Diabetes Case Study

• • Hillary is a 70 year old female (white causation) living with T2DM for 25 years. Recently had a Non-STEMI and was treated with a PCI to her LAD and Cx
  • Blood glucose: On assessment today, random BG 17.4 mmol/L.
  • Risk factors: HbA1c unknown, non-smoker, BMI 30, WC 98cm, nil, insufficiently active
  • Concerns: Lost a good portion of the feeling in her feet, leaving them numb on the soles and unable to feel the ground when walking. Worries about becoming a T1 diabetic.
  • Diabetes management: Glucometer (current device is 7 yrs old). metformin, gliclazide and empagliflozin
  • Cardiac meds: aspirin, ticagrelor ramipril, bisoprolol atorvastatin, ezetimibe
• What further questions would you ask and why

  • Diabetes Management & Glucose Control
  • What is your usual blood glucose level range, and when do you typically check it?
  • How often do you check your blood glucose, and what device do you use?
  • Do you ever experience symptoms like excessive thirst, fatigue, or blurry vision?
  • Cardiovascular Concerns
  • chest pain, tightness, or shortness of breath during physical activity or rest?
  • Neuropathy & Foot Care
  • Have you experienced any changes in your balance or had falls due to numbness in your feet?
  • Lifestyle & Physical Activity
  • What types of physical activities are you currently doing, and for how long?
  • Do you have any pain, dizziness, or fatigue during physical activity?
• What other considerations and/or actions would you take?

  • Diabetes Management Adjustments
  • HbA1c Measurement: Obtain her most recent HbA1c level to assess her long-term glucose control
  • random BG was 17.4 mmol/L - suggests she may benefit from review of her diabetes management.
  • Medication Review:
  • Empagliflozin (SGLT-2 inhibitor) SGLT-2 inhibitors have shown to benefit heart failure, but can increase risk for dehydration and renal issues.
  • Gliclazide (a sulfonylurea) may cause hypoglycemia, especially with a decrease in food intake or exercise. This needs to be considered when recommending lifestyle changes.
  • Metformin can improve insulin sensitivity and glucose control, but should be used cautiously in people with renal impairment (common in diabetes).
  • Cardiovascular Care
  • Blood Pressure Monitoring: 120-129/70-79
  • Medications
  • Foot Care & Neuropathy
• What are the exercise considerations?

  • 150 minutes per week of moderate-intensity aerobic exercise - 50 to 59% maximum HR
  • needs monitoring - risk of falls due to loss of sensation
  • no swimming
  • warm up, cool down
  • strength training 2-3 times per week
  • flexibility/balance 2-3 times per week - yoga, tai chi