Question

Complaint

“I’ve been urinating a lot.”

History

Marion is a 45-year-old overweight patient who presents at the urgency care clinic with frequency, urgency, and burning on urination. She has had urinary tract infections before, and the symptoms are similar. The triage nurse orders a urinalysis, and the results are consistent with a urinary tract infection. However, the urinalysis also shows protein in the urine and a high glucose level. A random plasma glucose level is drawn and shows 220 mg/dL. Her blood pressure is 150/90 mm Hg. When these values are reported to her, she states that she is not surprised. Her mother and her aunt both have type 2 diabetes, and she has used her mother’s glucose monitor to check her own blood glucose levels in the past. When they are high, she adjusts her diet. Because this is an urgency-care setting, her urinary tract infection is treated; a fasting chemistry panel, lipid profile, HbA1c, and thyroid function tests are ordered; and she is referred to her primary care nurse practitioner for work-up of probable type 2 diabetes. Screening for microalbuminuria is postponed until her urinary tract infection is cured because urinary tract infections can cause transient elevations in urinary albumin excretion.

Assessment

Marion’s laboratory findings are as follows:

• Fasting plasma glucose 180 mg/dL
• Triglycerides 350 mg/dL
• High-density lipoprotein cholesterol 35 mg/dL
• Low-density lipoprotein cholesterol 134 mg/dL
• HbA1c 7.8%
• Serum creatinine 1.2
• Glomerular filtration rate >60
• Thyroid function studies within normal limits

            Marion has satisfied the criteria for a diagnosis of diabetes and has concurrent hypertension and hyperlipidemia.

1. What is the initial treatment for Marion’s type 2 diabetes? And provide a rationale.
2. What initial education does she need?
3. Which comes first, diet or exercise?

Answer 1

#. Generally, metformin is the first medication prescribed for type 2 diabetes. It works by lowering glucose production in the liver and improving your body's sensitivity to insulin so that your body uses insulin more effectively.

#. Topics for intial education she needs includes :-

- Importance of medication and compliance to it

- Diet management

- Regular exercise

- Weight loss

#. Diet comes first . First you have to make changes in the diet . A person can change one's body composition through diet alone without exercise. However it's the combination of both that provides a complete healthy package. Applying the 80 percent nutrition-to-20 percent fitness rule is simply a statement of the importance of nutrition .