Diabetes Case Study

You are a float pool nurse assigned to work in the emergency department today.

1. You arrive at work and your first patient arrives. It is a 22-year-old female
who complains of severe hunger and thirst, 9/10 abdominal pain, headache,
and a recent unexplained weight loss of 10 lbs.

a. What diagnosis is your initial concern? Why?

Answer: _______________________________________________________________________________
__________________________________________________________________________________________

b. What labs do you want to get on this patient? What do you expect the results
to be?
Answer: _______________________________________________________________________________
__________________________________________________________________________________________

c. Describe the pathophysiology of this disease process on a cellular level.

Answer: _______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Diabetes Case Study

 2. The following lab values result:

ABG:
BMP: pH 6.8
Na 137 pCO2 11
K 7.8 HCO3 14
Cl 102 Misc:
Glucose 986 HgA1C 15.2

BUN 64 UA:
Cr 2.4 Ketones +4

Ca 9.6 Glucose +2

Mg 2.1 USG 1.052

Phos 5.0

a. Interpret each lab result. Are they normal or abnormal? Which ones are
significant? Is this what you expected?
Answer: _______________________________________________________________________________
__________________________________________________________________________________________

b. What diagnosis can be made based on these lab results? Hint: there is an
underlying diagnosis, AND a complication of said diagnosis that this patient is
currently experiencing.
Answer: _______________________________________________________________________________
__________________________________________________________________________________________

Diabetes Case Study

 3. The doctors confirm that your patient is diagnosed with Type I diabetes
mellitus and is currently in Diabetic Ketoacidosis. They consult
endocrinology for assistance and begin initial treatment. You proceed to
do a full assessment on your patient and begin treatment.

a. Describe in detail the assessment findings you expect to find on your

head-to-toe assessment.
Answer: _______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

b. What vital sign changes would you expect to see? What would be normal and
what would you expect in this patient.
Answer: _______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

c. What treatment would you expect to start in the ED? Describe each intervention
you expect the doctor to order and why that treatment would be effective.
Answer: _______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Diabetes Case Study

 4. You receive the following orders from the MD:

Order Frequency

ABG Q1 hr

BMP Q2 hrs

Normal Saline IV 100ml/hr continuous

Insulin aspart .1U/kg/hr continuously via IV

a. Review each of these orders. Are they appropriate? Is there anything you need
to question or clarify? Are there any additional interventions you should ask for
an order for?
Answer: _______________________________________________________________________________
__________________________________________________________________________________________

b. After implementing the appropriate interventions you call report to the floor
nurse. Write your SBAR report for this patient.
Answer: _______________________________________________________________________________
__________________________________________________________________________________________

The following day, you report to work and this shift you are floated to the medical unit.
You take report and are assigned the patient with newly diagnosed diabetes that you
treated in the ED yesterday. They have been treated with fluids and insulin overnight
and are out of DKA.

Diabetes Case Study

 5. Your patient is a new diabetic and does not know anything about the
disease. Now that the DKA has resolved, the treatment team is focused on
long-term interventions and education.

a. Explain how diabetes works to your patient in a way they will understand.
Answer: _______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

b. Teach the patient about the signs and symptoms of hyper and hypoglycemia.
How can you help them remember these symptoms?
Answer: _______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

c. Recognition of hypoglycemia and knowing what to do is essential for your

patient’s safety going home. What do you teach them about hypoglycemia?
What BG is considered hypoglycemic? What do they need to do?
Answer: _______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Diabetes Case Study

 6. The endocrinologist prescribes a basal bolus dosing system for your
patient’s insulin management. The patient has never taken insulin or given
themselves injections before.

a. What types of insulin are there? What are the peak, onset, and duration of
each?
Answer: _______________________________________________________________________________
__________________________________________________________________________________________

b. For a basal-bolus system, what two types of insulin are prescribed? Explain to
the patient how they work, and when he will administer them.
Answer: _______________________________________________________________________________
__________________________________________________________________________________________

c. During what time frame will the patient need to monitor for hypoglycemia?
Answer: _______________________________________________________________________________
__________________________________________________________________________________________

7. You begin working on educating the patient on insulin administration.

a. Teach the patient the do’s and don’ts of storing insulin.

Answer: _______________________________________________________________________________
__________________________________________________________________________________________

b. Teach the patient the do’s and don’ts of mixing insulin.

