Reference no: EM133507172
Question
A 14-year-old African American female, comes to your rural community health center for "follow-up." Three weeks ago while visiting her aunt in another city during summer vacation, she became ill and was hospitalized for 3 days. She was diagnosed with diabetic ketoacidosis (DKA), required intensive care for 2 days, and at that time was diagnosed with diabetes. She was discharged on a two injection per day regimen of combined short- and intermediate-acting insulin. During the hospitalization, she and her aunt met with a nutritionist and a diabetes educator. She is currently monitoring her blood glucose levels four times per day. She complains of feeling very hungry before lunch and at bedtime. She has brought her glucose meter to the visit. Mother is in the waiting room on your request
Review of blood glucose values . R=Regular insulin; N=NPH insulin
Date, Breakfast, Lunch, Dinner, Bedtime, Breakfast, Lunch, Dinner, Bedtime
10/1, 10R/25N, 10R/10N, 81, 50, 96, 69, ,
10/2, 10R/25N, 10R/10N, 92, 75, 85, 70, ,
10/3, 10R/25N, 10R/10N, 100, 67, 82, 100, ,
10/4, 10R/25N, 10R/10N, 96, 102, 112, 56, ,
10/6, 10R/25N, 7R/10N, 87, 43, 76, 72, ,
10/7, 7R/25N, , , , , , ,
Family history: maternal grandmother; uncle type 2 diabetes 2 and he uncle receives dialysis ESRF. She has two younger siblings, an 11-year-old brother and a 5-year-old sister.
ROS:
GYN: Menarche occurred 2 years ago; menstrual periods are irregular and occur every 2 to 3 months. She denies sexual activity, smoking, or drug use.
Endo: Mary administers all insulin injections and states how hard it is to resist eating "junk food."
Psycho/social: plays softball on a school team 2 days per week, is inactive on other days. She is in the ninth grade and is a "B" student. She has several friends but has not told anyone about her diabetes. She asks you, "Will I always need to take insulin?" On exam: Height: 63 inches; weight 150 pounds; blood pressure 132/86 heart rate 78 beats per minute; respirations14 per minute; s positive for the presence of moderate acanthosis nigricans on the back of her neck and at her axillae; office urinalysis pH 7.0, specific gravity 1.010; glucose, protein, and ketones negative.
1. Discuss what further data do you need to work with this patient and her diabetes diagnosis? Discuss your response.
2. Discuss what type of diabetes this patient has, integrated the capillary glucose log in the discussion.
3. Discuss the epidemiology of obesity and type 2 diabetes in children.