Answer: Type 2 Diabetes Mellitus and Body Weight

All these symptoms are associated with type 2 diabetes (Kennon& Carty, 2015). BMI = Body weight in Kg / (Height in meter)2 Thus, BMI of Mr. The normal BMI range for an individual ranges from 18.5 Kg/M2 to around 25 Kg/M2. An individual can be considered to be obese if their BMI exceeds 30 Kg/M2. The person will be considered to be morbidly obese if their BMI exceeds 40 Kg/M2 (Jih et al

Running head: QUIZ ON CASE STUDY
QUIZ ON CASE STUDY
Name of the University:
Name of the Student:
Author Note:

1QUIZ ON CASE STUDY
Answer 1.
Mr. B has symptoms like polyuria, nocturia, polydipsia, lethargy along with
glycosuria and hyperglycaemia. All these symptoms are associated with type 2 diabetes
(Kennon& Carty, 2015). Hence, it can be decided that Mr. B has type 2 diabetes mellitus.
Answer 2.
BMI = Body weight in Kg / (Height in meter)2
Thus, BMI of Mr. B = 106 / (1.78)2 = 33.45 Kg/ M2
Answer 3.
The normal BMI range for an individual ranges from 18.5 Kg/M2 to around 25
Kg/M2. A BMI that exceeds 25 Kg/M2, can be considered as overweight or obese. An
individual can be considered to be obese if their BMI exceeds 30 Kg/M2. The person will be
considered to be morbidly obese if their BMI exceeds 40 Kg/M2 (Jih et al., 2014). Thus Mr. B
can be considered to be Obese, but not morbidly obese.
Answer 4.
The first factor to be considered is his excess weight. The risk of the associated
complications of diabetes and obesity is higher in his case (Korat, Willett & Hu, 2014).
The second factor can be his old age. The risk of morbidity is high at this age.
The third factor is his sedentary life style practice. He will face difficulties to adapt an
active life style.
The fourth factor is his choice to not to take medications for his diabetic condition,
which is necessary considering the type of his diabetes and his age (Korat, Willett & Hu,
2014).

2QUIZ ON CASE STUDY
Answer 5.
The first aspect to be considered is that Mr. B should be advised to consume complex
carbohydrate, which will not be responsible for an instant rise in the blood glucose level.
The second aspect is to describe a strict prohibition on the consumption of the food
with high sugar content, which might be responsible for an instant rise in the blood glucose
level.
The third one is to encourage the type 2 diabetic patient to encourage in consuming
protein based foods, which have negligible effects on the blood sugar.
The fourth guideline should be focused on the less consumption of fat. Even though
fat so not have a direct effect on the blood glucose level, it is responsible for a slower
consumption of glucose by the cells (Ley, Hamdy, Mohan, & Hu, 2014).
Answer 6.
1. The blood glucose level is supposed to be lowered moderately.
2. The insulin is supposed to work better in its activity.
3. His weight should be reduced.
4. His stress level should be lowered improving his mental health (Balducci et
al., 2014).
Answer 7.
The statement is true.
Answer 8.
Both of the readings of the fasting blood sugar and the post prandial blood sugar are
still abnormal and does not suggest any significant improvement in the condition of Mr. B.

3QUIZ ON CASE STUDY
Answer 9.
The statement is true.
Answer 10.
Metformin simply increases the sensitivity of the insulin and other organs of the body
to lower the blood glucose level(Diabetes.org. 2020). It should be the first line of treatment
for Mr. B, since the use of this medication does not involve further weight gain and the risk
of hypoglycaemia.
Answer 11.
The statement is false, because the diet of a healthy individual must contain animal
proteins and fat unlike diabetic individuals.
Answer 12.
The statement is true.
Answer 13.
The statement is partially true. Type 2 diabetes mellitus can be controlled by adapting
those measures (Asif, 2014). However, half of the people do not adapt to those measures in
order to control their diabetes.
Answer 14.
The statement is false. Gliclazide® belongs to the sulfonylurea class of drugs (Maggi,
Canobbio, Bruni, Musitelli& Conte, 2015).
Answer 15.
The statement is true. The use of Gliclazide® is associated with the side effect of
hypoglycaemia (Maggi, Canobbio, Bruni, Musitelli& Conte, 2015).

