Clinical Reasoning Case Study #77 Endocrine Disorders

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Case study 76 Endocrine Disorders
1. Interpret Y.L.'s laboratory results
• HbA1C is elevated at 8.8% and the goal for diabetics is to keep that value below 7%
Hemoglobin A1c. Her number is concerning because it indicates that her blood sugar has been way too high over the past few months. The A1c is an indication of glycosylation in the body which is damaging to the blood vessels and peripheral nerves. It causes thickening of the basement membrane which will impair oxygen transport to the tissues and carbon dioxide removal.
• High BP
• Total Cholesterol is elevated at 256mg/dL, normal value is below 200mg/dL
• Fasting glucose is high at 184mg/dL, normal value is below 126mg/dL
• Triglycerides are elevated at 346 mg/dL, normal
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If you cannot see the bottoms of your feet, use a mirror or ask someone for help.
Be more active -Plan your physical activity program with your health team. Wash your feet every day. Dry them carefully, especially between the toes.
Keep your skin soft and smooth - Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes.
Keep toenails trimmed
Wear shoes and socks at all times - Never walk barefoot.
Wear comfortable shoes that fit well and protect your feet.
Protect your feet from hot and cold - Wear shoes at the beach or on hot pavement, don’t put your feet into hot water, never use heating pads, or electric blankets. You can burn your feet without realizing it.
Keep the blood flowing to your feet - Put your feet up when sitting, Wiggle your toes and move your ankles up and down for 5 minutes, two (2) or three (3) times a day. Don't cross your legs for long periods of time.
13. What are some changes that Y.L. can make to reduce the risk or slow the progression of both macrovascular and microvascular disease?
• Decreases morbidity
• A1c control
• lowering blood pressure
• lowering cholesterol
Smoking cessation, exercise and healthy eating habits will help to lower these.
14. Given all of the information in the foregoing scenario, what DM-related complication do you believe Y.L. is most at risk for, and why?