Endocrine Case Study

Question: Discuss about the Endocrine Case Study. Answer: Glycated hemoglobin, commonly referred to as HbA1c has been used as an indicator of how well blood sugar is being controlled over a longer period of time. Average glycemia or blood sugar levels over a period of about 12 preceding weeks are measured with the help of HbA1c, which is essentially the non-enzymatic glycation of hemoglobin (Nathan, McGee, Steffes, Lachin, Group*, 2014). Ms. LK has a higher than normal value of HbA1c at 7.6%. This could put her at risk of complications that arise from high blood sugar. In order to lower this value she has to exercise better control on eating consistently. The amount of food intake at each meal has to be monitored in order to avoid hypoglycemia on one hand and control fasting and postprandial blood glucose levels on the other. The regular exercise regimen at the gym has to be supported by an active life style (Horton Subauste, 2016). The counting of carbohydrates is necessary at every meal. This will allow the insulin to keep blood sugar levels within the normal range. Ms. LK will be advised to be follow the diet, exercise and medication recommendations diligently. Non-adherence to diet, exercise and medication regimen can severely risk her health. Hyperglycemia due to consumption of high sugar foods can trigger another episode of ketoacidosis and put the patient's health to risk. Hospitalisation in the intensive car e unit may be required to stabilize the various parameters of health, such as, blood glucose, insulin dose, potassium levels in blood, restoration of pH of blood and dehydration. Long term impact of hyperglycemia or uncontrolled blood sugar on various organs- eyes, kidneys, peripheral vascular disease, cardiovascular disease, poor foot health, eye disease, kidney disease and several complications could result. Skipping meals after taking an insulin dose could cause hypoglycemia which can cause low energy. Choosing meals that contain high amounts of carbohydrates can jeopardise patient's health. Sugar sweetened beverages can cause hyperglycemia. Intake of alcohol can cause hyperglycemia in patients with type 1 diabetes. Even occasional indulgence should be avoided. Because development of ketoacidosis can be life threatening. Management of diabetic ketoacidosis is required for correction of fluid loss and this is done with intravenous normal saline. The hyperglycemia is corrected with insulin and electrolyte disturbances are corrected by giving potassium intravenously. If correction of acid-base balance is required infusion of sodium bicarbonate may be given. The administration of normal saline given to correct dehydration may be enough to correct acidosis. Ms. LK may not be discharged unless she can be returned to her usual insulin regimen with no evidence of recurring ketosis. When tests confirm a pH of more than 7.3 nd when bicarbonate exceeds 18mEq/L, patient can be returned to an oral diet and subcutaneous doses of insulin can be resumed. Long acting insulin is given to patients who had been diagnosed with type 1 diabetes before the symptoms of ketoacidosis appeared (Hamdy, 2017). Ms. LK has been prescribed a dose of Novorapid 6 units before breakfast and 2 units before the evening meal. Additionally she has been given Mixtard 30/70 12 units before breakfast and 4 units before the evening meal. While Novorapid is recombinant human insulin of the fast acting type, Mixtard is a mix of the rapid acting soluble insulin and the longer acting 'isophane' that acts over several hours. This allows the patient to consume carbohydrates for several hours after the injection and remain protected from high blood glucose levels. Since the duration of release is several hours during the day, the patient can consume carbohydrates and still remain protected from hyperglycemia. Exercise improves the ability of insulin to transport glucose in the cells for oxidation and release of energy. Intake of carbohydrates does not raise blood glucose due to injection of insulin in patients with type 1 diabetes mellitus (/mixtard.html, 2017). There are several causes other than consuming too many carbohydrates that can cause hyperglycemia. Infection or any illness that causes release of adrenaline or cortisol can cause hyperglycemia, because both these hormones interfere with insulin function. A diabetic ketoacidosis can result during pneumonia or urinary tract infections. At times, patients may miss dose of insulin and this can trigger an episode of hyperglycemia and ketoacidosis. Patients with alcohol dependence or substance dependence, particularly cocaine are also likely to suffer from ketoacidosis. Sudden emotional or physical trauma, heart attack and medications, such as, corticosteroids and certain diuretics are known causes of ketoacidosis. Patients with type 2 diabetes are sometimes diagnosed with hyperglycemia for the first time due to ketoacidosis (/Causes.aspx, 2015). Hyperglycemia in diabetes type 1 and type 2 makes it likely for the patient to suffer from microvascular and macrovascular complications that can cause foot injury and eye disease. Macrovascular complications occur due to formation of advanced glycated products, oxidative stress and low grade inflammation (Chawla, Chawla, Jaggi, 2016). Diabetic patients who have had the condition for a number of years are likely to suffer from poor foot health. Foot ulcers in diabetic patients may occur when a wound below the ankle is of a non-healing or poorly healing type. Foot gangrene may occur if tissue death or decay occurs due to an ischemia of foot, this is usually evidenced by a Doppler test. Deformity, dislocation, destruction or subluxation occurs when a bone, joint or tissue of the ankle or foot is/are inflamed. This is usually accompanied by neuropathy that may or may not be preceded by trauma. In severe cases foot amputation may be necessary (Al-Rubeaan, et al., 2015). Peripheral vascular disease usually affects blood vessels of the lower extremities. Due to atherosclerosis, risk of cardiovascular disease and cerebrovascular disease are high among diabetes patients (Thiruvoipati, Kielhorn, Armstrong, 2015). References /Causes.aspx. (2015, April 23). Retrieved from https://www.nhs.uk: https://www.nhs.uk/conditions/diabetic-ketoacidosis/Pages/Causes.aspx /mixtard.html. (2017, March 2). Retrieved from https://www.drugs.com: https://www.drugs.com/uk/mixtard.html Al-Rubeaan, K., Derwish, M., Ouizi, S., Youssef, A., Subhani, S., Ibrahim, H., Alamri, B. (2015). Diabetic Foot Complications and Their Risk Factors from a Large Retrospective Cohort Study. PLoS One, 10(5): e0124446. Chawla, A., Chawla, R., Jaggi, S. (2016). Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum? Indian Journal of Endocrinology and Metabolism, 20(4): 546551. Hamdy, O. (2017, March 23). /118361-treatment. Retrieved from https://emedicine.medscape.com: https://emedicine.medscape.com/article/118361-treatment Horton, W., Subauste, J. (2016). Care of the Athlete With Type 1 Diabetes Mellitus: A Clinical Review. InternationalJournalof Endocrinology Metbolism, 14(2): e36091. Nathan, D., McGee, P., Steffes, M., Lachin, J., Group*, D. R. (2014). Relationship of Glycated Albumin to Blood Glucose and HbA1c Values and to Retinopathy, Nephropathy, and Cardiovascular Outcomes in the DCCT/EDIC Study. Diabetes, 63(1): 282290. Thiruvoipati, T., Kielhorn, C., Armstrong, E. (2015). Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. World Journal of Diabetes, 6(7): 961969.