This is a case commentary about a diabetic patient, in regards to the patient interviewed in a clinic setting. The case is studied in a holistic manner, where medical and non-medical aspects were fully covered. A detailed account of the people involved and thoughts are also included.
Ms Linda Mogen*, 76, is a retired school teacher who currently lives with her husband in the town area. She pays a visit to the clinic every 3 months for an overall checkup as well as to obtain her medications, which is mainly insulin. Her family is doing fairly well and there is no financial burden, although she prefers to visit this particular clinic although it is relatively further from her house because there are no charges for her as an ex-government employee. She appears as a contented lady who is well-read about her condition.
Aside from that, she also suffered from hypertension, chiefly due to stress from her previous work as a teacher. In the past, Ms Mogen had been diagnosed with a thyroid nodule in the throat, and a cyst in the breast, which were both benign and removed 5 and 8 years ago respectively. As a baby, she used suffer from asthma, but as time passed it became less apparent.
Ms Mogen discovered her condition because her father and two sisters had diabetes too, which appeared to be a hereditary disease in her family. She was strongly recommended by her sister – who is a nurse- to have a checkup. Apart from her course of insulin (pill form), Ms Mogen also consumes alternative medicine, such as Barley Green Herb, as well as other supplements. There are rashes resulting as an allergy to insect bites as well, possibly related to her diabetes.
*Names changed to maintain confidentiality
Diabetes mellitus (DM) consists of a cluster of metabolic disorders that presents high unusual levels of blood sugar, analogous to hyperglycemia (Kumar, 2009). Type 1 DM is caused by destruction of pancreatic islet B cell primarily by an autoimmune process, leading to insulin deficiency, where the patient becomes prone to developing ketoacidosis, whereas type 2 DM results from insulin resistance and weakened insulin secretion, aside from disproportionate hepatic glucose production. Some common presenting symptoms of DM are polyuria, polydipsia, weight loss, fatigue, weakness, blurred vision, frequent superficial infections and poor wound healing (Kasper, 2008). From urine testing, patient would also present with glycosuria and ketonuria. Insulin is responsible in stimulating bone formation, thus there might be significant bone loss in untreated diabetes mellitus (Saladin, 2010). In relation to diet, starchy food has to be reduced, i.e. rice, bread, pastries, potatoes and sugar. Ms Mogen had to significantly cut down on her intake of rice, as rice contains complex carbohydrates and the body has a limit of converting the glucose to energy.
Risk factors for type 2 DM includes a family history of diabetes, race or ethnicity, polycystic ovary syndrome or acanthosis nigricans, habitual physical inactivity, obesity and hypertension (Kasper, 2008). In Ms Mogen¿½¿½s case, she had a family history of diabetes, where her father and siblings were also affected and also she had hypertension, which is now under control. Optimal treatment for diabetes is not merely balancing the plasma glucose, but DM-specific complications and risk factors for DM-associated diseases ought to be identified and handled with a wide-range diabetes care. Generally, treatment for type 1 DM is 0.5-1.0 U/kg per day of insulin partitioned into several doses. Mixtures of insulin preparation with variable times of commencement and duration of action should be utilized. Type 2 DM can be controlled with diet and exercise alone or alongside oral-glucose-lowering agents, insulin, or a combination of oral mediators and insulin (Kasper, 2008).