Diabetes And Drug Treatments Discussion Paper

Diabetes And Drug Treatments Discussion Paper

Three Objectives:

List three differential diagnoses based on the information provided

Formulate a treatment plan for the primary diagnosis

Provide educational and health promotion tips

Patient Information

Initials: Z.Z

Age: 66 years old

Gender: female

Race: African American

Historian: patient

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Subjective Data

Chief complaint (CC): Increasing tiredness, urination, thirst and hunger.”

History of Present Illness (HPI): The patient ZZ is a 66-year-old African American female who presents to the clinic with complaints of increasing tiredness, hunger, and thirst. She reports that she has been feeling like this for months and thought it was due to exhaustion from her volunteering work. She tries taking it slow, resting and sleeping more, but she still feels the same or even worst. Her son asked her to see the provider after she started having intermittent blurry vision two weeks ago; he thinks it might be something else going on. She denies chest pain, shortness of breath, palpitation, cough, weight loss and fever. Diabetes And Drug Treatments Discussion Paper

Allergies: No known food or drug allergies

Current medications:

Hydrochlorothiazide 12.5 mg daily

Lisinopril 10 mg daily

Atorvastatin 20mg daily

Past Medical History (PMH):

Childhood illnesses: No significant childhood illness

Adult illnesses: Hypertension, Hyperlipidemia

Immunization: Influenza 09/2021, Tdap booster 06/2018, Shingles 02/2019. Covid-19 booster 01/2022, Pneumococcal 08/2019

Surgeries: No past surgical history

Family Medical History

Father – deceased at 60yr had hypertension, stroke, and heart attack

Mother – Living – has hypertension and diabetes type 2

Son – alive and healthy

Social history:

Occupation – a retired teacher

Major hobbies – enjoys reading, watching TV and volunteering in church or soup kitchen

Family status – Divorced with one son who lives nearby.

Tobacco – never smoked or used an illicit drug

Alcohol use – one glass of red wine once or twice a week

Living environment – lives in a one-bedroom apartment

Exercise- once or twice a week

Diet –loves to eat out or order in

Review of Systems:

General: report tiredness, fatigue

HEENT;

Head: denies headache or dizziness.

Eyes: report intermittent blurry vision, denies pain or visual loss

Ears: denies hearing loss or difficulty, pain, or discharge.

Nose: denies runny nose, sneezing, nasal drainage, or nasal congestion

Throat: denies sore throat, dryness, and hoarseness

Cardiovascular: denies chest pain or palpitation

Respiratory: denies shortness of breath or difficulty breathing

Gastrointestinal: denies abdominal pain, diarrhea or constipation, nausea, and vomiting

Genitourinary: reports increased frequency and nocturia, denies dysuria, hematuria, or urine incontinence

Musculoskeletal: denies joint pain, swelling and stiffness

Skin: denies rash or itching. Diabetes And Drug Treatments Discussion Paper

Neurological system: denies tremors, seizures, vertigoThree Objectives:

Psychiatric: denies anxiety, depression, impaired concentration, and psychosis.

Endocrine: report increased thirst and hunger; denies heat or cold intolerance

Hematology: denies abnormal bleeding

Objective data

Vital signs: Temp: 36.2, HR: 80, BP: 135/76, RR: 18, O2 sat.97%, 0/10

Height: 70 inches, Weight: 190lbs, BMI: 27.3 kg/m2

Physical Examination:

General: the patient is pleasant and appropriate, well-groomed, and no acute distress noted

HEENT:

Head: Normocephalic

Eye: PERRLA, EOM’s intact and symmetric, the sclera is white, no discharge, peripheral vision grossly intact,

Ear: hearing grossly intact. canals clear with no cerumen, tympanic membranes intact, pearly gray, intact with light reflex

Nose: nasal mucosa reddened and moist without obvious drainage

Throat: oropharynx pink and moist

Neck: Supple, trachea midline

Respiratory: Symmetrical with respiration, lungs clear to auscultation, no rhonchi, stridor, wheezing, or crackles

Cardiovascular: the heart is normative at the 5th ICS. Normal sounds S1 and S2 are present without murmurs and pericardial rub. Peripheral arterial pulse is present and normal. There are no palpable bruits

Abdomen: soft, benign, non-tender, normal bowel sounds in all quadrants

Genitourinary: deferred

Rectal: deferred

Skin: no lesions or rashes.

