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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Assess the signs and symptoms of hyperglycemia

  • Differentiate diabetes-related complications

  • Evaluate the goals of therapy for type 2 diabetes (T2DM) mellitus

  • Develop an appropriate diabetes self-management education, treatment, and monitoring plan for a patient with T2DM and its related conditions

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PATIENT PRESENTATION

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Chief Complaint

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"My physician told me I need to control my sugar better. I'm feeling okay, but I think I have another urinary infection. I am going to the bathroom more frequently and sometimes it burns. Will cranberry juice help?"

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History of Present Illness

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AL is a 36-year-old woman who presents to the community pharmacy/clinic complaining of frequent and burning urination. She reports having recurrent UTIs and vaginal yeast infections for the past 8 years, ever since the birth of her second child. She is adherent to her physician appointments every 3 months since she was diagnosed with T2DM 3 years ago. She is aware that her glucose and A1c are not at goal and she needs to control her diabetes. She states that she takes her medications daily as prescribed and only misses an occasional dose. She checks her fasting blood glucose almost every day. She tries to monitor the amount and type of food she eats; but often "cheats," especially during tax season when she and her husband are very busy with their business. She walks 3–4 days per week for 20–30 minutes, depending on the weather. She denies any feelings of dizziness, lightheadedness, or fatigue.

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Past Medical History

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Dyslipidemia × 5 years

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T2DM × 3 years

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Obesity × 20 years

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Recurrent UTI and yeast infections × 8 years

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Gestational DM in two pregnancies (10 and 8 years ago)

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Family History

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Father had T2DM, dyslipidemia, and hypertension, and died from a myocardial infarction at the age of 56. Mother is alive at age 60 and has T2DM, dyslipidemia, sleep apnea, and GERD. Brother is alive at age 40 and has T2DM and HTN. Sister is alive at age 33 and is healthy.

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Social History

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She came to the United States from Puerto Rico at the age of 6, speaks Spanish and English. She is married for 13 years and lives with husband and two children aged 9 and 7. Works as an administrative assistant for her husband's accounting business. He is self-employed.

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Tobacco/Alcohol/Substance Use

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Social drinker (one to two glasses of wine two to three times per week); (−) tobacco or illicit drug use.

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Allergies/Intolerances/Adverse Drug Events

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No known drug or food allergies

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Medications (Current)

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Metformin 1,000 mg PO q 24 h ...

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