For the past 2 or 3 years, Donna has always had fasting blood sugar levels in the 100-120 mg/dL range. When she presents in your clinic however, her fasting blood sugar is 137 and her hemoglobin A1c is 8.3%. Donna is 58 years old, does not have a history of diabetes, has a height of 5'4" and weighs 165 lbs and she is on medication for hypertension. She says she has tried to lose weight many times in the past and often has success, but she always gains it back. She reports that she eats a "fairly healthy" diet but just loves to bake and often indulges in sweets. She does not know much about diabetes, except that it requires you to give yourself shots-and she hates needles!

1) What can you tell Donna about her diabetes status? What lab values helped you to determine that, and what are the relevant cut-points?

2) If Donna's hemoglobin A1c is 8.3%, what is her average blood sugar? How does that compare to her fasting blood sugar, and why is it different or similar?

3) Donna is so scared of needles that at any mention of diabetes, she immediately resists, saying, "Don't expect me to give myself a shot." What can you tell her about various diabetes treatments and the likelihood of her needing to give herself a shot?

4) Explain why Type 2 diabetes often shows up later in life and how it differs from Type 1 Diabetes. How do the treatments for the two diseases compare?

5) What lifestyle changes would you recommend for Donna? What dietary recommendations would you make? Explain why you decided to focus on the behaviors that you did.