Case Study:
Mrs. Ksanthia is a 56 year old obese woman with Diabetes Mellitus Type 2 “DMT2 or DM2” who is admitted for treatment of an infected, painless, DM related foot ulcer. There is a 20×10 cm area of cellulitis surrounding the ulcer, which has some purulent drainage and contains significant fibrinous matter (the wound bed is grey and mucus looking, not red with “grains”).
The pt is started on IV antibiotics. Surgeons have requested that she be NPO (nothing by mouth) after midnight for surgical debridement in the morning. Mrs. Xanthia’s current wt is 100kg, and her recent blood sugar levels were in the mid 200s (normal 70-120). A recent glycosylated hemoglobin (HbA1C test) was 10.9% (normal less than 7%). Her home regimen includes glipizide 10 mg BID and metformin 1000mg BID. Blood glucose in the ED is 289 mg/dl.

1. What does the hemoglobin A1C test indicate? Is hers high or low?
2. Why are people with DM more likely to get a foot injury without noticing than people without DM?
3. Why are people with DM more likely to get an infection that won’t heal?
4. Why do people with uncontrolled DM often end up on dialysis?
5. What are three behavioral choices people can make to avoid getting, or control, DM-2?