A 56-year-old female with poorly controlled Type 2 diabetes, hypertension, and hyperlipidemia is experiencing complications such as peripheral neuropathy and diabetic retinopathy. The healthcare team is considering the addition of a GLP-1 receptor agonist to her treatment plan. Which of the following benefits of GLP-1 receptor agonists is most relevant for this patient’s condition?

A) Improvement in insulin secretion and reduction in postprandial glucose levels

B) Direct lowering of blood pressure without lifestyle modifications

C) Rapid improvement in peripheral neuropathy symptoms

D) Immediate reversal of diabetic retinopathy

A 56-year-old female patient with Type 2 diabetes is experiencing persistent hyperglycemia and hypertension despite being on insulin therapy. Her HbA1c is 9.2%, and she has developed peripheral neuropathy and diabetic retinopathy. The healthcare team plans to adjust her insulin regimen and add a GLP-1 receptor agonist. As a nurse, which priority intervention should you implement to aid in the management of this patient's condition?

A) Educate the patient on the importance of regular foot inspections to prevent complications.

B) Instruct the patient to perform blood glucose monitoring only when feeling symptoms of hypoglycemia.

C) Advise the patient to avoid physical activity to prevent further fatigue.

D) Encourage the patient to consume a high-protein diet to manage blood glucose levels.

A patient with type 2 diabetes mellitus, despite recent medication adjustments and lifestyle recommendations, continues to show suboptimal glycemic control with an HbA1c of 8.5%. Which nursing intervention should be prioritized to address the patient's ongoing elevated blood glucose levels?

B) Review the patient's understanding and implementation of dietary changes with a focus on low glycemic index foods.

A) Educate the patient on the importance of strict adherence to the prescribed medication regimen.

B) Review the patient's understanding and implementation of dietary changes with a focus on low glycemic index foods.

C) Encourage the patient to increase their physical activity beyond the recommended 150 minutes per week.

D) Suggest increasing the dose of the current GLP-1 receptor agonist.

A patient with type 2 diabetes mellitus is showing slight improvement in glycemic control after recent medication adjustments, yet still experiences episodes of fatigue and blurred vision. Her HbA1c is 8.5% and fasting blood glucose is 210 mg/dL. Which nursing intervention is most appropriate to prioritize at this time to further improve her diabetes management?

B) Educate the patient on the importance of adhering to a low glycemic index diet and regular exercise.

A) Increase the dosage of the GLP-1 receptor agonist.

B) Educate the patient on the importance of adhering to a low glycemic index diet and regular exercise.

C) Recommend the patient to monitor blood glucose levels more frequently throughout the day.

D) Suggest consulting with the physician about starting a statin for dyslipidemia.

A patient with type 2 diabetes presents with increased episodes of dizziness, tingling sensations in the hands and feet, and unintentional weight loss. Her HbA1c has plateaued at 8.5%, and fasting blood glucose is elevated at 215 mg/dL. Which of the following nursing interventions is most appropriate to address her current symptoms and suspected diabetic neuropathy?

B) Educate the patient on the importance of foot care and daily inspection.

A) Encourage increased carbohydrate intake to manage energy levels.

B) Educate the patient on the importance of foot care and daily inspection.

C) Suggest reducing physical activity to prevent fatigue.

D) Advise the patient to discontinue exercise until symptoms resolve.

A patient with type 2 diabetes presents with symptoms suggestive of diabetic neuropathy and poor glycemic control. Her HbA1c is 8.5%, fasting blood glucose is 215 mg/dL, and triglycerides are elevated. Which nursing intervention is the most appropriate to address her condition?

B) Educate the patient on the importance of adhering to her prescribed diet and medication regimen to manage blood glucose and lipid levels.

A) Encourage the patient to increase her physical activity level to improve blood glucose control.

B) Educate the patient on the importance of adhering to her prescribed diet and medication regimen to manage blood glucose and lipid levels.

