks to prevent hypoglycemia and advised him to always have a source of fast-acting carbohydrate, like fruit juice or glucose tablets, on hand. This new development underlined the need for ongoing patient education and the importance of diligent self-monitoring in diabetes management.

Section 4

Change in Patient Status:

Over the next few weeks, the patient diligently followed the healthcare team's instructions. He ate regular meals, with healthy snacks in between, and kept glucose tablets on hand at all times. Despite these efforts, he still reported occasional episodes of light-headedness and shakiness, usually occurring late in the afternoon. He also noticed that his symptoms were more pronounced on days when he engaged in more physical activity than usual.

These changes suggested that the patient's blood glucose levels might still be fluctuating throughout the day. His latest blood glucose reading was 78 mg/dL, which was within the normal range, but on the lower end. The healthcare team considered this along with his reported symptoms, and hypothesized that his physical activity might be causing additional drops in his blood glucose levels. They proposed to adjust the timing and dosage of his Metformin in order to better align with his meal and activity schedule. This case highlights the importance of individualized treatment plans and the need for ongoing adjustments in diabetes management, based on the patient's lifestyle and response to medication.

Section 5

Change in Patient Status:

Within a week of the adjustments to his Metformin dosage and timing, the patient reported a significant reduction in the instances of light-headedness and shakiness. He noted these symptoms were now only occurring occasionally, rather than regularly in the late afternoons. However, he did occasionally experience symptoms of mild hypoglycemia, especially if he had engaged in strenuous physical activities. His latest blood glucose reading was 82 mg/dL, slightly higher than the previous reading, but still within the normal range.

This suggested that the patient's blood glucose levels were becoming more stable, but the healthcare team decided to perform further testing to ensure that his physical activity was not causing undue stress on his body. They ordered a hemoglobin A1c test to get a better picture of his average blood glucose control over the past two to three months. This would help them understand if the recent changes in his medication and lifestyle were having the desired effect. This stage of the patient's journey underscores the need for ongoing monitoring and adjustments in diabetes management.