Type 2 diabetes occurs when our body can’t produce enough insulin to move glucose into our cells
Assignment Details: Type 2 diabetes occurs when our body can’t produce enough insulin to move glucose into our cells. Deficient insulin levels cause glucose to remain in our bloodstream, elevating our blood glucose and resulting in type II diabetes (Basu, 2017). The necessary workup for a 45-year-old obese female who is newly diagnosed with Type II diabetes includes monitoring the albumin-to-creatinine ratio, A1C, ankle-brachial index, bone mineral density, blood pressure, body mass index (BMI), estimated glomerular filtration rate (eGFR), dilated eye exam, and cholesterol and triglycerides levels. This patient should have her creatinine and electrolyte levels checked to assess kidney functions, a urinalysis to evaluate proteinuria, an EKG to determine the heart function, and a fundoscopy to assess the eyes.
A1C is a test that measures blood glucose levels for the previous two to three months, and it is also used to determine if a patient is at risk for other complications such as vision impairment, kidney disease, or nerve damage. Normal A1C levels should be less than 5.7%, 5.7%-6.4% are prediabetic, and an A1C above 6.5% indicates diabetes. An A1C level should be done every six months if the last A1C was within normal limits, and it should be repeated every three months if there were changes made to medications or if the previous A1C level was not within normal limits (American Diabetes Association, 2023). An albumin-to-creatinine ratio (ACR) is a urine exam that tests for the amount of albumin, a protein that can cause kidney damage, in the urine. The normal range for ACR is less than 30 mg/g of urine creatinine, and this exam needs to be done once a year if the patient has type II diabetes or more frequently if the previous ACR level is high. (American Diabetes Association, 2023). An ankle-brachial index is a reading obtained with blood pressure taken at the ankle and compared to blood pressure taken from the arm to screen for peripheral artery disease (PAD) to prevent risk for amputation of limbs due to reduced blood flow.
The normal range for the ankle-brachial index is 0.9 to 1.3, and patients will only need this exam if they have symptoms of PAD (American Diabetes Association, 2023). Blood pressure will need to be monitored closely to measure the force of blood flow in the blood vessels, and for diabetic patients, their blood pressure should be less than 130/80 mmHg to reduce the risk of hypertension, stroke, heart disease, vision loss, and kidney disease (American Diabetes Association, 2023). Bone mineral density is a scan that estimates the bones’ density and fragility with a normal T-score of -1.0 or above. A T-score between -1.0 and -2.5 indicates low bone density, and a T-score below -2.5 indicates osteoporosis. Diabetic patients have a higher risk for developing hip fractures and osteoporosis, so obtaining a baseline scan will benefit diabetic patients (American Diabetes Association, 2023). A body mass index (BMI) measures body fat according to height and weight, with a normal BMI of 18.5 to 24.9. Anything above 24.9 indicates overweight or obese, increasing a patient’s risk of developing heart disease, prediabetes, and type II diabetes. A dilated eye exam should be performed every one to two years to rule out diabetic eye diseases, including diabetic retinopathy, cataracts, and glaucoma (American Diabetes Association, 2023). Estimated glomerular filtration rate (eGFR) is an estimate of the kidney functions based on the level of creatinine in the blood, with the normal range being 100-120 ml/min/1.73 m2 and the target number being higher than 80 ml/min/1.73 m2 (American Diabetes Association, 2023). Diabetic patients should get their eGFR tested once or twice a year if previous results are abnormal. Lastly, cholesterol and triglycerides are examined in a blood test called the lipid panel, which checks the HDL, LDL, triglycerides, and total cholesterol. Diabetic patients should have their lipid panel screened yearly to prevent cardiovascular disease.
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