C) Suggest the patient reduce her insulin dosage to prevent further weight loss and possible hypoglycemia.

D) Advise the patient to focus on a low-carbohydrate diet exclusively to lower triglycerides.

A patient with diabetes presents to the clinic with fatigue, dizziness, and a slight increase in blood pressure. Lab results indicate elevated serum creatinine and decreased eGFR, suggesting early diabetic nephropathy. Despite adherence to her insulin regimen, her glycemic control remains poor. Which intervention should the nurse prioritize to address both her renal function and blood pressure?

C) Introduce an ACE inhibitor to manage blood pressure and provide renal protection.

A) Increase the dose of her basal insulin.

B) Initiate a low-protein diet to protect kidney function.

C) Introduce an ACE inhibitor to manage blood pressure and provide renal protection.

D) Refer the patient to a neurologist for neuropathy evaluation.

A patient with type 2 diabetes presents with fatigue, dizziness, mild edema, and signs of neuropathy. Recent labs indicate increased serum creatinine and microalbuminuria. The healthcare team is considering adjusting her treatment plan, including insulin regimen and introducing an ACE inhibitor. What is the priority nursing intervention to address the patient's current condition?

B) Monitor the patient's blood pressure closely and report significant changes to the healthcare provider.

A) Educate the patient on the importance of adhering to a low-sodium diet to manage edema.

B) Monitor the patient's blood pressure closely and report significant changes to the healthcare provider.

C) Instruct the patient on proper foot care techniques to prevent complications from neuropathy.

D) Collaborate with the dietitian to adjust the patient's carbohydrate intake for better glycemic control.

A patient with type 2 diabetes is on an intensified basal-bolus insulin regimen and lisinopril for blood pressure control. She reports persistent tingling in her extremities and presents with a foot ulcer. Which nursing intervention is most critical to prioritize during her follow-up visit?

A) Educate the patient on the importance of daily foot care and ulcer monitoring.

B) Reinforce carbohydrate counting and portion control with the patient.

C) Assess the patient's understanding of insulin administration techniques.

D) Monitor the patient's blood pressure to evaluate the effectiveness of lisinopril.

A patient with diabetes is experiencing moderate diabetic neuropathy and has been prescribed gabapentin for symptom management. What is the most critical nursing intervention to prioritize for this patient?

C) Emphasize the importance of daily foot care and inspecting for any new lesions or ulcers.

A) Educate the patient on the importance of adhering to the gabapentin dosing schedule to manage pain effectively.

B) Instruct the patient to monitor and report any changes in glucose levels due to potential interactions between gabapentin and insulin.

C) Emphasize the importance of daily foot care and inspecting for any new lesions or ulcers.

D) Advise the patient to increase physical activity to help improve energy levels and metabolic function.

insulin issue related to diabetes - Nursing Case Study

Pathophysiology

• Primary mechanism: In Type 1 Diabetes, the immune system mistakenly attacks and destroys beta cells in the pancreas, leading to an absolute deficiency of insulin, which is crucial for glucose uptake by cells.

• Secondary mechanism: In Type 2 Diabetes, cells become resistant to insulin, requiring the pancreas to produce more insulin to maintain normal glucose levels. Over time, this can lead to beta-cell dysfunction and eventual insulin deficiency.

• Key complication: Chronic hyperglycemia from inadequate insulin action can cause damage to blood vessels and nerves, leading to complications such as cardiovascular disease, neuropathy, and nephropathy.