Musculoskeletal: no joint pain and tenderness

Neurological: speech clear and coherent, alert and oriented to person, place, time and situation

Psychiatric: appropriate mood and affect. Maintained good eye contact throughout the interview and examination.

Diagnostic Testing and Results:

CBC- to rule out infection

CMP- to check blood sugar level

Glycated hemoglobin testing (A1C) – to assess the patient average blood sugar level in the past 3 months

Lipid panel – to check cholesterol and triglycerides levels

Thyroid-stimulating hormone (TSH) – to assess thyroid function

Random blood glucose test – to check blood sugar level

Urine Analysis (dipstick UA) – to rule out infection (UTI)

Results:

WBC – WNL

Glucose – 118 mg/dL (high)

A1C – 7.0 %

Total cholesterol – 205 mg/dL

LDL – 110 mg/dL
HDL – 100 mg/dL

TSH – 4.9 mIU/L

Glucose test – 200 mg/dL

UA – ++ Glucose 0.9 mmol/L; no leukocytes

Assessment

Primary diagnosis:

Type 2 diabetes E11.9- in this type of diabetes, the body does not make enough or use insulin well; that is, the pancreas does not produce enough insulin, or the cells are resistant to insulin, thereby taking in less sugar (Abrilla et al., 2021). It is considered adult-onset diabetes because it is more common in middle-aged and older adults. Its symptoms include tiredness, increased hunger or thirst, unplanned weight loss, frequent urination and blurred vision ( Abrilla et al., 2021). The risk factor includes being overweight or obese, lack of physical exercise, or having a family history of diabetes (Martenstyn et al., 2020). The patient is diabetic base on the labs above, especially the AIc, which indicates the average blood sugar level for three months. The patient has type two diabetes instead of type one because of her age (older), is overweight, has symptoms that appear gradually, and has a family history (Abrilla et al., 2021)Diabetes And Drug Treatments Discussion Paper.

Differential diagnosis:

Type 1 Diabetes mellitus E10.9: in type one diabetes, the body’s immune system destroys the cell that produces insulin, thereby preventing the pancreas from making insulin (Leslie et al., 2021). Its symptoms are similar to type 2 diabetes, which are increased thirst and urination, hunger, blurred vision, fatigue and unexplained weight loss (Sawyer et al., 2022). It is considered Juvenile diabetes because it is primarily diagnosed in children or teens (Sawyer et al., 2022). Its symptoms develop suddenly, but adults with type 1 diabetes have a longer symptomatic period than children and teens because their loss of insulin secretory capacity usually is less pronounced (Leslie et al., 2021). Though the presentations are the same, the patient is less likely to have type one diabetes due to her age, onset, and history.

Hyperthyroidism E05.0- in hyperthyroidism, the thyroid gland makes more thyroid hormones than the body needs. Excess thyroid hormone production speeds up the body’s metabolism leading to overactive function (Kravets, 2018). The symptoms of hyperthyroidism tend to come on slowly and vary from person to person; they include excess thirst or increased appetite, fatigue, and rapid or irregular heartbeat (Sharma et al., 2020). It is more common in women and patients older than 60 (Sharma et al., 2020). Hyperthyroidism symptoms are similar to other diseases like type 2 diabetes; therefore, tests like TSH must be done to confirm the diagnosis (Sharma et al., 2020). The patient’s TSH level is WNL, which refutes the hyperthyroidism diagnosis.

