Race and ethic groups
Endocrine Function:
C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for several “female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep her hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.
Case Study Questions
In which race and ethnic groups is DM more prevalent? Based on C.B.'s clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis.
If C.B. develops a bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.
What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?
Sample Solution
Case Study: C.B. and Potential Diabetes Mellitus Type 2
Question 1: Prevalence of DM in Different Races and Ethnicities
Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by high blood sugar (hyperglycemia). While it affects all populations, certain groups show higher prevalence:
- Native Americans: Have the highest DM prevalence among all US racial/ethnic groups, with 2.3 times the national average.
- African Americans, Hispanics/Latinos, and Asian Americans: Also have higher prevalence compared to non-Hispanic whites.
Question 2: Signs and Symptoms of DM in C.B.
C.B. exhibits several signs and symptoms suggestive of DM Type 2:
- Elevated fasting blood sugar (141 mg/dL): Normal range is <100 mg/dL.
- Increased thirst and urination: Classic symptoms of hyperglycemia.
- Unexplained weight gain: 15 pounds in 6 months, especially with central obesity, is concerning.
- Weakness and numbness in one foot: Potential neuropathy, a DM complication.
Full Answer Section
Question 3: Impact of Pneumonia on Glycemia
C.B.'s glycemia is likely to increase if she develops bacterial pneumonia. Reasons include:
- Stress response: The body releases stress hormones like cortisol, raising blood sugar.
- Reduced insulin sensitivity: Inflammation from infection worsens insulin resistance.
- Increased glucose production: Liver releases glucose during illness.
- Decreased activity: Limited mobility can reduce glucose uptake in muscles.
Question 4: Recommended Treatment for C.B.
Non-pharmacological:
- Lifestyle changes: Diet modification, weight management, and regular exercise are crucial.
- Diabetes education: Understanding the condition and self-management strategies is essential.
- Blood sugar monitoring: Regular measurement helps track progress and adjust interventions.
Pharmacological:
- Oral medications: Metformin is often the first-line drug for type 2 DM.
- Insulin therapy: May be needed if oral medications are insufficient.
Additional Considerations:
- Cultural sensitivity: Respecting C.B.'s Winnebago heritage and incorporating culturally appropriate approaches is vital.
- Addressing financial concerns: Exploring affordable medication options and access to healthcare resources is crucial.
- Holistic approach: Combining traditional practices with conventional medicine, if C.B. is receptive, can be beneficial.
Disclaimer: This information is for educational purposes only and does not constitute medical advice. Please consult a qualified healthcare professional for diagnosis and treatment of any medical condition.