A 50-year-old woman with an 8-year history of diabetes mellitus presents with difficulty controlling her blood sugars for the past 2 weeks. Her self-monitoring blood glucose readings have been in the 200s–300s for 2 weeks. She has managed her type 2 DM with diet, exercise, and metformin 1,000 mg twice a day. Her last glycosylated hemoglobin (HgbA1c) level, which was measured 2 months ago, was 6.8%. She has had asthma since age 18. She felt her asthma was getting worse for the past 6 months as she was having increased dyspnea and dry cough. She has managed her asthma with a daily combined long-acting beta-2 adrenergic agonist, an inhaled corticosteroid, and montelukast. She also uses her short-acting beta-2 adrenergic agonist, albuterol, about once a day. She went to her pulmonologist about 2 months ago and was diagnosed with severe asthma. A decision was made to start her on oral prednisone (corticosteroid). The first month she took 5 mg a day with some relief, but the symptoms returned, so her prednisone dose was increased to 10 mg a day. She has been taking the 10 mg dose for 3 weeks. She says her breathing is better, but she feels increasingly tired and like she is gaining weight. Physical examination reveals an anxious woman with blood pressure of 144/92 mmHg; pulse of 90 beats per minute; respirations 20 per minute; and weight of 190 pounds. She is talking in full sentences. Lung sounds are clear bilaterally. No accessory muscles are being used. No cyanosis is present. Answer the following questions.
1. Though this item involves pharmacology, it is still important. Which is the most likely cause of this patient’s loss of glucose control? Inhaled corticosteroid Prednisone therapy Asthma exacerbation Albuterol
2. All of the following actions are important for this patient to learn regarding glucocorticoid therapy, but which is the most important? Monitor cuts for healing Take the medication with food Do not stop taking the medication abruptly Contact her healthcare provider if she has any manifestations of infection
3. Which endocrine condition is this patient at risk of developing? Hyperthyroidism Pheochromocytoma Addison disease Cushing syndrome
4. Given this patient’s acute loss of glucose control, which of the following interventions would be ordered for this patient? Insulin as needed per routine sliding scale (dosing based on blood glucose levels) Increase exercise Decrease caloric intake Decrease prednisone dose Elaborate, number each answer, and cite appropriately.
