You work in the diabetes mellitus (DM) center at a large teaching hospital. The first patient you meet is K.W., a 25-year-old Hispanic woman, who was just released from the hospital 2 days ago after being diagnosed with type I DM. Nine days ago K.W. went to see the physician after a 1-month history of frequent urination, thirst, severe fatigue, blurred vision, and some burning and tingling in her feet. She attributed those symptoms to working long hours at the computer. Her random glucose level was 410mg/dL. The next day her laboratory values were as follows: fasting glucose 335mg/dL, hemoglobin A1c (HbA1c) 8.8%, cholesterol 310mg/dL, triglycerides 300mg/dL, high-density lipoprotein (HDL) 25mg/dL, low-density lipoprotein (LDL) 160mg/dL, ratio 12.4, and creatinine 0.9mg/dL. Her body mass index is 37.6. Her blood pressure (BP) is 160/96mm Hg. She was admitted to the hospital for control of her glucose levels and the initiation of insulin therapy with carbohydrate (CHO) counting. After discharge, K.W. has been referred to you for comprehensive education. You are to cover four basic areas: pharmacotherapy, glucose monitoring, medical nutrition therapy (MNT), and exercise.

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W. was started on sliding scale lispro (Humalog) four times daily and glargine (Lantus) insulin 30 units at bedtime.

1.What is the most significant difference between these two insulins?

2.W. says she knows people who “only take 2 shots” because they are on NPH and regular insulin and wants to know why she can’t do that. Explain the advantages of using the glargine (Lantus) and lispro (Humalog) insulin regimen.

Identify important content to review regarding glucose monitoring

W. states her diet is mostly fast foods, and the foods cooked at home are high in starch and fat. She says because of her work schedule; mealtimes often vary from day to day. What is CHO (carbohydrate) counting, and why would this method work well for K.W?
Identify important points to be covered in a basic nutrition plan with CHO counting?

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