Plan

Consults:

Referred to a dietitian to help with diet

Referral to a certified diabetes educator for more information

Referred to an ophthalmologist for a yearly comprehensive eye examinations

Pharmacological management:

Prescribe Metformin 500 milligrams (mg) two times a day taken with the morning and evening meals. Side effects are nausea, abdominal pain, bloating or diarrhea

Prescribe Atorvastatin 40mg daily; take two 20mg pills or one 40mg

Non-pharmacological management;

Monitor blood glucose twice a day, morning and at bedtime, and keep daily logs for follow-up visits.

Do daily foot check to assess for any cuts, sores, blisters, or other changes to the skin or nails?

Engage in routine physical exercise at least three days per week; activities like brisk walking or riding a bike can help improve glucose levels in older people with diabetes.

Eat a smaller portion of a healthy diet that includes fruits, vegetables, whole grains, beans, nuts and seeds.

Do not skip a meal and monitor calorie intake.

Monitor for hypoglycemia’s signs and symptoms, including diaphoresis, tachycardia, shakiness, difficulty concentrating, slurred speech, and seizure.

The goal is to lose at least 10 lbs. in 6 months, which will result in better control of blood sugar levels. Diabetes And Drug Treatments Discussion Paper

Health Promotion:

Monitor A1C every three months

Annual physical and routine labs

Continue taking annual flu shot and any Covid-19 booster base on CDC recommendation

Follow CDC guidelines for Covid-19

Annual eye and dental exam

Follow up’;

Follow up in two weeks to assess response to treatment or sooner if needed

Schedule A1C lab in 3 months

Discussion questions

Which test is used to differentiate between type 1 and type 2 diabetes?

What other recommendations, treatments or teaching will you provide for the patients?

What are the complications of type 2 diabetes? Diabetes And Drug Treatments Discussion Paper

References

Abrilla, A. A., Pajes, A. N. N. I., & Jimeno, C. A. (2021). Metformin extended-release versus metformin immediate-release for adults with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. Diabetes Research and Clinical Practice, 178. https://doi.org/10.1016/j.diabres.2021.108824

Al-Dwaikat, T. N., Rababah, J. A., Al-Hammouri, M. M., & Chlebowy, D. O. (2021). Social support, self-efficacy, and psychological wellbeing of adults with type 2 diabetes. Western Journal of Nursing Research, 43(4), 288–297. https://doi.org/10.1177/0193945920921101

Kravets, I. (2018, March 1). Hyperthyroidism: diagnosis and treatment. American Family Physician, 93(5), 363.

Leslie, R. D., Evans-Molina, C., Freund-Brown, J., Buzzetti, R., Dabelea, D., Gillespie, K. M., Goland, R., Jones, A. G., Kacher, M., Phillips, L. S., Rolandsson, O., Wardian, J. L., & Dunne, J. L. (2021). Adult-Onset Type 1 Diabetes: Current Understanding and Challenges. Diabetes Care, 44(11), 2449–2456. https://doi.org/10.2337/dc21-0770

Martenstyn, J., King, M., & Rutherford, C. (2020). Impact of weight-loss interventions on patient-reported outcomes in overweight and obese adults with type 2 diabetes: A systematic review. Journal of Behavioral Medicine, 43(6), 873–891. https://doi.org/10.1007/s10865-020-00140-7

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Sawyer, B., Hilliard, E., Hackney, K. J., & Stastny, S. (2022). Barriers and Strategies for Type 1 Diabetes Management Among Emerging Adults: A Qualitative Study. Clinical Medicine Insights: Endocrinology & Diabetes, 1–10. https://doi.org/10.1177/11795514221098389

Sharma, S., Mudgal, S., & Mandal, A. (2020). Thyroid disease in older people: Nursing perspectives. Thyroid Research & Practice, 17(3), 110–117. https://doi.org/10.4103/trp.trp_25_20 Diabetes And Drug Treatments Discussion Paper