Patient Summary:
Fatma is 22 yo study at Gulf university, and lives with her parents. She Dx with T1DM at 8 yrs.
of age, since her Dx she fixed with his insulin medication (MDI), not adjusted according to food
eaten diet. She has not attended specialist diabetes or dietetic services for several years. Fatma is
worried of developing diabetes complications later in life, mainly with her high HbA1c recorded
6 months ago.
Chief complaint: Her Friend states that Fatma had not been feeling well at college the previous
day. She thought she was fighting off a virus. Fatma had noticed increased thirst and increased
frequency in urination. When she didn't come to the class at the next day or answer her cell phone,
her friend went to check on her and called her mother and found that Fatma was almost
unconscious and transported to Jaber Hospital with sever hyperglycemia.
During examination, she appeared pale, dehydrated with dry mucous membranes, and poor skin
turgor, tachycardia, hypotension, with acetone breath. She was treated with insulin and saline I.V.
Sixteen hrs. later, she was active, alert, well hydrated and cheerful, indicating she felt well. Her
physician decided to stop IV and switch his insulin to subcutaneous injections and to start a fluid
diet. She was later put on a diabetes diet with 3 injections of Apidra insulin, (8) U Breakfast, (10)
U Lunch, and (6) U Dinner, and a bedtime on Toujeo (20) U/daily.
Anthropometric data: CWT.: 48 kg Ht.: 168 cm UBW: 68 kg (6 months ago)
Laboratory on admission
Chemistry
Glucose 600 (mg/dL) 33 (mmol/L)
HbA1C (%) 15
Na (mEq/L) 130
Osmolality (mmol/kg/H2O) 322
Urinalysis
PH 4.5
Protein +1
Glucose +3
Ketones +2
Diet History:
Usual intake for past several months:
• BF: 1 slices of toast with 2 Tbsp Jam & 2
Tbsp peanut butter, 1 boiled egg with
medium avocado (approx. 2 Tbsp), and 1
cup fresh orange juice.
• Lunch: Subway sandwich, chips, 1 large soft
drink (Coca cola)
• Snack: ice-cream, or crackers
• Dinner: Usually cooks pasta, vegetables, and
some type of meat.
• Eats out Fast Food restaurant 3-4 times per
week at dinner.
