Reference no: EM132436586

Mrs. Folley is a 51-year-old African American female who works as a bookkeeper for an insurance company. Her father and brother have type 2 diabetes mellitus, and have had severe complications because of poor control of blood glucose.  

She is 5' 4" tall and weighs 174 pounds with a medium frame. She has a history of obesity, hypertension, hypothyroidism, and frequent urinary tract infections, and is currently taking propranolol hydrochloride and synthroid.  

Mrs. Folley complains of constant fatigue over the past two months and has lost 8 pounds, although she is thirsty and hungry and eats all the time. She is concerned that she may have another urinary tract infection because she has frequent urination and pain in her lower abdomen. Her physician orders some fasting blood tests and the results show the following: glucose 380 mg/dL (normal 70-110 mg/dL), HbA1c 7.6% (normal < 6%), serum LDL cholesterol 270 mg/dL (normal <200 mg/dL), triglycerides 290 mg/dL (normal <200 mg/dL). She is diagnosed with type 2 diabetes, and started on a 1200kcal diet and glyburide. She is also scheduled to see the nurse, who is a Certified Diabeties Educator (CDE), at the end of the week for further counseling.

1. What symptoms of type 2 diabetes does Mrs. Folley manifest? Explain the pathophysiology of these symptoms.
2. What is the relationship between being overweight or obese and diabetes?
3. What is the HbA1c and how is it used to monitor diabetes?
4. In view of her other laboratory results, what other dietary counseling will Mrs. Folley need?
5. What is the difference between the two meal planning strategies, exchange lists and carbohydrate counting? Which strategy do you think the CDE will teach Mrs. Folley? Why?
6. Mrs. Folley's family members suffer from some of the complications of uncontrolled diabetes. What are some of the chronic complications that she is at risk for developing?
7. Why is a referral to a Certified Diabetes Educator important for this patient?