Ms.

Kate Wilson is a 65-year-old woman who has been admitted to your

surgical ward for the drainage of a Bakers Cyst. She was diagnosed with Type 2
Diabetes Mellitus (T2DM) 7 months ago, during a routine workup for surgery.
She takes no specific medication for her diabetes, and has been told by her GP
to ‘watch what she eats’. She was devastated to discover her diagnosis of
T2DM, as she was aware of the risks due to her family history. She has not
returned to her GP since her initial diagnosis. She has no other past medical
history of note. Kate says tearfully “I have been trying to eat right and exercise,
but I can’t walk because of the pain in my knee and I was feeling down and
eating ice cream. I have hardly eaten anything in the last week because I am
trying to lose weight and get my blood sugar down”. Her mother and older
sister were both diagnosed with T2DM in their early 50’s.
Kate tells you she has had the Bakers Cyst for about 2 years. It has been
increasing in size over the last 7 months, restricting her movements. The
planned surgery is drainage followed by two follow up cortisone injections.
On Admission at 0800 - her blood glucose level (BGL) was 22.9 mmol/L;
HbA1c: 11%. She has been fasting since midnight. She notes that she is feeling
quite “stressed” about the surgery.
On admission the following were recorded:
Height: 167cm
Weight: 105kg
Blood Pressure: 140/80 mmHg
Pulse rate: 95 beats/min
Respiratory Rate: 22 breaths/minute
Temperature: 36.7 ºC SpO2: 97%
Part 1 Questions (1000 words) Ms.Wilson is distressed that her blood glucose
level is elevated and asks you for help in understanding her diabetes. She tells
you that she has a friend who is very overweight, eats lots of cake and hardly
ever exercises, and he does not have diabetes.
1. Describe the pathophysiology of T2DM with links to Kate’s case.

2. Include in your answer risk factors for T2DM,

3. the pathogenesis of T2DM,

Furthermore, an ageing-associated reduction in the responsiveness of β cells to
carbohydrate partly underlies the fall in glucose tolerance with ageing.
4. possible complications of T2DM

5. and outline the 3 levels of treatment options for T2DM.

6. (600) 2. Differentiate between T2DM and T1DM (at least 6 differences).

(100)

7. 3. Identify at least 2 reasons Kate’s BGL is high on admission. Discuss

how each reason you identify effects BGLs. (300)

Part 2 Questions (700 words)

The surgery is successful and Kate comes to see you in the outpatient clinic for
cortisone injections (Kenacort-A 40).She has been commenced on metformin
(APO-Metformin Tablets) and glipizide (Minidiab Tablets) to help control her
diabetes. Her blood test on this visit were BGL 8.8 mmol/L; HbA1c: 8%.
1. Discuss the three medications Kate is on. Include in your answer the
action, complications/side effects and nursing considerations linked to
Kate’s situation. (500)

2. Discuss the two blood results, one from prior to surgery and one from
the clinic visit of Kate’s BGL and HbA1c. What are they?

What do they measure and why have they changed? (200)

Part 3 Questions (300 words) While Kate is waiting to see the doctor, she starts
talking to you about her condition. She asks if she has insulin dependent
diabetes or early onset diabetes. She is also unsure of how to use her BGL
machine and BGL strips.
1 Discuss why the terms insulin dependent diabetes mellitus/ non insulin
dependent diabetes mellitus and early onset/mature onset are misleading.
(100)

2 You need to teach Kate how to use her BGL machine.

Discuss the “teach back” method for patient education (include evidence
from peer reviewed sources).

Discuss how you would use this method to teach Kate how to use her BGL
machine. (200)