Question: A 60 Y.o. Female Patient Who Was Diagnosed With Type 2 Diabetes 4 Years Ago Has Just Been Prescribed With Multiple Dose Insulin Injection In Addition To The Metformin That She Has Been Taking Since Her Diagnosis To Aid Her Glucose Management. She Said That She Thought That Insulin Was Only For Type 1 Diabetes, She Didn’t Understand Why She Would Need …

A 60 y.o. female patient who was diagnosed with type 2 diabetes4 years ago has just been prescribed with multiple dose insulininjection in addition to the metformin that she has been takingsince her diagnosis to aid her glucose management. She said thatshe thought that insulin was only for type 1 diabetes, she didn’tunderstand why she would need insulin. She also complained that shewas not able to read the numbers on the insulin pen, as her visionwas getting worse these years. She said that she loved fruits andsweets, now that her diabetes was getting worse, she was determinedto avoid all of them. Height: 5’3”, Weight: 170 lbs

1. The patient said that “she thought that insulin was only fortype 1 diabetes, she didn’t understand why she would need insulin.”Explain to the patient how insulin levels, insulin resistance, andblood glucose levels change in the process of type 2 diabetesdevelopment and progression (8 pts).

2. One of the reasons that she was not able to see clearly wasrelated to her diabetes. Briefly describe the mechanism by whichdiabetes may impair vision (7 pts).

3. Should she avoid fruits and sweets? What alternative advicewould you give her? (6 pts)

4. Set up a daily calorie intake goal and briefly justify it,then determine and calculate the macronutrient distribution (% kcaland grams of macronutrients). (8 pts)

5. The patient said that she ate the following items last night.(1) fill out grams of carbohydrate. (2) If her insulin to carbratio is 1:15, how many units of insulin does she need? (6 pts)