Case study ( 6448 views as of December 12, 2018 )
Carol, a 47-year-old woman, is generally healthy. She has a history of being athletic, but a long-term knee injury has decreased her ability to exercise. Carol has gained 28 pounds over the last five years. She has been too busy to exercise since having her children and running her own small business.
Carol visits her family physician and complains of fatigue, frequent urination and visual blurring. Her past history includes two prior pregnancies. Her youngest child weighed 9.7 lbs (4.4 kg) at birth. She is not on any prescription medications. Her menstrual cycle has been irregular for the past 4 years since she started gaining weight. There is a family history of type 2 diabetes in both of Carol's parents.
A physical examination reveals Carol's blood pressure is 140/85 mmHg. Her BMI (body mass index) is 29. Carol has increased central body fat with an abdominal circumference of 95 cm. Laboratory investigations reveal a fasting blood glucose of 9.8 mmol/l (176 mg/dl) and a HgA1c of 8.2.
Carol is referred both to a Registered Dietitian and a Nurse working as part of a dedicated diabetes centre. She learns the fundamentals of diabetes management including a balanced meal plan. An exercise prescription is given to her. Her fasting blood sugars are elevated on repeat testing and she is prescribed metformin to reduce high sugars.
Carol could also benefit from regular follow-up with her family doctor and endocrinologist, as well as a personal trainer to help her adapt and progress with her exercise program. Carol could also consider speaking with her local pharmacist to understand the medication she has been prescribed and identify any contraindications.Author: Dr. Richard Bebb