4QUIZ ON CASE STUDY
Answer 16.
The side effects of Gliclazide® include diarrhoea, stomach ache, indigestion and
constipation, which can be considered as gastrointestinal side effects (Maggi, Canobbio,
Bruni, Musitelli& Conte, 2015).
Answer 17.
The statement is true.
Answer 18.
1. The signs and symptoms of hyperglycaemia and hypoglycaemia.
a. Hyperglycaemia symptoms include feeling extremely thirsty, frequent
urge to urinate, blurry vision along with the feeling of fatigue.
b. Hypoglycaemia symptoms include dizziness, confusion, fatigue and
even fainting (Morales & Schneider, 2014).
2. Maintenance of proper diet and nutrition plan.
a. Her diet must consist of complex carbohydrates and proteins and must
be excluded of the food with high sugar or fat content (Tay et al.,
2014).
b. This is to lower the risk of hyperglycaemia or further progression of
the disease condition in her.
3. Proper monitoring of the blood sugar level.
a. By this teaching she can keep track of the success of her treatment plan
(Ong, Chua & Ng, 2014).
b. Upon detection of the high blood glucose level, she must refer back to
her physician immediately.
4. Regular exercise.

5QUIZ ON CASE STUDY
a. Exercising will keep her from gaining weight and developing obesity,
which is a common co-morbid condition associated with the diabetic
condition.
b. This will also help her in keeping her stress level low (Magee,
Khan,Desale&Nassar, 2014).
Answer 19.
The statement is true.
Answer 20.
The experience of Mrs. Smith can be associated with the symptoms of hypoglycaemia
or low blood sugar level in body (Morales & Schneider, 2014). This incident is common for
the normal individuals. However, in case of a diabetic patient, who is already receiving a
treatment, should be tested for this fluctuation in their blood glucose level (Basu, Johnson,
Kudva & Basu, 2014).
Answer 21.
The statement is true.
Answer 22.
Mrs. Smith was experiencing the symptoms of hypoglycaemia only after her walk,
thus after exercising only. Her symptoms settled after consuming some food. Thus it can be
deduced that she was experiencing post-exercise ‘hypos’(Morales & Schneider, 2014).
Answer 23.
The statement is false.
Answer 24.

6QUIZ ON CASE STUDY
Mrs. Smith had her blood sugar lowered to an acceptable level successfully.
Additionally she is even experiencing hypoglycaemia symptoms after exercising. Thus it can
be decided that the current dose of Gliclazide® is working effectively for her (Clemens et al.,
2015). Further increase in the dose will increase the risk of her developing severe
hypoglycaemic condition.
Answer 25.
The statement is false.
Answer 26.
Gliclazide® help in lowering the blood glucose level in patient. A higher dose of this
medication will increase the risk of developing a severe hypoglycaemic condition in a
diabetic patient instead of lowering the risk of it(Clemens et al., 2015).
Answer 27.
The statement is true.
Answer 28.
Hypoglycaemic condition is associated with various severe outcome in the diabetic
patients, such as stroke or diabetic coma condition. The patients who are receiving insulin
treatment are at high risk of developing these conditions(Morales & Schneider, 2014). Thus
the interventions mentioned in the statement is important for Billy to follow in order to lower
the mortal risk.
Answer 29.
The statement is true.
Answer 30.

7QUIZ ON CASE STUDY
Sweetened cordial or jelly beans have high sugar content. Consuming them in a small
amount will be effective in treating the hypoglycaemic condition, since the food will be able
to restore the deficiency of glucose in blood instantly. This will lower the risk of further
complications that are associated with this disease condition (Morales & Schneider, 2014).
Answer 31.
1. Billy must follow a proper dietary plan and should not be skipping any of his
meals.
2. He should be very careful during self-administration of insulin, ensuring the
doses.
3. In case there is frequent phenomenon of him experiencing hypoglycaemia, he
must consult with his DE at the earliest opportunity.
Answer 32.
The statement is false.
Answer 33.
The hypoglycaemic condition is associated with excessively low glucose level in the
blood. If the situation is not restored to normal at the earliest opportunity, the condition might
lead to stroke, which results from the fact that the glucose supply is not enough for the proper
functioning of the brain. Thus if an individual is experiencing the symptoms, they must
address the situation immediately in order to prevent further progression of the condition,
which can be the diabetic coma or even death(Morales & Schneider, 2014).
Answer 34.
The statement is true.
Answer 35.