Answer: _______________________________________________________________________________
__________________________________________________________________________________________

c. Teach the patient the do’s and don’ts of subcutaneous injections for his insulin.
What’s the proper angle? What sites can he choose? What else does he need to
understand?
Answer: _______________________________________________________________________________
__________________________________________________________________________________________

Diabetes Case Study

 8. After the patient has done a return demonstration on insulin
administration, you leave and check on your other patients. About 30
minutes later you return, and find the patient unconscious on the floor.

a. What do you think happened? What is the most likely reason your patient is
unconscious given their diagnosis and treatment?
Answer: _______________________________________________________________________________
__________________________________________________________________________________________

b. What is your priority nursing action?

Answer: _______________________________________________________________________________
__________________________________________________________________________________________

9. You check their blood sugar and it is 32. You shout for help, and shake the
patient trying to wake him, but he remains unconscious.

a. What is your next priority?

Answer: _______________________________________________________________________________
__________________________________________________________________________________________

b. Outline the steps you will take in treating this patient's hypoglycemia.
Answer: _______________________________________________________________________________
__________________________________________________________________________________________

c. How would your interventions differ if the patient was conscious?

Answer: _______________________________________________________________________________
__________________________________________________________________________________________

Diabetes Case Study

 10. The patient later tells you that his grandfather was obese and developed
diabetes in his late 70s. He tells you that his grandfather also took a pill to
control his blood sugar, and asks if he could do that instead of the insulin
injections.

a. What type of diabetes did the patient’s grandfather have? Explain how this
differs from Type I diabetes.
Answer: _______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

b. Explain to the patient how oral antidiabetic agents work. Will this work for this
patient? Why or why not?
Answer: _______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Diabetes Case Study

 Diabetes Case Study
Answers & Explanations
**If you missed ANY part of these explanations, GO BACK to your notes on that section
and STUDY THEM MORE!!!**

1. You arrive at work and your first patient arrives. It is a 22-year-old female
who complains of severe hunger and thirst, 9/10 abdominal pain, headache,
and a recent unexplained weight loss of 10 lbs.
a. What diagnosis is your initial concern? Why?

Answer: You should be concerned that this patient possibly has Diabetes Mellitus and is in
Diabetic Ketoacidosis (DKA). The signs and symptoms of severe hunger (polyphagia), and severe
thirst (polydipsia) are very specific findings for diabetes and DKA. The abdominal pain,
headache, and weight loss additionally point to DKA and should confirm that this is your initial
concern.
b. What labs do you want to get on this patient? What do you expect the results to be?

Answer: You want a BMP, ABG, and UA. The BMP will show electrolyte levels and blood
glucose. You expect an elevated serum potassium and elevated BG. Additionally, a BMP will
show you kidney function with a BUN/Cr - you know DKA can affect the kidneys and elevate
these numbers. The ABG should be done to help evaluate for DKA. You expect a low pH, low
pCO2, and low HCO3 - uncompensated metabolic acidosis. Lastly the UA will show ketones in
the urine. You expect + ketones, and due to the extra solutes in the urine, a high USG and
osmolarity.
c. Describe the pathophysiology of this disease process on a cellular level.

Answer: DMTI is an autoimmune disease. The body has destroyed the beta cells of the
pancreas that produce insulin and there is little or no insulin in the body. Without insulin, there
are very high levels of glucose in the bloodstream. Insulin acts like a key to unlock the cells and
carry glucose into the cells. Without insulin, no glucose can get to the cells for fuel. With DKA,
there is absolutely no insulin to carry glucose to the cells. Glucose builds up in the blood (high
BG), causing the blood to become hypertonic, causing fluid to shift into the vascular space. The
kidneys work to filter this excess fluid and glucose causing polyuria. The cells are not receiving
any fluid or glucose - they are starving and dehydrated, and this causes polydipsia & polyphagia.
Because cells don’t have any glucose for energy, they break down proteins and fat for energy.
Breaking down fat produces ketones - which are an acid. The build-up of the ketones causes
metabolic acidosis. The body starts trying to breathe harder and faster to blow off CO2 and
compensate for the metabolic acidosis - Kussmaul respirations. Lastly, because the glucose can’t
get into the cells, potassium also can’t get into the cells. (most of our body's potassium is
intracellular, stored inside of the cells.) It enters the cells WITH glucose, and cannot enter on its
own. Without insulin, no glucose can enter the cells, and therefore no potassium. This leads to a
high serum potassium level.

