Question

Donna’s Diabetes For the past 2 or 3 years, Donna has always had fasting blood sugar levels in the 100-120 mg/dL range. When she presents in your clinic however, her fasting blood sugar is 137 mg/dL and her hemoglobin A1c is 8.3%. Donna’s 24-hr recall includes:  Breakfast: English muffin with 2 t. butter, 1 slice American cheese, 1 Jimmy Dean sausage patty, 20 oz. water  Snack: 1 large (4x4") brownie  Lunch: chicken salad sandwich on 2 slices wheat bread with lettuce, tomato, and mayonnaise, 1 oz. BBQ chips, 12 oz. orange soda  Dinner: Lean Cuisine Alfredo Pasta with Chicken & Broccoli, 16 oz. sweet tea  Snack: 2 c. chocolate Haagen-Dazs ice cream. Donna is 58 years old, does not have a history of diabetes, is 5’2" and weighs 165#, and she is on medication for hypertension. She says she has tried to lose weight many times in the past and often has success, but she always gains it back. She reports that she eats a "fairly healthy" diet but just loves to bake and often indulges in sweets. She does not know much about diabetes, except that it requires you to give yourself shots—and she hates needles, saying "Don’t expect me to give myself a shot!"

What can you tell Donna about her current and past diabetes status?

Answer 1

Donna shows signs of diabetes based on her fasting blood sugar levels and hemoglobin A1c. Her diet high in carbohydrates and sweets may contribute to elevated blood sugar levels. It is important for Donna to receive education and guidance on managing her diabetes and making healthier food choices.

Step-by-step explanation:

Based on Donna's fasting blood sugar level of 137 mg/dL and hemoglobin A1c of 8.3%, it indicates that she has diabetes. Normal fasting blood sugar levels should be below 100 mg/dL, so Donna's levels are outside the normal range. Her hemoglobin A1c value reflects an average blood glucose level over the past 4 months, and a level above 9% signifies poor control of diabetes. Since Donna has a history of fasting blood sugar levels in the 100-120 mg/dL range for the past 2-3 years, her elevated levels now indicate a worsening of her diabetes condition.

In addition to her lab results, Donna's 24-hour recall reveals a diet high in carbohydrates and sugary foods, which can contribute to elevated blood sugar levels. Her indulgence in sweets and lack of knowledge about diabetes management suggests a need for education and guidance on making healthier food choices.

Given Donna's dislike for needles, it would be important to explore alternative treatment options for her diabetes management, such as oral medications. Lifestyle modifications, including regular exercise and portion control, can also help in managing her diabetes and weight.