Patient Profile

Demographics:

56-year-old female, office manager

History:

• Key past medical history: Type 2 diabetes diagnosed 10 years ago, hypertension, hyperlipidemia

• Current medications: Metformin 1000 mg twice daily, Lisinopril 20 mg daily, Atorvastatin 40 mg daily, Insulin glargine 20 units at bedtime

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing fatigue and blurred vision over the past month

• Key symptoms: Fatigue, blurred vision, occasional tingling in feet, increased urination, and thirst

• Vital signs: Blood pressure 145/90 mmHg, heart rate 88 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, blood glucose 240 mg/dL

Section 1

As the clinical team continues to monitor the 56-year-old female patient with a history of Type 2 diabetes, they note several concerning findings during the initial assessment. Her blood pressure remains elevated at 145/90 mmHg, and her blood glucose level is persistently high at 240 mg/dL despite being on insulin therapy. Given her symptoms of fatigue, blurred vision, and increased thirst and urination, the healthcare provider orders a comprehensive metabolic panel and an HbA1c test to evaluate long-term glycemic control. The HbA1c result returns at 9.2%, indicating poor control of her diabetes over the past three months.

The physical examination reveals decreased sensation in her feet, confirming the presence of peripheral neuropathy. Additionally, her fundoscopic exam shows signs of background diabetic retinopathy, which explains her blurred vision. These findings suggest that despite current treatment, the patient is experiencing moderate complications of her diabetes, likely due to insulin resistance and potential beta-cell dysfunction. These complications necessitate a reevaluation of her treatment plan, focusing on optimizing glycemic control and addressing her hypertension and hyperlipidemia to prevent further vascular damage.

Given these developments, the healthcare team decides to adjust her insulin regimen and consider the addition of a GLP-1 receptor agonist to improve insulin sensitivity and promote weight loss, which could also benefit her lipid profile and blood pressure. The team emphasizes the importance of lifestyle modifications, such as dietary changes and increased physical activity, to enhance the effectiveness of her treatment and mitigate the risk of further complications. Regular follow-up appointments are scheduled to closely monitor her response to the new interventions and make necessary adjustments to her management plan.

Section 2

After three weeks of adjusting the treatment plan, the healthcare team conducts a follow-up assessment to evaluate the patient's response to the interventions. During the visit, the patient reports a slight improvement in her energy levels and a reduction in thirst and urination frequency. However, she continues to experience episodes of fatigue and occasional blurred vision. Her blood pressure remains elevated at 140/88 mmHg, and despite the changes in her insulin regimen and the addition of a GLP-1 receptor agonist, her fasting blood glucose level is still high at 210 mg/dL.

The lab results from her recent tests reveal a slight improvement, with an HbA1c level of 8.5%, indicating progress in glycemic control, albeit still above the target range. Her lipid profile shows a mild reduction in LDL cholesterol, now at 130 mg/dL, but her triglycerides remain elevated at 210 mg/dL. These findings suggest that while there is some positive response to the treatment adjustments, her diabetes remains suboptimally managed, and further modifications are necessary.

Recognizing the ongoing challenges, the healthcare team decides to intensify their focus on lifestyle modifications. They collaborate with a dietitian to tailor a meal plan that emphasizes low glycemic index foods and balanced macronutrient distribution. Additionally, the patient is encouraged to engage in regular physical activity, aiming for 150 minutes of moderate-intensity exercise per week. The team schedules another follow-up appointment in one month to closely monitor the patient's progress and make further adjustments as needed, emphasizing the importance of adherence to both the pharmacological and non-pharmacological aspects of her treatment plan.

Section 3

During the next follow-up appointment, the patient arrives visibly fatigued and concerned about new symptoms. She reports experiencing increased episodes of dizziness and occasional tingling sensations in her hands and feet over the past two weeks. Her physical examination reveals an unintentional weight loss of five pounds since her last visit, and her blood pressure has slightly increased to 145/90 mmHg. The healthcare team notes that despite adherence to the exercise regimen, her activity tolerance has decreased, and her energy levels have not improved as expected.

New lab results indicate an HbA1c level that has plateaued at 8.5%, suggesting no further improvement in glycemic control since the last assessment. Her fasting blood glucose remains elevated at 215 mg/dL. Notably, her lipid profile shows further elevation in triglycerides, now at 240 mg/dL, while LDL cholesterol remains unchanged. Given these findings, the team suspects the development of diabetic neuropathy and considers the possibility of insulin resistance or other underlying factors complicating her diabetes management.