Diabetes Case Study

 2. The following lab values result:

BMP:
ABG:
Na 137
pH 6.8
K 7.8
pCO2 11
Cl 102
HCO3 14
Glucose 986
Misc:
BUN 64
HgA1C 15.2
Cr 2.4
UA:
Ca 9.6 Ketones +4
Mg 2.1 Glucose +2
Phos 5.0 USG 1.052

a. Interpret each lab result. Are they normal or abnormal? Which ones are significant? Is this
what you expected? For each abnormal lab explain why it is abnormal based on the
pathophysiology of DKA.

Answer:

Lab Pt’s Normal Interpretation

value range

Na 137 135-145 Normal

K 7.8 3.5-5.0 High

This is a very significant finding. Hyperkalemia is
incredibly dangerous and very common in DKA.
because the glucose can’t get into the cells,
potassium also can’t get into the cells. (most of our
body's potassium is intracellular, stored inside of the
cells.) It enters the cells WITH glucose, and cannot
enter on its own. Without insulin, no glucose can
enter the cells, and therefore no potassium. This
leads to a high serum potassium.

Cl 102 95-105 Normal

Diabetes Case Study

 Glucose 986 70-100 High
This is the keystone finding of the DKA diagnosis. The
body has destroyed the beta cells of the pancreas
that produce insulin and there is little or no insulin in
the body. Without insulin, there are very high levels
of glucose in the bloodstream. Insulin acts like a key
to unlock the cells and carry glucose into the cells.
Without insulin, no glucose can get to the cells for
fuel. With DKA, there is absolutely no insulin to carry
glucose to the cells. Glucose builds up in the blood
(High BG).

BUN 64 5-20 High

This indicates kidney damage. The high BG caused
the blood to become hypertonic, causing fluid to shift
into the vascular space. The kidneys work to filter this
excess fluid and glucose causing polyuria, and this
overworking of the kidneys can cause kidney damage,
reflected by an elevated BUN & Cr.

Cr 2.4 0.6-1.2 High

This indicates kidney damage. The high BG caused
the blood to become hypertonic, causing fluid to shift
into the vascular space. The kidneys work to filter this
excess fluid and glucose causing polyuria, and this
overworking of the kidneys can cause kidney damage,
reflected by an elevated BUN & Cr.

Ca 9.6 8.5-10.5 Normal

Mg 2.1 1.5-2.5 Normal

Phos 5.0 2.5-4.5 Borderline-high

pH 6.8 7.35-7.45 Low - acidotic

Because cells don’t have any glucose for energy, they
break down proteins and fat for energy. Breaking
down fat produces ketones - which are an acid. The
build up of the ketones causes metabolic acidosis;
low pH.

pCO2 11 35-45 Low

With the low, acidic pH, the body starts trying to
breathe harder and faster to blow off CO2 (an acid)
and compensate for the metabolic acidosis, causing a
low pCO2 level.

HCO3 14 22-28 Low

Serum bicarbonate binds to the excess ketones and
decreases the body's serum bicarbonate levels.

Diabetes Case Study

 HgA1C 15.2 4.5-5.6% High
This test helps determine whether you are at an
increased risk of developing diabetes; to help
diagnose diabetes and prediabetes; to monitor
diabetes and to aid in treatment decisions. Patients
with diabetes should have their A1C checked every
3-4 months. Hemoglobin A1c, also called A1c or
glycated hemoglobin, is hemoglobin with glucose
attached. The A1c test evaluates the average amount
of glucose in the blood over the last 2 to 3 months by
measuring the percentage of glycated hemoglobin in
the blood.

Ketones +4 none High

The presence of ketones in the urine confirms that the
patient is burning fat for energy and is in DKA.

Glucose +2 none High

Large amount of glucose in the serum is being filtered
by the kidneys into the urine.

USG 1.052 1.005-1.030 High

Due to the excess ketones, glucose, and solutes in the
urine, the urine specific gravity is very high.

b. What diagnosis can be made based on these lab results? Hint: there is an underlying
diagnosis, AND a complication of said diagnosis that this patient is currently experiencing.

Answer: Diabetes Mellitus Type I – this patient is experiencing the complication of Diabetic
Ketoacidosis (DKA).

