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Case Study: Whose Diabetes Is It Anyway? Diabetes Self-Management After a Stroke

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	Presentation

 
H.S. is a 55-year-old woman who has had type 1 diabetes since age 36 years. Except for retinal microaneurysms, she has no microvascular diabetes complications. She has statin-treated hyperlipidemia, mild peripheral vascular disease, and mild carotid artery stenosis. She has no history of hypertension. Her family history is positive for cardiovascular disease, including a father, uncle, and brother who died of myocardial infarctions in their 50s. She is a former smoker, having quit about 5 years ago. Her husband smokes two packs per day.

H.S. had a syncopal episode, fell, and lost consciousness in autumn 2003. She was found by her husband, who contacted paramedics. Blood glucose measured by the paramedics was 42 mg/dl. She was given glucose tablets. She complained of neck pain and so was transported to a hospital, where X-rays and a computed tomography scan of the neck revealed multiple cervical spine fractures that required surgical intervention. During surgery, she suffered a large, right-sided stroke.

After nearly 4 months of hospitalization and inpatient rehabilitation, she was able to return home. She has persistent motor deficits on her left side. She is able to walk with a cane but has no useful motor function in the left hand or arm. Her speech is accurate but slow, and her affect is somewhat flat. She reports that she sometimes forgets recent events and occasionally has difficulty with sequencing tasks. As a result of the stroke and her persistent deficits, she elected to retire from her job as a records department manager in a local government office. Her husband also left his job in order to provide full-time assistance to her.

H.S.'s diabetes management routine before her stroke consisted of two shots daily of mixed NPH and rapid-acting insulin. She checked her blood glucose levels twice daily and more often if . . . [Full Text of this Article]

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	Clinical Pearls

 

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