Problem
Case scenario
Part A
Rita is a 62-year-old woman who comes to the clinic for a routine physical examination.
She works as a banking executive and does little exercise. She says she is "just tired."
She has gained 8.2 kgs over the past year and eats a high-fat diet.
At the clinic her blood pressure is 162/98mmHg, her heart rate is 92 beats/min, and her respiration rate is 20 breaths /min. She complains of some weakness in her right foot that began about a month ago. She says it also feels a little numb.
A sensory examination reveals diminished sensations of light touch, proprioception, and vibration in both feet. She also complains of increased thirst and frequent nighttime urination. She denies any other weakness, numbness, or changes in vision.
A physical examination reveals an erythematous scaling rash in both inguinal areas and in axillae. She states the rash has been there on and off for several years and is worse in the warm weather.
Task
I. What risk factors for diabetes does Rita have?
II. Which type of diabetes is Rita at highest risk for developing and why?
III. What clinical manifestations of diabetes is Rita displaying?
IV. What diagnostic tests for diabetes would you expect the doctor to order for Rita?
V. Briefly discuss what is prediabetes and the relevance in this case.
Part B
Rita's diagnostic testing results come back from the lab. The doctor confirms a diagnosis of Type 2 diabetes mellitus.
Random glucose test: 14 mmol/l (253 mg/dL)
Hb A1c: 75mmol/mol or 9.1%
Urine: positive for glucose and negative for protein
Wet preparation of smear from rash: consistent with Candida albicans
ECG: evidence of early ventricular hypertrophy
Task
I. Briefly describe the pathophysiology of the type 2 diabetes.
II. The clinic is planning care with Rita. Name three health or allied health professionals who will be involved in Rita's collaborative care in the community
III. What will the goals of collaborative care be for Rita? (Identify at least 5)
IV. Identify five essential treatment interventions and self-management goals you expect to teach Rita about based on her diagnosis at this stage?
V. Briefly explain why the following will be important health promotion goals for Rita:
i. Exercise
ii. Diabetic diet
iii. Weight loss
iv. Foot and eye care
VI. Name three specialist services or community groups including a funding source that the person can be referred to assist with self-management and self-care in rela- tion to diabetes care.