Diabetes Case Study

 3. The doctors confirm that your patient is diagnosed with Type I diabetes
mellitus and is currently in Diabetic Ketoacidosis. They consult
endocrinology for assistance and begin initial treatment. You proceed to
do a full assessment on your patient and begin treatment.
a. Describe in detail the assessment findings you expect to find on your head-to-toe
assessment.

Answer:
▪ Neuro - lethargic, weak, fatigued, irritable, blurry vision
▪ Cardiac - dry flushed skin
▪ Respiratory - fast labored breathing (kussmaul respirations), fruity-smelling breath
▪ GI/GU - Polydipsia, polyphagia, polyuria, nausea, vomiting, abdominal pain
▪ Heme/ID - unexplained weight loss

b. What vital sign changes would you expect to see? What would be normal and what would
you expect in this patient.

Answer: Tachycardia, hypotension, and tachypnea are all possible vital sign changes in DKA.
The blood pressure can become low due to polyuria causing an excessive loss of fluid from the
vascular space and hypovolemic shock. As the blood pressure lowers, the body senses the need
to increase cardiac output and elevates the heart rate to try to compensate, therefore causing
tachycardia. Lastly, the respiratory rate increases due to compensation from the low (acidic) pH.
The body attempts to breathe harder and faster to blow off CO2 (an acid) and compensate for
the metabolic acidosis.
Normals:
HR: 60-100
RR: 12-188
BP: 120/80

c. What treatment would you expect to start in the ED? Describe each intervention you expect
the doctor to order and why that treatment would be effective.

Answer: The major treatments to be implemented in the ED are close lab monitoring, IV fluids,
and an insulin drip. For labs, you would expect to monitor an hourly BG and serum potassium as
well as ABGs to evaluate the metabolic acidosis. For fluids, NS is used to start, and when the
BG lowers to 250-300, D5W is added to the solution to prevent hypoglycemia. Your goal is to
lower blood sugar slowly preventing a rapid drop that would cause a shift of fluid into the cells
and cerebral edema. Lastly, Insulin must be administered to decrease the blood sugar. It will
bring glucose and potassium back into the cell - reducing the BG and serum K levels.

Diabetes Case Study

 4. You receive the following orders from the MD:

Order Frequency

ABG Q1 hr

BMP Q2 hrs

Normal Saline IV 100ml/hr continuous

Insulin aspart .1U/kg/hr continuously via IV

a. Review each of these orders. Are they appropriate? Is there anything you need to question or
clarify? Are there any additional interventions you should ask for an order for?

Answer:

Order Frequency Appropriate?

ABG Q1 hr Yes. Monitoring the ABG every

hour to evaluate the metabolic
acidosis is very appropriate. No
clarification needed.

BMP Q2 hrs A full BMP every 2 hours isn't

needed. Rather, we need hourly
monitoring of the glucose and
serum potassium. The RN might
clarify if there is an additional
reason the MD ordered a full BMP,
but it can likely be changed to just
BG and K, and needs to be q1 hour.

Normal Saline IV 100ml/hr continuous Yes - NS is the fluid of choice when

starting fluid resuscitation in DKA
patients. This will help offset the
massive fluid loss due to polyuria
preventing hypovolemic shock.

Insulin aspart 0.1U/kg/hr continuously via IV NO. This order is not appropriate.
Insulin aspart is a RAPID acting
insulin and can NOT be
administered via IV. Regular insulin
needs to be ordered for this
patient. The RN should clarify this
order and should NOT administer
this insulin via IV.

Diabetes Case Study

 b. After implementing the appropriate interventions you call report to the floor nurse. Write
your SBAR report for this patient.

Answer:
Situation: This is a 22-year-old female who presented to the ED today complaining of severe
hunger and thirst, 9/10 abdominal pain, headache, and a recent unexplained weight loss of 10
lbs.
Background: We drew labs and the patient had an elevated serum K at 7.8 and elevated BG at
986. Their ABG was 6.8/11/14 and their urine was positive for ketones. We started the
following treatments for DKA: NS @ 100ml/hr and Regular Insulin at 0.1U/kg/hr.
Assessment: The patient is in DKA. Their neuro status is lethargic and weak, and they report
blurry vision. They have dry flushed skin. They are exhibiting kussmaul respirations, and they
have fruity-smelling breath. They have polydipsia, polyphagia, polyuria, nausea, vomiting, and
report 9/10 abdominal pain.
Recommendation: Continued IVF and IV insulin. When their blood sugar gets down to 250-300,
D5W should be added to the fluid so their blood sugar does not drop too quickly. Careful
monitoring of neuro status, serum K levels, BG, and ABGs is indicated.

