Venous PH HbA1c 7.35 8.6% Taking into consideration the background information and results from the physical examination, choose 3 pieces of information that suggest this patient may have diabetes; provide research-based discussion to support your 3 choices.
Pulse: The patient pulse rate of 82 per minute is high and is directly linked to diabetes. A normal pulse rate should be lower, around 50-70 beats a minute is perfect CITATION Ser14 \l 1033 (Gordon, 2014). High blood sugar levels is common in people having diabetes and this cause potential changes by increasing heart rate. One of the signs of hypoglycaemia, a type of diabetes is rapid pulse.
Height: The patient is 155 cm, meaning she is short. The increase in risk for diabetes is correlated to reduction in height. Height is determined genetically but increasingly impact non-communicable diseases, diabetes being one of them. Individuals who are short have higher risk of developing type 2 diabetes than individuals who are tall CITATION Sci16 \l 1033 (Science Daily, 2016).
Body Mass Index: The patient may have diabetes because she has a BMI of 27. An individual having a BMI of over 25 is considered overweight and have higher chances of developing type 2 diabetes CITATION Chl15 \l 1033 (Lambert, 2015). Therefore, the greater the BMI, the greater the risk of developing diabetes and other conditions.
Which 2 aspects of her biochemistry measures are of concern and why? Support your answer with at least 2 references.
Ketones in Urine:
Urine test is important in diagnosis of diabetes and helps in monitoring the urine level of ketones. This assist in managing diabetes. A diabetes test may test for ketones presence in the urine. If ketones are detected it means the patient is not producing little or no insulin. Thus, body cells cannot take sufficient glucose from the blood, making the body to break down fat into ketones.
Monitoring the level of ketone is therefore critical for people with type 1 diabetes. Trace and normal ketone levels is less than 0.6 mmol/L. Any results that are abnormal show that one has ketones in the urine. Thus, 0.6 to 1.5 mmol means that the level of ketone is starting to build up. This leads to diabetes build up.
Blood sugar level is of concern because is very high. The normal level of blood glucose need to be around 70 to 100 mg/dL for individuals without diabetes CITATION Ame13 \l 1033 (American Diabetes Association, 2013). The blood glucose level for the patient are already high and past prediabetes and symptoms for diabetes may be already clear.
Given the information available to you up to this point, is a diagnosis for type 1 or type 2 diabetes likely to be made? Give justification for your conclusion and provide 1-2 references to support your answer
A diagnosis for type 1 or type 2 diabetes likely to be made because, based on the biochemistry results, the level of blood glucose is very high. A blood glucose level that is normal need to be around 70 to 100 mg/dL for individuals without diabetes CITATION Ame13 \l 1033 (American Diabetes Association, 2013). The patient blood glucose level is 18.6mmol/l (336 mg/dL), this is very high.
Moreover, trace and normal ketone levels is less than 0.6 mmol/L CITATION Ser14 \l 1033 (Gordon, 2014). Any results that are abnormal show that one has ketones in the urine. Thus, 0.6 to 1.5 mmol means that the level of ketone is starting to build up. This leads to type 1 or type 2 diabetes build up for the patient.
Following diagnosis, and prior to any medications being prescribed, which 3 diet and lifestyle interventions would you suggest may improve this patients diabetic control and long term prognosis? Support your answers with 1 reference for each intervention.
There is a need for self-management training and exercises that helps in preventing diabetes through weight loss maintenance CITATION Ame06 \l 1033 (American Diabetes Association, 2006).
Reduction of fat and energy intake assist in reducing blood glucose level which in turn lead to reduced probability of developing any type of diabetes CITATION Ame06 \l 1033 (American Diabetes Association, 2006).
Reduced alcohol intake lower the risk of developing diabetes. This is mostly suggested on sugar alcohols and sweeteners that are non-nutritive CITATION Ame06 \l 1033 (American Diabetes Association, 2006).
Using the table below, highlight the typical differences between Type 1 Diabetes and Type 2 Diabetes.
Presenting features Type 1 DM Type 2 DM
Usual weight range (BMI Range) 25.0 29.9 30.0 and Above
Age of onset childhood middle-aged and older people
Autoantibodies Present Detected in about 60% of type 1 diabetics Not detected in about 60% of type 1 diabetics
Insulin Resistance Characterized by a lack of insulinAssociated with insulin resistance.
Risk of Diabetic Ketoacidosis Ketoacidosis is the first sign of type 1 diabetes and it is common Ketoacidosis is less common but usually develop.
American Diabetes Association. (2006). Nutrition Recommendations and Interventions for Diabetes. Retrieved from http://care.diabetesjournals.org/content/30/suppl_1/S48.full: http://care.diabetesjournals.org/content/30/suppl_1/S48.full
American Diabetes Association. (2013). Diagnosing Diabetes and Learning About Prediabetes. Retrieved from http://www.diabetes.org: http://www.diabetes.org/diabetes-basics/diagnosis/?referrer=https://www.google.com/
Gordon, S. (2014, April 22). Retrieved from http://consumer.healthday.com: http://consumer.healthday.com/diabetes-information-10/blood-glucose-monitor-news-69/low-blood-sugar-may-affect-heartbeat-in-people-with-diabetes-687042.html
Lambert, C. (2015, September 2015). Is Body Mass Index a waste of time? NHS guidelines say anyone with a BMI of 27 is overweight, even if they don't look it. Retrieved from http://www.dailymail.co.uk: http://www.dailymail.co.uk/health/article-3234523/Is-Body-Mass-Index-waste-time-NHS-guidelines-say-BMI-27-overweight-don-t-look-it.html
Science Daily. (2016, February 2). Height influences risk of cardiovascular disease, diabetes, and cancer. Retrieved from https://www.sciencedaily.com: https://www.sciencedaily.com/releases/2016/02/160202121823.htm
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