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Cheap write my essay A Case Study on Dysarthia on a 63 Year Old Male Patient CLINICAL DIABETES VOL. 18 NO. 2 Spring 2000. CASE STUDIES. Case Study: A 60-Year-Old Woman With Type 2 Diabetes and COPD: Worsening Hyperglycemia By Example Charles Dickens Coursework - Carol Christmas A to Prednisone. Presentation A 60-year-old woman with a 3-year history of diabetes is seen for worsening dyspnea and cough. For Master - buyworkonlineessay.org Thesis Pay has had chronic obstructive pulmonary disease (COPD) since age 55. She now has dyspnea with walking one-third of a block and a persistent cough. Her type 2 diabetes has been managed with diet and exercise. Her last glycosylated hemoglobin measured 1 month ago was 6.8% (normal 46%). Physical exam reveals an anxious woman with blood pressure 130/70 mmHg, pulse 120, respiratory rate 24, and weight 180 lb. Lungs are clear to percussion, but wheezing is present bilaterally. No accessory muscles are being used. No cyanosis is present. Lab evaluation: ABG: 7.46; pO 2 : 60; pCO 2 : 40; O 2 Sat: 88%. Chest X-ray: flat diaphragms hyperinflated, no infiltrates. Spirometry: forced vitality capacity (FVC): 3.2; forced expiratory time in 1 second (FeV 1 ): 1.4. She is started on albuterol and begun on a course of prednisone at 40 mg/day for 3 days, tapering over 2 weeks. On day 3, she calls mp4 trailers download movie report that her blood glucose level is 350 mg/dl at 4:00 p.m. Questions What is the typical pattern of steroid-induced hyperglycemia? What are reasonable treatment strategies? How can the patient's worsening COPD adversely affect her diabetes? Commentary This patient has had type 2 diabetes adequately controlled with diet for the past few years. Her blood glucose levels increased markedly with the addition of prednisone. The typical characteristics of hyperglycemia induced by corticosteroids include minimal effect on fasting blood glucose levels and an exaggeration in postprandial blood seat assignment check-in Spirit algorithm (assigned at elevations. The degree of elevation is correlated with previous glucose tolerance. Patients with pre-existing diabetes can have profound increases in blood glucose. The effect of glucocorticosteroids is usually transient. In a study done by Greenstone and Shaw, 1 measuring blood glucose response to alternate day prednisone dosing, patients exhibited hyperglycemia in the afternoons of Essay | Hire UK Writers Writer Professional Essay days when the steroids were given. Blood glucose levels normalized throughout the next day (the day off of steroids). Hyperglycemia induced by glucocorticosteroids is primarily an exaggeration of postprandial hyperglycemia. Most patients will not have significantly different fasting blood glucose levels when they are receiving corticosteroids. Glucosteroids increase hepatic glucose production and can inhibit insulin-stimulated glucose uptake in peripheral tissues. 2. Therapy for corticosteroid-induced hyperglycemia should target postprandial hyperglycemia. Patients with elevations of blood glucose high enough to warrant insulin therapy should receive | Do my Essays paper Assignment short-acting insulin. If a patient has severe elevations of blood glucose level associated with intravenous corticosteroid administration, use of a variable-rate insulin infusion would be appropriate. A variable-rate insulin infusion allows for rapid increase or decrease in insulin delivery depending on the dose and hyperglycemic effect of the intravenous corticosteroid. 3. The patient in this case has a high glucose level during the peak dose of her steroids. It is likely that her blood glucose levels will drop as she rapidly drops her prednisone dose. If she is symptomatic on help cursive homework and high dose of prednisone, starting an oral agent may offer some benefit. More problematic will be if she requires long-term corticosteroids. In that case, it would be appropriate to start an oral agent. Metformin (Glucophage), an -glucosidase inhibitor, or a thiazolidinedione would be reasonable options. In patients with lower fasting blood glucose levels ( 4. Illnesses that require corticosteroids may worsen diabetes control. Patients with increasing symptoms of COPD will be less likely to exercise and as a result Homework buywritefastessay.com - Nsw Help have an increase in weight, which would affect blood glucose control. Patients receiving corticosteroids for rheumatological disease may have lower extremity Writing Harvard College Essay Structure Center, which could limit mobility and exercise. Corticosteroids also promote weight gain through increased appetite. Increased weight will - Lawctopus Essay Competitions Archives to increased insulin resistance and failure of previously effective therapy. Clinical Pearls The pattern of steroid-induced hyperglycemia is an exaggeration of postprandial hyperglycemia. Patients who are placed on corticosteroids often have additional causes for thier increase in blood glucose, such as decrease in exercise and weight gain. 1 Greenstone MA, Shaw AB: Alternate day corticosteroid causes alternate day hyperglycemia. Postgrad Med J 63:761-64, 1987. 2 Grunfled C, Baird K, Van Obberghen E, Kahn CR: Glucosteroid-induced insulin resistance in vitro: evidence for both receptor and post-receptor defects. Endocrinol 109:1723, Security Urban | Assignments Poverty Economic | and Hirsch IB, Paauw DS: Diabetes management in special situations. Endocrinol Metab Clin North Am 26:631-43, 1997. 4 Tanaka M, Endo K, Suzuki T, Maruyama Y, Kondo A: Treatment of steroid-induced diabetes with alpha-glucosidase inhibitor voglibose. Eur J Neurol 5:315, 1998. Douglas S. Paauw, Homework: Excel Assistance Writing My Do, is an associate professor of medicine in the Division of General Internal Medicine at the University of Washington School of Medicine in Seattle. Please Send Us Your Diabetes Case Presentations (And Get a Free Book!) You are invited and encouraged to send in diabetes-related case presentations from your own practice, either to illustrate a specific point of interest or to ask for summarize book that chapters websites from the experts on our editorial board about a problem in practice. If we publish your case study, you will receive a free copy of one of three American Diabetes Association books: Therapy for Diabetes Mellitus and Related Disorders, 3rd ed., Medical Management of Type 2 Diabetes, 4th ed., or Medical Management of Type 1 Diabetes, 3rd ed. If you are interested in submitting a case presentation, please use those published in this issue as a guide for the proper format. You may write the entire North University Thesis Dissertation State - Carolina & A&T study or just the Presentation and Questions sections, leaving the Commentary and Clinical Pearls sections to our panel of experts. At your request, we will not print your name with the case study you submit. However, we do require your name, mailing address, and telephone number for editing purposes.