Diabetes Case Study
Chief Complaint
“My left foot feels weak and numb. I have a hard time pointing my toes up.”
History of Present Illness
D.T. is 42-year-old Caucasian woman who has had an elevated blood sugar and cholesterol 2 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 her fasting blood sugar was 160 and her cholesterol was 250. However, she felt “perfectly fine at the time” and did not want to take any more medications. Except for a number of “female infections,” she has felt fine recently.
Today, she presents to the clinic complaining that her left foot has been weak and numb for nearly 3 weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. She does report 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 hydrated. She has gained a total of 50 pounds since her last pregnancy 10 years ago, 20 pounds in the last 6 months alone.
Past Medical History
- Seasonal allergic rhinitis (since her early 20s)
- Breast biopsy positive for fibroadenoma at age 30
- Gestational diabetes with second child 10 years ago
- Multiple yeast infections during the past 3 years that she has self-treated with OTC antifungal creams and salt bath
- Hypertension for 10 years
Past Surgical History
C-section 14 years ago
OB-GYN History
- Menarche at age 11
- Last pap smear 3 years ago
Family History
- Type 2 DM present in older brother and maternal grandfather. Both were diagnosed in their late 40s. Brother takes both pills and shots.
- Mother alive and well
- Father has COPD
- Two other siblings alive and well
- All three children are alive and well
Social History
- Married 29 years with 3 children; husband is a school teacher
- Family lives in a four bedroom single family home
- Patient works as a seamstress
- Smokes 1 pack per day (since age 16) and drinks two alcoholic drinks 4 days per week
- Denies illegal drug uses
- Never exercises and has tried multiple fad diets for weight loss with little success. She now eats a diet rich in fats and refined sugars.
Allergies
NKDA
Medications
- Lisinopril 10 mg daily
- Loratadine 10 mg daily
Review of Systems
General
Admits to recent onset of fatigue
HEENT
Has awakened on several occasions with blurred vision and dizziness or lightheadedness upon standing: Denies vertigo, head trauma, ear pain, difficulty swallowing or speaking
Cardiac
Denies chest pain, palpitations, and difficulty breathing while lying down
Lungs
Denies cough, shortness of breath, and wheezing
GI
Denies nausea, vomiting, abdominal bloating or pain, diarrhea, or food intolerance, but admits occasional episodes of constipation
GU
Has experienced increased frequency and volumes of urination, but denies pain during urination, blood in the urine, or urinary incontinence
EXT
Denies leg cramps or swelling in the ankles and feet; has never experienced weakness, tingling or numbness in arms or legs prior to this episode
Neuro
Has never had a seizure and denies recent headaches
Derm
Has a rash under her bilateral breast and in groin area
Endocrine
Denies a history of goiter and has not experienced heat or cold intolerance
Vital Signs
BP 165/100, T 98 F, P 88 regular, HT 5 feet 4 inches, RR 20 non labored, WT 210 lbs
What you need to do:
- Develop an evidence-based management plan.
- Include any pertinent diagnostics.
- Describe the patient education plan.
- Include cultural and lifespan considerations.
- Provide information on health promotion or health care maintenance needs.
- Describe the follow-up and referral for this patient.
- Prepare a 3–5-page paper (not including the title page or reference page).
Format
The paper should be no more than 3–5 pages (not including the title page and reference pages.
Assignment Requirements:
Before finalizing your work, you should:
- be sure to read the Assignment description carefully (as displayed above);
- consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
- utilize spelling and grammar check to minimize errors.
Your writing Assignment should:
- follow the conventions of Standard American English (correct grammar, punctuation, etc.);
- be well ordered, logical, and unified, as well as original and insightful;
- display superior content, organization, style, and mechanics; and
- use APA 6th Edition format as outlined in the APA Progression Ladder.
Submit your Assignment to the unit Dropbox before midnight on the last day of the unit.
When you are ready to submit your Assignment, select the unit Dropbox then attach your file. Make sure to save a copy of the Assignment you submit.
Expert Solution Preview
Introduction:
This case study presents a patient with a chief complaint of weakness and numbness in the left foot. The patient has a history of elevated blood sugar and cholesterol but has not followed up with a clinical diagnostic work-up. The patient has been experiencing symptoms of thirst and frequent urination but attributed them to the warm weather. The purpose of this assignment is to develop an evidence-based management plan, including pertinent diagnostics, patient education plan, cultural and lifespan considerations, health promotion or healthcare maintenance needs, and follow-up and referral recommendations.
1. Develop an evidence-based management plan:
The patient’s symptoms, along with her medical history, raise concerns about diabetes-related neuropathy. A thorough work-up, including blood glucose and HbA1C tests, nerve conduction studies, and electromyography, should be conducted to confirm the diagnosis. Additionally, a lipid panel, renal function tests, and thyroid function tests should be ordered to assess overall health and to rule out other underlying conditions. Management of diabetes-related neuropathy involves both pharmacologic and non-pharmacologic approaches such as maintaining blood glucose levels within target range, pain management, and physical activity. ACE inhibitors or ARBs are the first-line agents for blood pressure control in patients with diabetes.
2. Include any pertinent diagnostics:
The following diagnostics should be ordered: blood glucose and HbA1C tests, nerve conduction studies, electromyography, lipid panel, renal function tests, and thyroid function tests.
3. Describe the patient education plan:
The patient education plan should focus on managing blood glucose levels through dietary modifications, physical activity, and medication adherence. The patient should be educated about the importance of foot care and proper shoes to prevent foot ulcers and infections. Additionally, the patient should receive education regarding the importance of following up with her scheduled medical appointments, including regular check-ins with her primary care physician and endocrinologist.
4. Include cultural and lifespan considerations:
Incorporating cultural and lifespan considerations into the patient’s care plan is crucial in promoting health equity. In this case, a multidisciplinary team should be involved in providing culturally sensitive care that takes into account the patient’s beliefs, values, and practices. As the patient is a smoker and has a history of alcohol consumption, additional resources such as tobacco cessation and substance abuse treatment programs should be offered.
5. Provide information on health promotion or health care maintenance needs:
In addition to managing diabetes-related neuropathy, the patient has uncontrolled hypertension and is significantly overweight. Therefore, the patient should receive education on lifestyle modifications, including dietary changes and physical activity, to improve blood pressure control and achieve weight loss goals. Routine health maintenance, such as regular blood pressure and lipid screening, should also be emphasized.
6. Describe the follow-up and referral for this patient:
The patient should follow up with her primary care physician and endocrinologist for close monitoring of blood glucose levels, blood pressure control, and neuropathic symptoms. Additionally, referral to a diabetic educator, podiatrist, or pain specialist may be needed based on the patient’s symptoms and individual needs.
Conclusion:
The patient’s symptoms and medical history suggest diabetes-related neuropathy. A multidisciplinary approach that addresses pharmacologic and non-pharmacologic interventions along with patient education is necessary to manage her symptoms and improve overall health outcomes. Incorporating cultural and lifespan considerations and providing adequate follow-up and referral is vital in promoting health equity and ensuring optimal outcomes.
