The specific health professionals who provide comments about each case depend on the specific clinical issue; and 3 stimulate thought and discussion. The target readership is health professionals from a range of professional backgrounds and general as well as specialist professionals such as general practitioners, nurses, dietitians, and podiatrists.
Paauw, MD Presentation A year-old woman with a 3-year history of diabetes is seen for worsening dyspnea and cough. She has had chronic obstructive pulmonary disease COPD since age She now has dyspnea with walking one-third of a block and a persistent cough.
Her type 2 diabetes has been managed with diet and exercise. Her last glycosylated hemoglobin measured 1 month ago was 6. Lungs are clear to percussion, but wheezing is present bilaterally. No accessory muscles are being used.
No cyanosis is present. Questions What is the typical pattern of steroid-induced hyperglycemia? What are reasonable treatment strategies?
How can the patient's worsening COPD adversely affect her diabetes? Commentary This patient has had type 2 diabetes adequately controlled with diet for the past few years. Her blood glucose levels increased markedly with the addition of prednisone.
The typical characteristics of hyperglycemia induced by corticosteroids include minimal effect on fasting blood glucose levels and an exaggeration in postprandial blood glucose elevations.
The degree of elevation is correlated with previous glucose tolerance. Patients with pre-existing diabetes can have profound increases in blood glucose.
The effect of glucocorticosteroids is usually transient. In a study done by Greenstone and Shaw,1 measuring blood glucose response to alternate day prednisone dosing, patients exhibited hyperglycemia in the afternoons of the days when the steroids were given.
Blood glucose levels normalized throughout the next day the day off of steroids. Hyperglycemia induced by glucocorticosteroids is primarily an exaggeration of postprandial hyperglycemia. Most patients will not have significantly different fasting blood glucose levels when they are receiving corticosteroids.
Glucosteroids increase hepatic glucose production and can inhibit insulin-stimulated glucose uptake in peripheral tissues.The following case study illustrates the clinical role of advanced practice nurses in the management of a patient with type 2 diabetes.
Case Presentation A.B.
is a retired year-old man with a . All content on benjaminpohle.com, CPG Apps and in our online store remains exactly the same. For questions, contact [email protected] Diabetes Canada | Clinical Practice Guidelines - Case Studies. Case Study 1: Patient with Newly Diagnosed Type 1 Diabetes Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.
Results of hospital laboratory studies (Table ) revealed that the patient's initial blood glucose level was mg/dL and clinical presentation and laboratory findings. You may choose to review each patient with type 2 diabetes in any order. Select a case from the left by clicking the 'Click To Enter Case' link.
Once you enter the case and before answering questions, click on the patient’s tab to view his clinical presentation, medical history, and current medications. Insulin pen use for type 2 diabetes. Case Study 1.
The patient was a year-old man who has had type 2 diabetes for the past 6 years and had been taking insulin for the past 2 years. Jul 10, Type 1 Diabetes, Type 2 Diabetes, Case Studies, Articles, Blood Glucose Control There have been many studies that have been conducted meant to access the effect of alcohol consumption on diabetes - some suggesting that a moderate intake contributes to the risk for diabetes, and others suggesting moderate alcohol is a .
Case Study 1. The patient was a year-old man who has had type 2 diabetes for the past 6 years and had been taking insulin for the past 2 years. Th e aims of the book are to: (1) address commonly encountered diabetes management problems; (2) develop comprehensive responses from a range of relevant health professionals who suggest management approaches relevant to their area of practice. The specific health professionals who provide comments. Inzucchi SE et al. Management of Hyperglycemia in Type 2 Diabetes, A Patient Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes.