Diabetes Mellitus Case Study (45 min)

• POC glucose
• Heart and lung sounds and respiratory effort – ensure she is protecting her airway
• Assess skin and mucous membranes
• Level of consciousness and orientation

• Has she been excessively thirsty or hungry lately
• Has she been urinating a lot
• Has she lost weight unintentionally?
• Is there a history of diabetes in the family?
• Has she been told previously that she has diabetes?
• Does she take any medications on a daily basis?

• Serum glucose level
• BMP – electrolytes, anion gap, etc.
• Hgb A1c
• ABG to assess for acidosis
• Urine ketones

• Your daughter has Type 1 diabetes, which means that she has an autoimmune disorder that attacks the cells in her pancreas that make insulin. Type 1 diabetes typically has nothing to do with diet and lifestyle and usually has more to do with genetics.
• Your daughter’s healthy lifestyle will continue to help her control her blood sugar levels, but unfortunately, there is no cure for type 1 diabetes at this time.

• Miss Matthews will need intensive insulin therapy and IV fluids to counteract the ketoacidosis and bring her blood sugars down.
• She will then need to be started on long-acting insulin like Lantus and short-acting insulin-like NovoLog for correction with meals.

Unfortunately, at this time insulin is not available in pill form. It has to be taken via injection. Otherwise, it will not work correctly.

• Insulin vial with needles
• Insulin pen
• Insulin pump

• Miss Matthews should be taught how to count carbohydrates to determine the amount of insulin required.
• She should be given a prescribed sliding scale or insulin protocol to follow.
• Miss Matthews should also be instructed on when to take her long-acting insulin and when to take regular insulin in relation to meal times. It is important that she does not take short-acting insulins without being ready to eat.
• Miss Matthews should be educated on the possibility of morning hyperglycemia due to the Somogyi effect or Dawn phenomenon, and be given suggestions to try an evening dose of insulin or an evening snack.
• The importance of follow-up appointments with her primary care provider and/or endocrinologist should be stressed. She should have her Hgb A1c checked every 3 months to start with.
• She should also be educated on foods to avoid, such as desserts and sweets, and foods that are beneficial, such as fruits and vegetables and high-quality proteins.
• Miss Matthews should carry some candy or glucose tablets with her in case of a hypoglycemic reaction.