Faced with these challenges, the healthcare team deliberates on potential adjustments to her treatment plan. They consider optimizing her insulin regimen by adjusting dosages or exploring alternative basal-bolus strategies. The team also plans to conduct further diagnostic tests to evaluate her renal function and assess for potential nephropathy, given the new onset of symptoms. Emphasizing the importance of comprehensive management, they reinforce the need for strict adherence to both dietary recommendations and exercise, while also exploring potential pharmacological interventions to address her dyslipidemia and neuropathic symptoms. The patient is scheduled for another follow-up in two weeks to reassess her condition and evaluate the effectiveness of these modifications.

Section 4

Two weeks later, the patient returns for her follow-up appointment, presenting with noticeable fatigue and persistent dizziness. During the initial assessment, her vital signs reveal a blood pressure of 150/92 mmHg and a heart rate of 88 beats per minute. Despite adherence to her prescribed treatment plan, she reports no significant improvement in her energy levels or reduction in tingling sensations. Upon physical examination, she has lost an additional three pounds since her last visit, and her extremities appear slightly edematous. The healthcare team also notes mild erythema and reduced sensation in her feet, raising concerns about worsening neuropathy.

New lab results further complicate her clinical picture. Her renal function tests show a rise in serum creatinine to 1.4 mg/dL from her previous baseline of 1.1 mg/dL, and a reduction in estimated glomerular filtration rate (eGFR) to 55 mL/min/1.73 m², suggesting early signs of diabetic nephropathy. Her urine microalbumin levels have also increased, indicating potential kidney involvement. Despite these concerning findings, her HbA1c remains unchanged at 8.5%, and her fasting blood glucose continues to hover around 220 mg/dL, demonstrating persistent challenges in achieving glycemic control.

Faced with these evolving complications, the healthcare team prioritizes a comprehensive review of her current insulin regimen, considering an increase in her basal insulin dose or a switch to a more intensive basal-bolus strategy. They also contemplate introducing an ACE inhibitor to manage her blood pressure and provide renal protection. A referral to a dietitian is made to reinforce dietary modifications, while a consultation with a neurologist is scheduled to evaluate the extent of her neuropathy and explore potential pharmacological interventions. The team remains vigilant, planning for closer monitoring and frequent follow-ups to reassess her condition and refine her treatment plan as needed.

Section 5

During the follow-up visit, the healthcare team decides to focus on the patient's response to the newly implemented interventions. The patient begins a revised insulin regimen, incorporating an intensified basal-bolus strategy. Over the following weeks, her glucose levels are monitored closely, and there is a gradual improvement, with fasting blood glucose levels decreasing to approximately 180 mg/dL. Despite this progress, her HbA1c remains elevated at 8.2%, indicating that further adjustments might be necessary for optimal glycemic control. The addition of an ACE inhibitor, lisinopril, helps stabilize her blood pressure, which now reads 138/86 mmHg, and offers some renal protection.

However, the patient reports only mild improvements in her energy levels and continues to experience persistent tingling sensations in her extremities. The neurologist's assessment confirms moderate diabetic neuropathy, and a decision is made to initiate treatment with gabapentin to help manage her symptoms. The dietitian provides tailored dietary advice, emphasizing the importance of carbohydrate counting and portion control to further support her glucose management. Despite these interventions, the patient still experiences slight weight loss, suggesting ongoing metabolic challenges.

As the healthcare team continues to observe the patient's progress, they remain vigilant for new complications. During a routine foot examination, they discover a small ulcer on her left big toe, raising concerns about potential diabetic foot complications. This finding prompts an urgent referral to a podiatrist for specialized care. The team emphasizes the importance of daily foot care and regular monitoring, ensuring early detection and management of any new issues. With a comprehensive care plan in place, the patient is set for frequent follow-ups to closely monitor her condition and make necessary adjustments to her treatment plan.