8QUIZ ON CASE STUDY
The development of hypoglycaemia while driving is associated with the phenomena
like blurred vision of the driver, feeling dizzy and even fainting. All these might lead to a
severe road accident, which might claim multiple lives including the driver. Thus if Billy
experiences a severe ‘hypo’, while driving, the authorities will consider him physically unfit
for driving(Vicroads.vic.gov.au, 2020).
Answer 36.
Billy should immediately stop the vehicle and cease driving. After that he should
consume glucose tablets or other sugary food to restore his blood glucose level. He should
not resume driving until he is completely sure that all the symptoms of hypoglycaemia has
passed(Vicroads.vic.gov.au, 2020).
Answer 37.
If the patient has type 2 diabetes the initial dose for him or her will be 0.2 unit/kg of
body weight, which can be considered as a safe dose.
Answer 38.
Insulin Glargine is a long-acting insulin drug, which has been found to be effective in
lowering the fasting blood sugar in the diabetic individuals along with lowering the instances
of those patients developing nocturnal hypoglycaemic events, if it is administered before bed
time. Long acting insulin work slower and maintain the blood sugar level within a normal
range. Thus it is safe to use with or without consuming a meal (Diabetes.org., 2020).
Answer 39.
The rapid acting insulins are mainly given to the patients with type 1 diabetes
mellitus. The drugs are given mainly with the meal. The drugs help in using up the glucose in
the meal. The drugs can also be used in case of hyperglycaemia. These drugs are effective in

9QUIZ ON CASE STUDY
lowering the blood glucose level within a very short period of time (Diabetes.org., 2020).
Thus in case of hyperglycaemia, these drugs will be effective in fast restoration of the blood
glucose level.
Answer 40.
Bruising or formation of lumps on their abdomen might be resulting from the
lipohypertrophy condition, which is common phenomenon for the patients who are receiving
the insulin treatment. To avoid these a patient must keep changing the site of the injection
and he/ she should also use a new needle during every injection (Ji et al., 2017).
Answer 41.
The statement is true.
Answer 42.
Mainly the 45 degree angle is used for the longer needles, such as 5mm or 6mm long
needles, in order to avoid the intramuscular injection. However, a study on the Korean
patients found that the administration of insulin using 4mm needles and in 45 degree angle to
be appropriate (Sim et al., 2014).
Answer 43.
The statement is true.
Answer 44.
The site of injecting the insulin should be changed with every injection in order to
avoid the instances like lipohypertrophy or lipoatrophy(Ji et al., 2017). The rotation of
injecting site every time will also give the body some time to heal the previous site of
injection.

10QUIZ ON CASE STUDY
Answer 45.
Diabetes can be considered as a co-morbid condition that is associated with angina
(Page et al., 2015). The treatment plans and procedures for the different types of diabetes is
different (Dinesh, Kulkarni & Gangadhar, 2016). Thus it is a necessity to know the type of
diabetes Mr. Dunning have in order to develop a proper treatment plan for him.
Answer 46.
The question b, "How old were you when you were diagnosed with diabetes?" will be
the best choice (Zoungas et al., 2014).
Answer 47.
The type of diabetes should considered firstly. In case of type 1 diabetes, the patient
should be checking the blood glucose level about 4-10 times in a day(van Beers et al.,
2016).After that the daily routine of Mr. Dunning should also be considered, such as his
exercise time or the time of his meals.
Answer 48.
The answer a is can be considered to be most appropriate, which says that a HbA1c
test measures the blood glucose during the past 24 hours.
Answer 49.
In case of a diabetic patient, if it is found that the blood glucose level in the patient is
getting lowered moderately, without him or her developing frequent hyperglycaemic or
hypoglycaemic conditions, after they are advised with the diabetes self-management
guidelines, they can be considered to be efficient in self-care (Dehghan et al., 2017). The
assessment should be performed on the patient on a weekly basis.

11QUIZ ON CASE STUDY
Answer 50.
The health professionals might perform some physical assessments, such as BMI
assessment, Blood pressure assessment or the mental health assessments, such as anxiety
assessment, depression assessment. An individual with a high BMI, high blood pressure and
high level of anxiety can be considered to be at high risk of developing diabetes mellitus. The
individuals with a family history of the disease can be counted in the same category (Kerner,
& Brückel, 2014).
Answer 51.
1. His blood sugar level as per his last test. If the reading is too high and might
lead to hyperglycaemia, he will be requiring an immediate appointment and if
his blood sugar is slightly higher than normal, he will not require it (Maybin,
Charles & Honeyman, 2016).
2. The type of his diabetes. Type 2 diabetes can be managed without medications
and by introducing simple life-style changes initially. However, in case of
type-1 diabetes he requires immediate medicinal help (Maybin, Charles &
Honeyman, 2016).
3. If he is already receiving a treatment or not. If Mr.Livington is already
prescribed with a treatment plan and just asking for a second opinion, he does
not require an immediate appointment (Maybin, Charles & Honeyman, 2016).
4. Whether he is aware of diabetes self-management guidelines or not. If he does
not know the guidelines, he requires an earlier appointment (Dehghan et al.,
2017).
5. The severity of his symptoms, such as whether he is having polyuria or
experiencing severe fatigue or other severe symptoms. The more severe his