The following day, you report to work and this shift you are floated to the medical unit. You
take report and are assigned the patient with newly diagnosed diabetes that you treated in
the ED yesterday. They have been treated with fluids and insulin overnight and are out of
DKA.

5. Your patient is a new diabetic and does not know anything about the
disease. Now that the DKA has resolved, the treatment team is focused on
long-term interventions and education.
a. Explain how diabetes works to your patient in a way they will understand.

Answer: You have a type of diabetes called Type I. For a reason we don’t understand, your
body destroyed some of the cells in your pancreas. These cells made a hormone called insulin,
and now that they have been destroyed, your body can’t make insulin. Insulin is an important
hormone to your body for many reasons. It acts like a key to our cells, opening them up so that
the sugar we eat can get inside of the cells. Without insulin to act as that key, the sugar we eat
just stays in the bloodstream. This makes your blood sugar high, and your cells will be starving
without food. You will have to take insulin for the rest of your life so that the sugar you eat can
get into your cells.
b. Teach the patient about the signs and symptoms of hyper and hypoglycemia. How can you
help them remember these symptoms?

Answer: Hypoglycemia symptoms include: feeling cold, clammy, confused, shaky, nervous,
nauseous, hungry, and having a headache. You can remember these symptoms by ‘cold and
clammy, need some candy’. Hyperglycemia symptoms include: irritability, weight loss, thirst,
fatigue, extreme hunger, blurred vision, frequent urination, and dry flushed skin. You can
remember these symptoms by ‘dry and hot, need an insulin shot’.

Diabetes Case Study

 c. Recognition of hypoglycemia and knowing what to do is essential for your patient’s safety
going home. What do you teach them about hypoglycemia? What BG is considered
hypoglycemic? What do they need to do?

Answer: Hypoglycemia is when there is not enough glucose in the bloodstream. A blood
sugar reading less than 70 is considered hypoglycemia. It can be caused by not enough food, too
much insulin, or too much exercise. If your blood sugar is less than 70, the first thing to do is
have a snack that has about 15 grams of carbs. This could be 4-6 oz of soda/juice/milk or 8-10
pieces of candy. Wait 15 minutes, and check the BG again. If still <70, eat another 15 grams of
carbs. After the BG rises, eat a snack with complex carb/protein to help keep the BG up - for
example, crackers with peanut butter.

6. The endocrinologist prescribes a basal bolus dosing system for your

patient’s insulin management. The patient has never taken insulin or given
themselves injections before.
a. What types of insulin are there? What are the peak, onset, and duration of each?

Answer:

Type Generic Name Onset Peak Duration

Rapid-Acting Insulin aspart 15 min 30-90 min 3-5 hrs

Insulin lispro 15 min 30-90 min 3-5 hrs

Short-Acting Regular 30-60 min 2-4 hrs 6-8 hrs

Intermediate- NPH 1-2 hrs 6-14 hrs 16-24 hrs

acting

Long-acting Glargine 1-2 hrs none 24 hrs

b. For a basal-bolus system, what two types of insulin are prescribed? Explain to the patient
how they work, and when he will administer them.

Answer: In a basal bolus dosing system both long-acting and rapid-acting insulin will be
prescribed. The long-acting agent will be given once per day. The rapid-acting agent will be
given with meals to cover the carbs the patient eats.
c. During what time frame will the patient need to monitor for hypoglycemia?

Answer: The patient needs to monitor for hypoglycemia at the peak of insulin’s action.
Long-acting insulin has no peak, so there is no specific time to monitor for hypoglycemia. For the
rapid acting insulin however, the patient should be alert for hypoglycemia 30-90 minutes after
administering the insulin.

Diabetes Case Study

 7. You begin working on educating the patient on insulin administration.
a. Teach the patient the do’s and don’ts of storing insulin.

Answer: Always keep insulin away from heat and direct sunlight. Never freeze insulin. Store in
the refrigerator until ready for use. When actively using, keep at room temperature. At room
temperature, NPH is good for one month, Glargine is good for 28 days, and rapid and short
acting insulins are good for 28 days.
b. Teach the patient the do’s and don’ts of mixing insulin.

