Case study 76
Y.L., a 34-year-old Asian woman, comes to the clinic with complaints of chronic fatigue,
increased thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-
back pain on urination. She tells you she has a vaginal yeast infection that she has treated
numerous times with over-the-counter medication. She works full time as a clerk in a loan
company and states she has difficulty reading numbers and reports, resulting in her making
frequent mistakes. She says, “By the time I get home and make supper for my family, then put
my child to bed, I am too tired to exercise.” She reports her feet hurt; they often “burn or feel like
there are pins in them.” She has a history of gestational diabetes and reports that, after her
delivery, she went back to her traditional eating pattern, which is high in carbohydrates.
In reviewing Y.L.'s chart, you notice she has not been seen since the delivery of her child 6 years
ago. She has gained considerable weight; her current weight is 173 pounds. Today, her BP is
152/97 mm Hg, and a random plasma glucose is 291 mg/dL. The primary care provider suspects
that Y.L. has developed type 2 diabetes mellitus (DM) and orders the following laboratory
studies:
Laboratory Test Results
Fasting glucose 184 mg/dL
HbA1C 8.8%
Total cholesterol 256 mg/dL
Triglycerides 346 mg/dL
LDL 155 mg/dL
HDL 32 mg/dL
UA +glucose, −ketones
1. Interpret Y.L.'s laboratory results.
Fasting glucose level and HbA1C level indicates that the patient has Diabetes Mellitus. The
patient also has glucose in urine, which confirms DM. No ketones in the urinalysis means it is
type 1. YL has high Total Cholesterol, Triglyceride, LDL, and HDL. Patients with insulin
resistance often have problems with cholesterol...this is characteristic of type 2 DM. These things
all support the PCP’s dx.
2. Identify the three methods used to diagnose DM.
Glucose over 200 mg/dL
Fasting plasma glucose over 126 mg/dL.
Oral Glucose Tolerance testing
3. Identify three functions of insulin.
Enables glucose to move into cells to be used as an energy source, enabling glycogenesis.
Facilitates the entry of amino acids in the cell for protein synthesis.
Augments the fat storage and prevents the breakdown of fats for energy.
4. Describe the major pathophysiologic difference between type 1 and type 2 DM.
In type 1 DM, there is NO insulin being produced in your body. In type 2, there is some insulin
being made, but it is not enough to support your body and it must be supplemented, or the body
Y.L., a 34-year-old Asian woman, comes to the clinic with complaints of chronic fatigue,
increased thirst, constant hunger, and frequent urination. She denies any pain, burning, or low-
back pain on urination. She tells you she has a vaginal yeast infection that she has treated
numerous times with over-the-counter medication. She works full time as a clerk in a loan
company and states she has difficulty reading numbers and reports, resulting in her making
frequent mistakes. She says, “By the time I get home and make supper for my family, then put
my child to bed, I am too tired to exercise.” She reports her feet hurt; they often “burn or feel like
there are pins in them.” She has a history of gestational diabetes and reports that, after her
delivery, she went back to her traditional eating pattern, which is high in carbohydrates.
In reviewing Y.L.'s chart, you notice she has not been seen since the delivery of her child 6 years
ago. She has gained considerable weight; her current weight is 173 pounds. Today, her BP is
152/97 mm Hg, and a random plasma glucose is 291 mg/dL. The primary care provider suspects
that Y.L. has developed type 2 diabetes mellitus (DM) and orders the following laboratory
studies:
Laboratory Test Results
Fasting glucose 184 mg/dL
HbA1C 8.8%
Total cholesterol 256 mg/dL
Triglycerides 346 mg/dL
LDL 155 mg/dL
HDL 32 mg/dL
UA +glucose, −ketones
1. Interpret Y.L.'s laboratory results.
Fasting glucose level and HbA1C level indicates that the patient has Diabetes Mellitus. The
patient also has glucose in urine, which confirms DM. No ketones in the urinalysis means it is
type 1. YL has high Total Cholesterol, Triglyceride, LDL, and HDL. Patients with insulin
resistance often have problems with cholesterol...this is characteristic of type 2 DM. These things
all support the PCP’s dx.
2. Identify the three methods used to diagnose DM.
Glucose over 200 mg/dL
Fasting plasma glucose over 126 mg/dL.
Oral Glucose Tolerance testing
3. Identify three functions of insulin.
Enables glucose to move into cells to be used as an energy source, enabling glycogenesis.
Facilitates the entry of amino acids in the cell for protein synthesis.
Augments the fat storage and prevents the breakdown of fats for energy.
4. Describe the major pathophysiologic difference between type 1 and type 2 DM.
In type 1 DM, there is NO insulin being produced in your body. In type 2, there is some insulin
being made, but it is not enough to support your body and it must be supplemented, or the body
