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Endocrine Function

Endocrine Function:
C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three 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 that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for a number of “female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports 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 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.
Case Study Questions

In which race and ethnic groups is DM more prevalent? Based on C.B. clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis.
If C.B. develop a bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.
What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?

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Case Study: C.B. and Potential Diabetes Mellitus Type 2

Prevalence of Diabetes Mellitus (DM) by Race and Ethnicity:

While diabetes mellitus can affect anyone, certain races and ethnicities have a higher prevalence compared to others. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the following groups have a higher risk of developing type 2 diabetes:

Native Americans: Among Native Americans, including Winnebago individuals like C.B., the prevalence of diagnosed diabetes is roughly 2.4 times higher than non-Hispanic whites.
Black Americans: Black Americans have a 1.2 times higher risk compared to non-Hispanic whites.
Hispanic Americans: Hispanic Americans have a 1.7 times higher risk compared to non-Hispanic whites.
Asian Americans: While the overall risk varies among Asian American subgroups, some groups like Pacific Islanders have a significantly higher risk compared to non-Hispanic whites.

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Signs and Symptoms in C.B. Compatible with Diabetes Mellitus Type 2:

Polydipsia (increased thirst): C.B. reports being very thirsty lately, which is a classic symptom of high blood sugar levels.
Polyuria (increased urination): She also mentions getting up more often at night to urinate, another classic symptom of diabetes.
Unexplained weight gain: Her significant weight gain, especially in the recent months, can be linked to uncontrolled diabetes.
Neuropathy (nerve damage): Weakness and numbness in her foot can be a sign of nerve damage caused by chronic high blood sugar.
Previous high blood sugar and cholesterol levels: Her past blood sugar and cholesterol readings, although not recent, raise concerns for potential underlying diabetes.

Glycemia and Bacterial Pneumonia:

If C.B. develops bacterial pneumonia, her blood sugar levels (glycemia) are likely to increase significantly. This happens due to several reasons:

Stress hormones: During an infection, the body releases stress hormones like cortisol, which can elevate blood sugar levels.
Decreased insulin sensitivity: Illness can make the body less responsive to insulin, leading to higher blood sugar levels.
Increased glucose production: The body might produce more glucose for energy during illness, further contributing to hyperglycemia.

Therefore, it’s crucial to closely monitor C.B.’s blood sugar levels if she develops pneumonia and adjust her insulin or other medications accordingly.

Recommended Therapy for C.B.:

Given C.B.’s symptoms and risk factors, it’s highly recommended that she undergoes a comprehensive diabetes diagnosis, including blood sugar tests and other assessments. Once confirmed, treatment would focus on both non-pharmacological and pharmacological approaches:

Non-pharmacological:

Lifestyle changes: This includes adopting a healthy diet, regular physical activity, and weight management. A registered dietitian and an exercise specialist can help her create personalized plans.
Blood sugar monitoring: Regularly monitoring her blood sugar levels helps understand how her body responds to food, exercise, and medications.
Diabetes education: Learning about diabetes self-management is crucial for her long-term well-being.

Pharmacological:

Oral medications: Depending on the severity of her diabetes, oral medications like metformin might be prescribed to help her body use insulin more effectively.
Insulin therapy: If oral medications are insufficient, insulin injections might be needed to directly control blood sugar levels.

It’s important to remember that this is just a general overview, and the specific treatment plan for C.B. should be determined by a qualified healthcare professional after a thorough examination and assessment.

Please note that I am not a medical professional, and this information should not be taken as a substitute for professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.

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Endocrine Function

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Case Study: C.B. and Potential Diabetes Mellitus Type 2

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