12QUIZ ON CASE STUDY
symptoms are he will be requiring an earlier appointment (Maybin, Charles &
Honeyman, 2016).
Answer 52.
Diabetes presents a high risk of kidney damage, visual impairment, and
cardiovascular diseases along with Alzheimer ’s disease (Marventano et al.,2014).
Answer 53.
1. High blood pressure;
2. Impaired vision or eye problems;
3. Depression;
4. Risk of stroke (Marventano et al., 2014).
Answer 54.
The statement is true.
Answer 55.
The type 2 diabetes mellitus is associated with a high blood sugar level, which in turn
is associated with impaired blood circulation. The development of the foot ulcers are
common in the patients with type 2 diabetes. Thus the patients require an immediate foot
assessment after their diagnosis.
Answer 56.
The statement is true.
Answer 57.
The type 2 diabetes mellitus is associated with a high blood sugar level, which in turn
is associated with impaired blood circulation. The impaired vision are a resulting event of

13QUIZ ON CASE STUDY
that phenomenon. Thus the eye damage is also associated with type 2 diabetes mellitus
condition in the diabetic individuals and they should be referred for an eye examination post-
diagnosis (Lee, Wong, & Sabanayagam, 2015).
Answer 58.
The statement is true.
Answer 59.
The people with type 1 diabetes have high risk of developing retinopathy.
Retinopathy is a disease condition that leads to blindness (Lee, Wong & Sabanayagam,
2015). Thus the patients with type 1 diabetes mellitus require a referral for eye examination
after their diagnosis.
Answer 60.
Diabetic retinopathy is a disease condition, where the blood vessels present in the
photo-sensitive tissues of retina at the back of the eye are damaged by the high blood glucose
level. The situation can lead to blindness (Lee, Wong & Sabanayagam, 2015).
To prevent this condition, the blood sugar level should be kept in control. There
should be a regular eye examination to track whether or not there is a development of this
condition.
Answer 62.
Diaformin®is a first line treatment for diabetes and it is given to the patients with less
severe conditions. Thus the individuals do not require frequent blood sugar assessments as
the individuals who are taking Glibenclamide®. Glibenclamide® is a second line of
treatment and is given to the people with more complicated conditions.

14QUIZ ON CASE STUDY
Answer 63.
The answer is, b. Gastrointestinal upset.
Answer 64.
The possible causes of hypoglycaemia in a type 1 diabetic patient can be, Missed or
delayed meals/ snacks; Increased exercise; Too much insulin.
Answer 65.
A hypoglycaemia kit should include,
1. Food that have a high sugar content like jelly beans, chocolate bars or sugary drinks;
2. Glucose tablets;
3. Essential contact numbers, such as numbers of the next kin and the number of the
physician or nurse;
4. Record book for blood glucose incidents (Morales & Schneider, 2014).
Answer 66.
A hospital setting must have the facility to administer carbohydrates intravenously
and also to measure the blood glucose level of the patient accurately and in short intervals in
order to treat an unconscious hypoglycaemia patient (Morales & Schneider, 2014).
Answer 67.
After the administration of a single dose of glucagon, one should wait for at least 15
minutes before administering the second dose. The glucagon start working within 8-15
minutes.
Answer 68.

15QUIZ ON CASE STUDY
Large amount of beer or alcohol increases the efficacy of insulin, which leads to an
excessively low blood glucose level or hypoglycaemic condition (Steiner, Crowell & Lang,
2015).
Answer 69.
1. Glimepiride® (Home et al., 2015)
2. Repaglinide® (Ma et al., 2014).
Answer 70.
The oral hypoglycaemic agents must be taken with the meals. If the meal is skipped,
the dosage should be skipped as well. The prescribed dose of the medication should be
consumed only (Ganesan & Sultan, 2019).
Answer 71.
Carbohydrate solution should be administered through the PEG tube to treat
hypoglycaemia (Yoon & Morishita, 2016).
Answer 72.
1. Yoghurt drinks;
2. Carrot juice;
3. Apple juice (Potter et al., 2011).

16QUIZ ON CASE STUDY
Answer 73.
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17QUIZ ON CASE STUDY
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18QUIZ ON CASE STUDY
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19QUIZ ON CASE STUDY
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20QUIZ ON CASE STUDY
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21QUIZ ON CASE STUDY
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