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Typist_4582168
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History:
She was diagnosed with T1D at the age of 19.
She is currently on multiple daily injections (MDI).
Reports worsening hyperglycemia, primarily in the late luteal phase (starting 5–7 days prior to menses), with morning fasting glucose values consistently between 240–280 mg/dL for the past 4 days.
She denies any nighttime snacking or changes in dietary intake.
She denies missing any insulin injections or site rotation issues.
She does not report any recent fever, upper respiratory, or urinary symptoms.
Social History:
She follows a balanced diet with consistent adherence to ADA-recommended carbohydrate counting.
She reports no changes in her physical activity levels, maintaining a light exercise routine (30-minute daily walks).
She denies smoking, alcohol, or illicit substance use.
Review of Systems:
Denies any nausea, vomiting, or diarrhea.
Denies any abdominal pain, dysuria, frequency, or polyuria.
All other systems are pertinent negative for acute infectious or systemic symptoms.
Physical Examination:
Vital signs: BP 118/74 mmHg, HR 72 bpm, RR 14/min, Temp 36.6°C (97.9°F).
Cardiovascular: Normal S1/S2, regular rate and rhythm, no murmurs.
Abdomen: Soft, non-tender, non-distended, no organomegaly or CVA tenderness.
Skin: Lipohypertrophy absent at injection sites (abdomen, thighs).
Examination of all other systems is negative for abnormal findings.
Diagnostic Lab Studies:
Urine Ketones: Trace
Serum Glucose: 265 mg/dL (elevated)
Serum Bicarbonate: 24 mEq/L (normal anion gap)
Past Medical History:
LMP was 24 days ago, with a predictable 28-day cycle length (placing her in the late luteal phase).
Type 1 Diabetes: A1c 8.1%; taking 22 units of glargine at bedtime and lispro with meals at a carbohydrate ratio (CR) of 1:12.
No new prescription or over-the-counter medications.
Case Resolution:
The patient was diagnosed with catamenial (menstrual cycle-related) hyperglycemia secondary to late-luteal phase progesterone-mediated insulin resistance. Her basal insulin dose was increased by 20% (to 26 units) starting 7 days prior to expected menses, and her insulin-to-carbohydrate ratio was adjusted from 1:12 to 1:9 during this period. She was instructed to revert to her baseline regimen (22 units basal, 1:12 CR) on Day 1 of menses.
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টেক্সট প্র্যাকটিস - সময় 1050 - English
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