What risk factors in Edith’s history made it more likely she would develop Type 2 diabetes rather than Type 1? (support 4 outcomes) 2. What conditions could Edith have developed over the last few days based on the above information?( support 2 outcomes)
HISTORY OF PRESENT ILLNESS: Edith Martens is a 66-year-old female who is recovering from
viral pneumonia. When her daughter came to check on her, she found Edith in bed
complaining of weakness, constant fatigue and abdominal pain.
For the past few days, Edith has been complaining of thirst and frequent urination. She also
reports that she cannot see very well. Edith has lost approximately 4 lbs over the last week.
Her daughter brought Edith to the ER.
PAST HISTORY: There is a history of osteoarthritis that responds well to ASA. Edith was
diagnosed with Type 2 diabetes approximately two years ago. She takes glyburide 10 mg every
morning before breakfast and is on an 1800 calorie diet, which she follows closely.
SOCIAL HISTORY: Edith has lived alone since the death of her husband. She is not physically
active; her activities consist of light housework and occasional shopping trips.
FAMILY HISTORY: Edith’s father had Type 2 diabetes complicated by peripheral vascular
disease. He died at the age of 59 from an MI.
PHYSICAL EXAMINATION: On examination, she is 5’ 4” and weighs 95.9 kg (211 lb) Vitals -
temp 37.80 C, pulse 112, respirations 28, BP 96/50.
Skin is dry and warm with poor turgor. Mucous membranes are dry. Edith is oriented x3 but
slightly lethargic and sleepy. Respirations are deep and rapid with rhonchi auscultated
bilaterally. Abdomen is soft and non-tender with bowel sounds present in all four quadrants.
Claudication and numbness are present in the lower extremities. A small 2 cm reddened,
circular area is present on the lateral aspect of the right great toe. Pedal pulses are faint but
present bilaterally. Ophthalmologic examination reveals several small micro aneurysms.
INVESTIGATIONS:
Arterial blood gases reveal a pH of 7.25
Hct and BUN both elevated
Serum glucose 213 mg/dl (11.8 mmol/L)
Glycosylated hemoglobin (HbA1C) 0.091
1. What risk factors in Edith’s history made it more likely she would develop Type 2 diabetes
rather than Type 1? (support 4 outcomes)
2. What conditions could Edith have developed over the last few days based on the above
information?( support 2 outcomes)
3. What additional information would help to differentiate between these conditions? Include
why in your answer( support 3=3 total 6 outcomes)
4. If Edith has DKA, what circumstances could have led to the development of this condition?
How will she be treated for this condition?( support 4 and 3 total 7 outcomes)
5. Edith’s HbA1c is elevated. According to the Canadian Diabetes Association guidelines, her
diabetic control is considered to be “inadequate, action required”. What does this tell the
physician? How can this be remedied? (support 1 and 4 total 5 outcomes)
6. What complications does Edith have that indicate her diabetes has not been well
controlled?( support 5 outcomes)
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HISTORY OF PRESENT ILLNESS: Edith Martens is a 66-year-old female who is recovering from
viral pneumonia. When her daughter came to check on her, she found Edith in bed
complaining of weakness, constant fatigue and abdominal pain.
For the past few days, Edith has been complaining of thirst and frequent urination. She also
reports that she cannot see very well. Edith has lost approximately 4 lbs over the last week.
Her daughter brought Edith to the ER.
PAST HISTORY: There is a history of osteoarthritis that responds well to ASA. Edith was
diagnosed with Type 2 diabetes approximately two years ago. She takes glyburide 10 mg every
morning before breakfast and is on an 1800 calorie diet, which she follows closely.
SOCIAL HISTORY: Edith has lived alone since the death of her husband. She is not physically
active; her activities consist of light housework and occasional shopping trips.
FAMILY HISTORY: Edith’s father had Type 2 diabetes complicated by peripheral vascular
disease. He died at the age of 59 from an MI.
PHYSICAL EXAMINATION: On examination, she is 5’ 4” and weighs 95.9 kg (211 lb) Vitals -
temp 37.80 C, pulse 112, respirations 28, BP 96/50.
Skin is dry and warm with poor turgor. Mucous membranes are dry. Edith is oriented x3 but
slightly lethargic and sleepy. Respirations are deep and rapid with rhonchi auscultated
bilaterally. Abdomen is soft and non-tender with bowel sounds present in all four quadrants.
Claudication and numbness are present in the lower extremities. A small 2 cm reddened,
circular area is present on the lateral aspect of the right great toe. Pedal pulses are faint but
present bilaterally. Ophthalmologic examination reveals several small micro aneurysms.
INVESTIGATIONS:
Arterial blood gases reveal a pH of 7.25
Hct and BUN both elevated
Serum glucose 213 mg/dl (11.8 mmol/L)
Glycosylated hemoglobin (HbA1C) 0.091
1. What risk factors in Edith’s history made it more likely she would develop Type 2 diabetes
rather than Type 1? (support 4 outcomes)
2. What conditions could Edith have developed over the last few days based on the above
information?( support 2 outcomes)
3. What additional information would help to differentiate between these conditions? Include
why in your answer( support 3=3 total 6 outcomes)
4. If Edith has DKA, what circumstances could have led to the development of this condition?
How will she be treated for this condition?( support 4 and 3 total 7 outcomes)
5. Edith’s HbA1c is elevated. According to the Canadian Diabetes Association guidelines, her
diabetic control is considered to be “inadequate, action required”. What does this tell the
physician? How can this be remedied? (support 1 and 4 total 5 outcomes)
6. What complications does Edith have that indicate her diabetes has not been well
controlled?( support 5 outcomes)
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