Case Study Abby, informative essay
• 32 years of age; body mass index (BMI) 27.4 kg/m2; Strong family history of type 2 diabetes; GDM
• Reason for OGTT: Post-Partum investigation
• OGTT results: fasting 7.9mmol/L, 2 hours 12.1mmol/L
• Currently breastfeeding
• Novorapid at breakfast, lunch, dinner and Lantus at bedtime.
Following diagnostic confirmation of type 2 diabetes the General Practitioner has referred Abby for structured diabetes patient education. She has been referring to Dr Google and friends for further information, and reports that she is confused and thinks the GP his misdiagnosed her. She informs you that she thinks that she has type 1 diabetes, because she is taking insulin injections. It is essential that individuals diagnosed with diabetes are fully informed and understand the type of diabetes they have been diagnosed with, the management and consequences to their health if they are not managed.
To prevent further confusion, you are required to provide:
• a brief explanation of the diagnostic tests that will identify and confirm type1 diabetes.
• explain the significance of the OGTT as a diagnostic test for type 2 diabetes.
Abby enquires why the GP has presided insulin injections for the management of her diabetes instead of tablets. To answer this question, you are required to:
• review and give a brief description of each of the seven classes of medicines used to treat type 2 diabetes in Australia (Biguanides, Sulphonylureas, Thiazolidinediones (Glitazones), Alpha-glucosidase Inhibitors, Dipeptidyl peptidase 4 (DPP4) inhibitors, Incretin mimetics, Sodium-glucose transporter (SGLT2) inhibitors).
• Discuss the mode of action, potential side effect, time of administration of each class of medication, and identify which class of medication is recommended for use in breastfeeding so Abby can discuss this with her GP.
• Discuss the benefit for the current insulin regime in relation to the human body and physiological insulin production, the benefits associated with glycaemic control.
• The most common side effect of insulin is hypoglycaemia, explain ‘what is hypoglycaemia’, the signs, symptoms and treatment.
• discuss factors that are likely to increase the risk of an individual experiencing hypoglycaemia and how it can be prevented.
• Diabetes mellitus is a chronic disease requiring lifestyle modification, explain what is meant by lifestyle modification. In your discussion it is important that you highlight that there is no need for a ‘special’ diet for diabetes, just the requirement to follow a sensible, balanced eating plan. Explain the composition of healthy eating, modest weight loss and the benefits to the management of diabetes as per clinical recommendations. Explain the importance of smoking cessation in the clinical context for overall health and association to diabetes.
• It is important to discuss the ongoing management and annual cycle of care for individuals diagnosed with diabetes. Briefly discuss the investigations that are part of the annual cycle of care, the frequency and the possible complication because of poor glycaemic control.
• For Abby to assist in the management of her diabetes, you will need to discuss the benefit blood glucose monitoring, the frequency and recommended target range as per clinical guidelines.
• Conclude your essay to inform Abby of the importance self-management in living a healthy life with diabetes.