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Clinical Cases; Questions and Answer Part 1 Case Study 1: Glycaemic status Question 1 Blood glucose monitoring has been an important tool in the effective management of out-patients with diabetes. This tool which entails self monitoring of blood glucose level in a specified period has been designed to help in glycaemic control and lowered the risk associated with high blood sugar level…
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Download file to see previous pages... Fasting blood glucose clearly shows a higher value that is far beyond the normal range hence an impaired fasting glycaemia. The main implication of the impaired fasting glucose is that of excessively high glycaemic level. The Urea value for the patient is also very high compared to the normal range. This simply indicates a higher concentration of urea in the blood which is an indication of a poorly functioning kidney with poor control of waste products. The HbA1c is also high hence an unsatisfactory assessment for the glycaemic control by the patient. This is because of the importance of the analysis which helps in analysing the average blood glucose level for an average of three months. The osmolality which is slightly lower than normal range does not actually support a high concentration of chemical particles or electrolytes in the blood but a reduced concentration which support a normal glycaemic control for the patient. However, it can be fully concluded that this osmolality is slightly lower than the normal range might be as a result of slight increased in fluid intake and poor control of water intake by the kidney. Question 2 In-house glycaemic monitoring has been an important mode of managing diabetes mellitus in out-patients. It has been found that a tightly controlled blood glucose level in patients with diabetes mellitus helps in reducing various forms of associated microvascular and macrovascular complications that could be seen in those patients (Gerich, J, 2005). Microvascular complications in those poorly controlled or monitored blood glucose level has been found to be the major cause of morbidity and mortality in people (Edelman, 1998). Those complications can also be seen in some groups of patient even before they are being diagnosed. It has been concluded by various researches that glycaemic monitoring has helped in achieving a normal HbA1c range over time and associated with the lowest risk of complications (Ousman & Sharma 2001). When the glycaemic control is being achieved effectively, the risk of manifestations of those immediate and late associated effects will be reduced and the patient will have his or her biochemical analysis results within the normal range. The major issue about the condition is that of those associated complications which the affected individuals tend to manifest when they are with a poorly controlled blood sugar. The major effects which are described as microvascular or macrovascular complications, shows their manifestation in most major systems of the body. The immediate effects of poorly controlled glycaemic level could be described in terms of disruption of the basic concentration of the body electrolytes with subsequent immediate and delayed effects. The derangement of the blood electrolytes will affects the functioning of the body's system hence deranged metabolic activity. One major effect is what is called the diabetic ketoacidosis and accelerated atherosclerosis which could lead to major systemic consequences which includes; cardiovascular effects, neurovascular effects, kidney failure, blindness, loss of hearing (American diabetes association, 2011). Question 3 Tight control program that could actually help this patient who has type 2 diabetes include; trying to lose the weight, and checking the blood glucose regularly. For this patient, achieving a weight loss could be accomplished ...Download file to see next pagesRead More
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