Maria is a 34-year-old woman with who presents to a healthcare provider to establish primary care

Maria is a 34-year-old woman with who presents to a healthcare provider to establish primary care

Case Presentation

Maria is a 34-year-old woman with who presents to a healthcare provider to establish primary care and management of her diabetes. She was diagnosed with type 2 diabetes 3 years ago, and has a history of polycystic ovary syndrome and hypertension. She works as a pharmacy technician at a local pharmacy chain, and has been married for 1 year. She lives with her husband and recently moved to the area from across the country for better job opportunities. Her A1C 1 year ago was at the recommended goal of 7.0%. Her current medications include metformin ER 2000 mg daily, enalapril 10 mg daily, and a prenatal vitamin daily. She has no allergies, and does not smoke or drink alcohol. She has been checking his glucose levels at home once daily, and readings vary from 110 to 165 mg/dL. She walks for 30 minutes 2 days a week (her days off), as she feels she is on her feet enough when she is at work. She would also like a referral to obstetrics/gynecology, as she and her husband want to start a family in the coming year and are not using any contraception.

Vital signs are as follows: weight, 72.5 kg; height, 63 in.; body mass index, 29.5; temperature, 98.4°F; pulse, 84 beats/min; respiratory rate, 20 breaths/min; and blood pressure, 140/82 mm Hg.

Lab results are as follows: A1C, 7.6%; glucose, 155 mg/dL; sodium, 135; blood urea nitrogen, 19; creatinine, 0.8; total cholesterol, 186 mg/dL; triglycerides, 186 mg/dL; HDL, 44; and LDL, 104.

 

Case Analysis Questions

1. What is your overall assessment of Marla’s current diabetes management status?
2. What considerations should be made regarding Marla’s desire to get pregnant?
3. How should Marla focus her self-management activities prior to becoming pregnant?