Diabetes education modules

Case studies Type 1 diabetes Case 1

A 19-year old student is for the first time living away from home at college. Her schedule at college varies day-to-day. Mealtimes are not regular. Her weight is 130 pounds (59 kg), her height is 56 (167.8 cm). She was diagnosed with diabetes 10 years ago. She has been taking intermediate and soluble at breakfast, soluble at supper and intermediate at bedtime. Recent A1c = 7% Blood glucose Fasting Day 1 176.4 mg/dl (9.8 mmol/L) Day 2 142.2 (7.9) Day 3 100.8 (5.6) Pre lunch 57.6 (3.2) 37.8 (2.1) 59.4 (3.3) Pre supper 82.8 (4.6) 189 (10.5) 111.6 (6.2) Late night 61.2 (3.4) 117 (6.5) 73.8 (4.1)

- Is her level of management satisfactory?

- What changes would you make to her diabetes management? And why?

- How would you convince her to make some changes?

- What would you recommend as her target BGLS?

- When would you follow up and what changes would you make next if still not at target?

Diabetes education modules

Case 2
A 38-year old lean man who works in a factory. He has had type 1 diabetes for 12 years. Recently, he had frequent severe hypoglycaemia events, passed out, woke up in hospital. His recent HbA1c is 10%. He takes insulin 70/30, (Mixtard) 60 units before breakfast, 40 units before dinner. His doctor has been increasing insulin dose because of the high HbA1c. Log book Days 1 2 3 4 5 6 7 8 9 Before breakfast 8.6 (155) 20.2 (363) 10.4 (187) 16.7 (300) 28.2 (507) 8.9 (160) 22.5 (405) Before lunch Before dinner 8.9 (160) 25.6 (460) 6.2 (110) 23.2 (417) 3.2 (57) 4.2 (74) 14.3 (255) Evening - times vary In hospital, hypo 16.2 (290) 4.6 (84) 1.2 (21.6)

17.0 (306) 15.5 (280) In hospital, hypo

He has not had any diabetes education recently. He finds he is eating all the time and has put on 5kg in the last 6 months. - What other information do you need?

- What do think is happening in this case?

- What would you recommend with regards to his insulin dosage, type of insulin, etc, for this man?

- What further tests should be done?

Diabetes education modules

Case 3
A 32-year old type 1 woman who has had diabetes for 12 years. Her current medication is: soluble 10 units, intermediate acting 15 units before breakfast and soluble 15 units, intermediate acting 15 units before dinner. Her most recent HbA1c was at 9.8%. She reports she is feeling very stressed, in fact she has taken a leave from work because she feels her diabetes is so out of control. She does not understand why her blood sugar fluctuates so much, she has been having very high levels when she feels very tired, and then she has had some severe hypoglycaemia events. She has two children and feels she simply cannot manage. She has been to diabetes education years ago, but was never told how to interpret her blood sugar levels or make any adjustments. - What other information do you need?

- What is your plan to help this lady?

Diabetes education modules

Case 4
Yvette is a 58-year old lady with type 1 diabetes for 29 years. She has mild background retinopathy and some peripheral neuropathy. She is currently taking TID insulin (intermediate acting & soluble), does self blood glucose monitoring 3-4 /day regularly. She has been very consistent with meals and activity, in order to avoid hypoglycaemia. She lives alone but her family calls to check on her every morning and evening because severe hypoglycaemia occurs regularly, ~ 1/week. She was taken to the hospital 6 times in the past year. Her A1C is 8.5%. Her current medication is: insulin soluble 4 units and intermediate acting 16 units before breakfast, soluble 2 units before dinner and intermediate acting 16 units at bedtime. Day Mon FBS 6.2 mmol/L (111mg/dl) 2.9 (52) Wed Thurs 3.1 (56) 7.9 (142) Lunch 11.6 mmol/L (208mg/dl) Tues 3.2 (57) 15.1 (272) 4.4 (79) 3.7 (66) 2.2 *ER (40) 13.6 (244) 10.7 (180) 8.2 (147) 11.9 (214) Supper 4.4 mmol/L (79mg/dl) Bed 9.4 mmol/L (170mg/dl)

- What information do you need from Yvette?

- Where is she having problems?

- What would you suggest?