Case illustrating blood glucose monitoring in type 2 diabetes
- David K McCulloch, MD
David K McCulloch, MD
- Washington Permanente Medical Group
The following case illustrates the value of blood glucose monitoring in patients with type 2 diabetes, depending upon the time, treatment, and stage of the disease.
A 56-year-old woman who is a clothing sales assistant presents with thirst, fatigue, and a vaginal yeast infection. She is 5 feet, 4 inches (163 cm) tall and weighs 265 lbs (120 kg). A random blood glucose value is 460 mg/dL (25.6 mmol/L), and her glycated hemoglobin (A1C) value is 11.4 percent. She eats a diet high in fat and refined carbohydrate, and she exercises little. She watches television for several hours nearly every evening, during which time she often eats two or three sugar-covered donuts.
Initial treatment — Appropriate initial management is to arrange for education about diabetes, in the form of written material, videos, and follow-up in an education and support group with other obese patients with type 2 diabetes; advise her to modify her eating habits (reducing caloric intake and eliminating refined carbohydrate) and encourage her to walk on a treadmill for at least 30 minutes at least five evenings a week at home. She should also be asked to measure fasting blood glucose every morning.
Her thirst, fatigue, and vaginal infection subside soon thereafter. During the next three weeks, her blood glucose values (in mg/dL and, in parentheses, mmol/L) during a typical week are as follows:
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