1
1 1
,1
1 1
1: INTRODUCTION AND CASE OVERVIEW
11 1 1 1 1
Type121diabetes1mellitus1is1a1chronic1metabolic1disorder1associated1with1numerous1microvascular1
and1macrovascular1complications1when1glycemic1control1is1suboptimal.1One1of1the1most1commo
n1and1debilitating1complications1is1diabetic1peripheral1neuropathy1(DPN),1which1significantly1imp
acts1quality1of1life,1functional1status,1and1long-term1morbidity.1This1comprehensive1i-
Human1case1analysis1examines1a168-year-
old1Hispanic1female,1Eleanor1Martinez,1who1presents1to1a1community1health1clinic1with1poorly1con
trolled1blood1glucose1levels1and1progressive1tingling1in1both1feet1over1a1sixmonth1period.1
The1purpose1of1this1case1study1is1to1demonstrate1advanced1clinical1reasoning,1outpatient1diagnos
tic1
evaluation,1and1evidence-
based1management1of1diabetic1peripheral1neuropathy1in1an1older1adult.1The1analysis1empha
sizes1early1recognition1of1neuropathic1symptoms,1appropriate1screening1for1diabetes-
1related1complications,1patient-
centered1education,1and1culturally1sensitive1outpatient1care1consistent1with1Walden1Universi
ty1clinical1expectations.1
,1
1 1
2: 11
CHIEF COMPLAINT
1 1
Chief1Complaint:1
“My1blood1sugar1keeps1being1high,1and1my1feet1have1been1tingling1and1burning1for1months.”1
This1chief1complaint1immediately1raises1concern1for1a1chronic1diabetes-
related1complication.1Progressive1sensory1changes1in1the1lower1extremities1are1classic1for1diab
etic1peripheral1neuropathy1and1warrant1comprehensive1evaluation1due1to1the1risk1of1foot1ulce
rs,1infection,1falls,1and1eventual1amputation1if1left1untreated.1
,1
1 1
3: 11
HISTORY OF PRESENT ILLNESS (HPI)
1 1 1 1 1
Eleanor1Martinez1is1a168-year-
old1Hispanic1female1who1presents1to1a1community1health1clinic1for1evaluation1of1persistently1elev
ated1blood1glucose1levels1and1progressive1tingling1in1both1feet1for1approximately1six1months.1She
1reports1that1the1symptoms1began1gradually1as1mild1numbness1in1her1toes1and1have1progressivel
y1worsened1to1include1burning,1tingling,1and1occasional1sharp,1electric-
like1pains1that1are1more1pronounced1at1night.1
The1patient1states1that1the1symptoms1are1bilateral1and1symmetrical,1extending1from1the1toes1u
pward1toward1the1mid-
foot.1She1denies1weakness1but1reports1decreased1sensation1when1walking,1causing1her1to1feel1
unsteady1at1times.1She1denies1recent1trauma,1new1footwear,1or1exposure1to1toxins.1She1reports1
difficulty1sleeping1due1to1discomfort1and1states1that1the1symptoms1interfere1with1daily1activitie
s.1
1 1
,1
1 1
1: INTRODUCTION AND CASE OVERVIEW
11 1 1 1 1
Type121diabetes1mellitus1is1a1chronic1metabolic1disorder1associated1with1numerous1microvascular1
and1macrovascular1complications1when1glycemic1control1is1suboptimal.1One1of1the1most1commo
n1and1debilitating1complications1is1diabetic1peripheral1neuropathy1(DPN),1which1significantly1imp
acts1quality1of1life,1functional1status,1and1long-term1morbidity.1This1comprehensive1i-
Human1case1analysis1examines1a168-year-
old1Hispanic1female,1Eleanor1Martinez,1who1presents1to1a1community1health1clinic1with1poorly1con
trolled1blood1glucose1levels1and1progressive1tingling1in1both1feet1over1a1sixmonth1period.1
The1purpose1of1this1case1study1is1to1demonstrate1advanced1clinical1reasoning,1outpatient1diagnos
tic1
evaluation,1and1evidence-
based1management1of1diabetic1peripheral1neuropathy1in1an1older1adult.1The1analysis1empha
sizes1early1recognition1of1neuropathic1symptoms,1appropriate1screening1for1diabetes-
1related1complications,1patient-
centered1education,1and1culturally1sensitive1outpatient1care1consistent1with1Walden1Universi
ty1clinical1expectations.1
,1
1 1
2: 11
CHIEF COMPLAINT
1 1
Chief1Complaint:1
“My1blood1sugar1keeps1being1high,1and1my1feet1have1been1tingling1and1burning1for1months.”1
This1chief1complaint1immediately1raises1concern1for1a1chronic1diabetes-
related1complication.1Progressive1sensory1changes1in1the1lower1extremities1are1classic1for1diab
etic1peripheral1neuropathy1and1warrant1comprehensive1evaluation1due1to1the1risk1of1foot1ulce
rs,1infection,1falls,1and1eventual1amputation1if1left1untreated.1
,1
1 1
3: 11
HISTORY OF PRESENT ILLNESS (HPI)
1 1 1 1 1
Eleanor1Martinez1is1a168-year-
old1Hispanic1female1who1presents1to1a1community1health1clinic1for1evaluation1of1persistently1elev
ated1blood1glucose1levels1and1progressive1tingling1in1both1feet1for1approximately1six1months.1She
1reports1that1the1symptoms1began1gradually1as1mild1numbness1in1her1toes1and1have1progressivel
y1worsened1to1include1burning,1tingling,1and1occasional1sharp,1electric-
like1pains1that1are1more1pronounced1at1night.1
The1patient1states1that1the1symptoms1are1bilateral1and1symmetrical,1extending1from1the1toes1u
pward1toward1the1mid-
foot.1She1denies1weakness1but1reports1decreased1sensation1when1walking,1causing1her1to1feel1
unsteady1at1times.1She1denies1recent1trauma,1new1footwear,1or1exposure1to1toxins.1She1reports1
difficulty1sleeping1due1to1discomfort1and1states1that1the1symptoms1interfere1with1daily1activitie
s.1