Answer: First, draw up air equal to the total amount of insulin needed. Then, inject the correct
amount of air into the NPH vial. Then, inject the remaining air into the regular insulin. Now draw
up the correct amount of regular insulin, and lastly draw up the correct amount of NPH insulin.
Draw up the clear insulin first, then cloudy (regular 1st, NPH 2nd! NEVER mix long-acting
insulin!)
c. Teach the patient the do’s and don’ts of subcutaneous injections for his insulin. What’s the
proper angle? What sites can he choose? What else does he need to understand?

Answer: The only insulin you can give via IV is Regular insulin - all others are given SubQ.
Ensure you rotate sites regularly; sites include the lateral aspect of the lower part of the upper
arm, the posterior aspect of the upper arms, the back, thighs, and the abdomen in the umbilical
region. Insulin syringes are measured in units. Never use expired or cloudy insulin unless it is
NPH. NPH is the only cloudy insulin. Lastly, the angle of injection for subcutaneous injections is
at 45 degrees, with the skin appropriately bunched so that the needle enters the subcutaneous
tissue, not the muscle.

8. After the patient has done a return demonstration on insulin

administration, you leave and check on your other patients. About 30
minutes later you return, and find the patient unconscious on the floor.
a. What do you think happened? What is the most likely reason your patient is unconscious
given their diagnosis and treatment?

Answer: They are most likely hypoglycemic.

b. What is your priority nursing action?

Answer: Check their blood sugar!!!!

9. You check their blood sugar and it is 32. You shout for help, and shake the
patient trying to wake him, but he remains unconscious.
a. What is your next priority?

Answer: If you have IV access, your priority is to push D50W to raise the patient’s blood sugar.
If you do not have IV access, administer IM glucagon. IM glucagon is a catabolic hormone that
raises the concentration of glucose in the bloodstream.

Diabetes Case Study

 b. Outline the steps you will take in treating this patient's hypoglycemia.

Answer: Your first priority nursing action is to check the blood sugar. Next, administer D50W
to raise the patient’s blood sugar. If you do not have IV access, administer IM glucagon. Wait 15
minutes, and check the blood sugar again. If still below 70, repeat the IV D5W or IM glucagon.
Once the patient is conscious, give them a snack that has about 15 grams of carbs. This could be
4-6 oz of soda/juice/milk or 8-10 pieces of candy. Wait 15 minutes, and check the BG again. If
still <70, eat another 15 grams of carbs. After the BG rises, give them a snack with complex
carb/protein to help keep the BG up - for example, crackers with peanut butter.
c. How would your interventions differ if the patient was conscious?

Answer: If the patient was conscious, you would not need to administer the D50W or IM
glucagon. Just go right to the 15-15-15 rule: 15 grams of carbs, wait 15 minutes, another 15
grams of carbs. If at any point the patient becomes unconscious, administer IV D50W.

10. The patient later tells you that his grandfather was obese and developed
diabetes in his late 70s. He tells you that his grandfather also took a pill to
control his blood sugar, and asks if he could do that instead of the insulin
injections.
a. What type of diabetes did the patient’s grandfather have? Explain how this differs from Type
I diabetes.

Answer: The patient’s grandfather most likely had Type II Diabetes Mellitus. In this type of
diabetes there is either not enough insulin, insulin resistance, or bad insulin. It is commonly
found with patients who are overweight as their body can’t make enough insulin to keep up with
the glucose they take in. This differs from Type I where the body doesn’t have ANY insulin, due
to destruction of the beta cells of the islets of Langerhans in the pancreas.
b. Explain to the patient how oral antidiabetic agents work. Will this work for this patient?
Why or why not?

Answer: Oral antidiabetic agents like this patient’s grandfather took work to decrease the
amount of circulating glucose in the patient’s body. They improve how the body produces insulin
and uses insulin which makes them an excellent adjunct to treatment is Type II diabetes. This is
because in Type II diabetes there is either not enough insulin, insulin resistance, or bad insulin -
and oral antidiabetics can address this. But, this patient has Type I Diabetes. Their body doesn’t
make ANY insulin. So, an oral anti-diabetic agent that helps to improve how the body uses
insulin will do them no good at all.

Diabetes Case Study