A.B. is a retired 69-year-old man with a 5-year history of type 2… A.B. is a retired 69-y

A.B. is a retired 69-year-old man with a 5-year history of type 2… A.B. is a retired 69-year-old man with a 5-year history of type 2 diabetes. He had symptoms indicating hyperglycemia for 2 years before diagnosis.  He had past episodes of nocturia associated with large pasta meals and Italian pastries. At the time of initial diagnosis, he was advised to lose weight (“at least 10 lb.”), but no further action was taken.A.B. presents with recent weight gain, suboptimal diabetes control, and foot pain. He had been started on glyburide (Diabeta), 2.5 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon.A.B. also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia (elevated LDL cholesterol, low HDL cholesterol, and elevated triglycerides). He has tolerated this medication and adheres to the daily schedule. He does not test his blood glucose levels at home and expresses doubt that this procedure would help him improve his diabetes control. “What would knowing the numbers do for me?,” he asks. “The doctor already knows the sugars are high.”A.B. states that he has “never been sick a day in my life.” He recently sold his business and has become very active in a variety of volunteer organizations. He lives with his wife of 48 years and has two married children, both of whom live in the same neighborhood.   A.B. has limited knowledge regarding diabetes self-care management and states that he does not understand why he has diabetes since he never eats sugar. During the past year, A.B. has gained 22 lb. Since retiring, he has been more physically active, playing golf once a week and gardening, but he has been unable to lose more than 2-3 lb. He has never seen a dietitian and has not been instructed in self-monitoring of blood glucose (SMBG).A.B.’s diet history reveals excessive carbohydrate intake in the form of bread and pasta. He drinks 8 oz. of red wine with dinner each evening. He stopped smoking more than 10 years ago, he reports, “when the cost of cigarettes topped a buck-fifty.”His hemoglobin A1c (A1C) has never been <8%. His blood pressure has been measured at 150/70, 148/92, and 166/88 mmHg on separate occasions during the past year at the local senior center screening clinic. Although he was told that his blood pressure was "up a little," he was not aware of the need to keep his blood pressure =130/80 mmHg for both cardiovascular and renal health.A.B. never had a foot exam as part of his primary care exams, nor has he been instructed in preventive foot care. However, his medical records also indicate that he has had no surgeries or hospitalizations, his immunizations are up to date, and, in general, he has been remarkably healthy for many years.He is admitted to your unit with gangrene on the right great toe.  He had surgery for debridement two days ago. His vitals and blood sugars have been stabilized and he is being discharged from your unit today with orders for Novolog and Lantus insulin; Lisinopril; Lipitor; home health care for dressing changes and diabetes education. Health Science Science Nursing NUR 309 Share QuestionEmailCopy link Comments (0)

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