Case study ( 6518 views as of July 22, 2019 )
Nancy is a 53-year-old women who presents to her family physician with frequent urination and fatigue. Lab testing reveals abundant sugar in her urine and an elevated random blood sugar level of 19 mmol/L. She reports having gained 40 pounds over the last 5 years, as a result of soft tissue injuries from a motor vehicle accident which has curtailed her ability to exercise. She also went through menopause which began at age 49. There is a family history of adult onset diabetes in her mother and two of her grandparents.
On examination, she has an elevated blood pressure of 146/86 with repeated testing and elevated cholesterol as well. Her lab results reveal her LDL cholesterol is 4.2 mmol/L and her HDL is 0.8 mmol/L. Her HgA1c, and her blood sugar control is 8.9%. She has been frustrated with her weight gain and inquires about hormone replacement therapy. She also has very poor sleep quality and wonders how this has affected her health.
Nancy has a lot of questions about managing her conditions. For example, what options exist to lower her cholesterol, what type of diabetes does she have and what is the best way to treat her blood sugar? How can she get onto a manageable exercise and diet plan? Who can she see about her sleep issues? Should she consider going on hormone replacement therapy?
Nancy would benefit from seeing an endocrinologist to get a proper diagnosis of her diabetes. A diabetes nurse educator could help Nancy learn to test and manage her diabetes at home. She would also benefit from seeing a dietitian to learn about diets, weight loss and how to help control sugars through diet. Nancy should speak to her family physician about menopause and hormone replacement therapy. A sleep specialist could rule out any sleep apnea that may be disturbing her sleep. Nancy should reach out to a personal trainer in her area to begin a new exercise routine that she can manage.Author: Dr. Richard Bebb