A case study of glycaemic control nursing essay

A case study of glycaemic control

This is the “Gold standard” test for the diagnosis of Diabetes Mellitus (DM). The reference range for this test is between 4-6 mmol/l4,5. The patient’s fasting blood glucose level, 12mmol/l, is far above the reference range confirming that he is suffering from DM. If they have not already been, urine ketone tests and serum Glutamic Acid Decarboxylase, islet cell and insulin antibody tests should be performed to rule out Type I DM and confirm the diagnosis of Type II DM6.

Urea

At 10.1 mmol/l his Urea levels are above the reference range, of 3.3 – 6.8 mmol/l 4,5. This could indicate impaired renal function, though could be the result of a high protein diet or recent surgery. It would be necessary to consider the patient’s history and do further tests, such as creatinine levels to test his glomerular filtrate rate to test kidney function. Nephron damage (diabetic nephropathy) is often seen in DM patients with long term hyperglycaemia4, 5.

Haemoglobin A1C (HbA1C)

This is the key test to show whether a patient has been maintaining good glycaemic control. The test measures the level of glycated haemoglobin in the plasma and gives an indication of the longer term (6 weeks to 2 months) average level of blood glucose. The patients HbA1C is 10% which is above the reference range of <6.5% 4,5, indicating that he has been frequently hyperglycaemic over the past 2 months4.

Osmolality

This is a measure of the number of glucose, urea, sodium and potassium molecules/kg of serum. The patient’s osmolality of 277mosm/kg is below the reference range of 285 -295 mosm/kg 4,5. The patient’s serum glucose and urea levels are elevated, so we would expect to see a high rather than a low serum osmolality. This result could be due to test errors, loss of sodium because of diabetic osmotic diuresis, diabetic nephropathy or dilution of the blood by excess fluid consumption. It would be advisable to rerun the test to verify that the patient has low osmolality, before performing further tests to investigate the causes1, 4.

Conclusion

Based on his high glycated HbA1C percentage, the patient glycaemic control of his Type II DM is assessed as poor.

Question 2

Good glycaemic control is essential if the risk of diabetic complications is to be minimised2. There are acute short term complications of DM, such as hyp…………………………………..

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