case studies - type 1 diabetes

7/27/2019 Case Studies - Type 1 Diabetes

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Diabetes education modules

Case studies Type 1 diabetes

Case 1

A 19-year old student is for the first time living away from home at college. Herschedule at college varies day-to-day. Mealtimes are not regular. Her weight is 130

pounds (59 kg), her height is 56 (167.8 cm). She was diagnosed with diabetes 10

years ago. She has been taking intermediate and soluble at breakfast, soluble atsupper and intermediate at bedtime.

Recent A1c = 7%

Blood glucose

Fasting Pre lunch Pre supper Late night

Day 1 176.4 mg/dl (9.8 mmol/L) 57.6 (3.2) 82.8 (4.6) 61.2 (3.4)

Day 2 142.2 (7.9) 37.8 (2.1) 189 (10.5) 117 (6.5)

Day 3 100.8 (5.6) 59.4 (3.3) 111.6 (6.2) 73.8 (4.1)

- Is her level of management satisfactory?

- What changes would you make to her diabetes management? And why?

- How would you convince her to make some changes?

- What would you recommend as her target BGLS?

- When would you follow up and what changes would you make next if still not attarget?


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Case 2

A 38-year old lean man who works in a factory. He has had type 1 diabetes for 12years. Recently, he had frequent severe hypoglycaemia events, passed out, woke up

in hospital. His recent HbA1c is 10%. He takes insulin 70/30, (Mixtard) 60 unitsbefore breakfast, 40 units before dinner. His doctor has been increasing insulin dose

because of the high HbA1c.

Log book

Days Before

breakfast

Before lunch Before dinner Evening - times vary

1 8.6 (155) 8.9 (160) In hospital, hypo

2 20.2 (363) 25.6 (460) 16.2 (290)3 10.4 (187) 6.2 (110) 4.6 (84)

4 16.7 (300) 1.2 (21.6)

5 28.2 (507) 23.2 (417)

6 3.2 (57) 17.0 (306)

7 8.9 (160) 4.2 (74) 15.5 (280)

8 In hospital, hypo

9 22.5 (405) 14.3 (255)

He has not had any diabetes education recently. He finds he is eating all the time

and has put on 5kg in the last 6 months.

- What other information do you need?

- What do think is happening in this case?

- What would you recommend with regards to his insulin dosage, type of insulin, etc,

for this man?

- What further tests should be done?


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Case 3

A 32-year old type 1 woman who has had diabetes for 12 years. Her currentmedication is: soluble 10 units, intermediate acting 15 units before breakfast and

soluble 15 units, intermediate acting 15 units before dinner. Her most recent HbA1cwas at 9.8%.

She reports she is feeling very stressed, in fact she has taken a leave from work

because she feels her diabetes is so out of control. She does not understand why her

blood sugar fluctuates so much, she has been having very high levels when she feelsvery tired, and then she has had some severe hypoglycaemia events.

She has two children and feels she simply cannot manage. She has been to diabetes

education years ago, but was never told how to interpret her blood sugar levels ormake any adjustments.

- What other information do you need?

- What is your plan to help this lady?


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Case 4

Yvette is a 58-year old lady with type 1 diabetes for 29 years. She has mildbackground retinopathy and some peripheral neuropathy. She is currently taking TID

insulin (intermediate acting & soluble), does self blood glucose monitoring 3-4 /dayregularly. She has been very consistent with meals and activity, in order to avoid

hypoglycaemia.

She lives alone but her family calls to check on her every morning and evening

because severe hypoglycaemia occurs regularly, ~ 1/week. She was taken to thehospital 6 times in the past year. Her A1C is 8.5%.

Her current medication is: insulin soluble 4 units and intermediate acting 16 units

before breakfast, soluble 2 units before dinner and intermediate acting 16 units atbedtime.

Day FBS Lunch Supper Bed

Mon 6.2 mmol/L

(111mg/dl)

11.6

mmol/L

(208mg/dl)

4.4 mmol/L

(79mg/dl)

9.4 mmol/L

(170mg/dl)

Tues 2.9

(52)

3.2

(57)

3.7

(66)

10.7

(180)

Wed 3.1

(56)

15.1

(272)

2.2 *ER

(40)

8.2

(147)

Thurs 7.9

(142)

4.4

(79)

13.6

(244)

11.9

(214)

- What information do you need from Yvette?

- Where is she having problems?

- What would you suggest?

case studies - type 1 diabetes

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