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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 her 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 2 Questions:

In which race and ethnic groups is DM more prevalent?
Based on C.B.’s 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. develops 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.?

Sample Answer

Case Study 2: C.B.’s Potential Diabetes Mellitus Type 2

Disclaimer: I am unable to provide medical advice or diagnose medical conditions. This information should not be taken as a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for any health concerns.

1. Race and Ethnicity:

Diabetes mellitus (DM) is more prevalent in certain racial and ethnic groups, including:

Native Americans: Compared to non-Hispanic whites, Native Americans have a 2.5 times higher prevalence of diagnosed diabetes.
African Americans: African Americans have a 1.7 times higher prevalence of diagnosed diabetes compared to non-Hispanic whites.
Hispanic/Latino Americans: Hispanic/Latino Americans have a 1.5 times higher prevalence of diagnosed diabetes compared to non-Hispanic whites.

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It’s important to note that these statistics highlight group trends and don’t apply to every individual. Each person’s risk for diabetes depends on various factors, including genetics, lifestyle, and environment.

2. Signs and Symptoms:

C.B. exhibits several signs and symptoms compatible with DM Type 2:

Weight gain: Gaining 65 pounds since pregnancy, especially 15 pounds in the last 6 months, suggests possible insulin resistance.
Excessive thirst (polydipsia): This is a classic symptom of high blood sugar, as the body tries to flush out excess glucose through urine.
Frequent urination (polyuria): This is another classic symptom of high blood sugar due to the increased volume of urine produced.
Foot weakness and numbness: This could indicate nerve damage (neuropathy) due to chronic high blood sugar.
History of high blood sugar and cholesterol: Although not followed up on, these previous findings raise concerns for potential underlying metabolic issues.

3. Glycemic Values and Bacterial Pneumonia:

If C.B. develops bacterial pneumonia, her glycemic values (blood sugar levels) are likely to be elevated due to:

Stress response: Illness and infection trigger the release of stress hormones, which can increase blood sugar levels.
Reduced insulin sensitivity: Inflammation and infection can worsen insulin resistance, making it harder for the body to control blood sugar.
Decreased appetite and food intake: This can lead to ketosis, a condition where the body burns fat for energy instead of glucose, resulting in high blood sugar.

4. Initial Therapy:

Non-pharmacological:

Lifestyle changes: Healthy diet, regular physical activity, and weight management are crucial for managing DM.
Blood sugar monitoring: Regular monitoring helps assess glucose control and guide treatment adjustments.
Education: Understanding DM and its management is essential for self-care and preventing complications.

Pharmacological:

The specific medication regimen depends on individual factors and should be determined by a healthcare professional. Some potential options include:

Oral medications: Metformin is often the first-line medication for DM Type 2. Other oral medications may be added depending on individual needs.
Insulin: If oral medications are not sufficient, insulin therapy may be needed to control blood sugar.

Remember:

This information is for educational purposes only and does not constitute medical advice.
Always consult with a qualified healthcare professional for diagnosis, treatment, and management of any medical condition.

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Endocrine Function

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Case Study 2: C.B.’s Potential Diabetes Mellitus Type 2

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