Introduction

Diabetes mellitus (DM) is an endocrine disorder associated with the inability to control blood glucose. Moreover, DM is a chronic metabolic derangement characterized by hyperglycemic states. We have diabetes type 1 and 2, gestational and pediatric diabetes (Robinson & Woo, 2015). Without effective management, diabetes can complicate neuropathies and vascular diseases that might lead to amputation of limbs. Management involves both pharmacological and non-pharmacological modalities. Pharmacological management consists of insulin and other oral glycemic control gents (Robinson & Woo, 2015). on the other hand, Non-pharmacological agent involves physical exercise to control weight and nutritional management for blood sugar control.

Rosa’s specific goals for the treatment

The main treatment objective for Rosa is to achieve or maintain a targeted

HbA1C less than 7.0% (Robinson & Woo, 2015).

Blood pressure of less than 140/90 mmHg (Robinson & Woo, 2015).

LDL lipids level of less than 100 mg/dL (Robinson & Woo, 2015).

HDL lipids level of not more than 50 mg per dL (Robinson & Woo, 2015).

Triglycerides lipids level of not more excellent 150 mg per dL (Robinson & Woo, 2015). Endocrine Diabetes Mellitus Case Study

All the above management objective is essential in preventing diabetes symptoms and complications.

Dietary and lifestyle modifications recommend for Rosa.

I would encourage Rosa to regulate caloric intake and properly space out meals and snacks. Highly processed sugar and fat should be avoided as well as alcohol. I would advise eating healthier foods and sticking with regular meal times (Robinson & Woo, 2015). I would recommend a diet rich in nutrients and low in fat and calories. I would also encourage Improving intake of fruits, vegetables, and whole grains while watching portion sizes according to her level of activity (Sapra & Bhandari, 2021). I can recommend evaluation by a dietitian and physical therapist if the patient feels the goals are challenging to attain by herself.

Rosa should increase physical activity and exercise since the goal is to teach Rosa to achieve a healthier eating plan to control her blood glucose and promote growing daily or weekly physical activity (Robinson & Woo, 2015). I recommend Physical exercise such as walking and jogging for at least 30min, for at least 3 days three days a week.

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Drug prescribed and the rational

If diet and physical exercise fail to control blood glucose levels, biguanides (Metformin) will be the drug of choice for Rosa (Sapra & Bhandari, 2021). I would incorporate Metformin in nutritional management and physical exercise therapy for maximum glycemic control. Metformin is not thought to cause hypoglycemia nor promote hyperinsulinemia or weight gain (Sapra & Bhandari, 2021). Again, Metformin promotes favorable effects on lipid profiles and includes a tendency to induce weight loss. Moreover, Biguanides show the best health outcomes for overweight patients younger than 60 (Sapra & Bhandari, 2021). Also, it may suppress appetite, inducing mild weight loss. It improves FPG, PG, and triglycerides. And it could be given as a once-daily dose facilitating patient compliance.

The goals for the FPG, Postprandial glucose and HbA1C

The specific objectives of:

Fasting Plasma Glucose is an FPG of less than 6.5% mg/ dL (Robinson & Woo, 2015)

Hemoglobin A1C level should be no more than 6.5% (Robinson & Woo, 2015)

A postprandial glucose level of not more than 180 mg per dL (Robinson & Woo, 2015)

Specific patient education for Rosa based on the prescribed treatment.

I would educate Rosa on the common side effects of Metformin. For example, be aware of side effects such as nausea, abdominal pain, tachycardia, and hypotension (Robinson & Woo, 2015). Again, I would initially inform her of the need A1c test at least every 3 months to assess the level of glucose control and the effectiveness of other treatments (Sapra & Bhandari, 2021). I would educate her on the need for additional tests like electrolytes, Serum creatinine, ketones, and blood glucose to assess the disease process, especially if symptoms persist (Wadde, 2017). If going for a procedure involving iodine contrast, Metformin should be stopped the day of the study and resumed no sooner than 48 hours after testing or when the renal function returns to baseline (Wadde, 2017). Also, that once-a-day dose contributes to compliance. Despite hypoglycemia not being listed as a side effect of Metformin, I would teach Rosa the signs and symptoms of hypoglycemia. Hence, she’s aware and actions to follow if feeling any of them.

Adverse reactions associated with the selected therapy.

I would consider changing Metformin as an alternative if signs and symptoms of lactic acidosis are developed, such as abdominal pain, diarrhea, weakness or increasing tiredness, and shallow breathing if uncontrollable diarrhea persists after 2 weeks of treatment (Wadde, 2017).

The following line of therapy if HbA1C is 8.8% after 3 months on the prescribed therapy

If the A1c is still 8.8% after 3 months, I would first acknowledge an improvement in the A1c overall and encourage the patient to keep up the excellent work with the treatment. I could recommend adding a second-generation sulfonylurea, depending on the FPG levels (Sapra & Bhandari, 2021). I would choose a small dose of long-acting glipizide because it reduces A1c by 1.1 to 1.9% and a small quantity to prevent hypoglycemic events; if necessary, the dose can be increased later (Wadde, 2017). Endocrine Diabetes Mellitus Case Study

Appropriate over-the-counter /herbal medicines for Rosa

Rosa could benefit from using herbal medicines such as American ginseng, ginger, and garlic because they are natural products that may lower blood glucose levels (Sapra & Bhandari, 2021). Again, a supplement of cinnamon can regulate blood glucose in type 2 diabetes by reducing blood glucose and improving lipid profile (Sapra & Bhandari, 2021).

Examples of selected drug interactions with other drugs or foods.

Drug-to-drug interactions with Metformin are in combination with therapeutic agents, and they can result in hypoglycemia. However, Bitter melon, fenugreek, and St. John’s wort should be avoided because of the variable effects on blood glucose levels (Wadde, 2017). It is recommended that patients Stop Metformin on the day of a procedure with iodine contrast and restart treatment no sooner than 48 hours after the process (Sapra & Bhandari, 2021).

Conclusion

Diabetes, just like other lifestyle diseases, needs a well-crafted management strategy to ensure serious complications are prevented. Patient-physician coordination is paramount for the effective management of diabetes. Lifestyle and nutritional modification are as crucial as pharmacological management. Patient education is critical to avoid disease progression and the development of complications.

References

Robinson, M., & Woo, T. (2015). Chapter 19: Drugs Affecting the Endocrine System: Pituitary, Thyroid, and Adrenal Drugs. In Pharmacotherapeutics for Advanced Practice Nurse Prescribers. F.A. Davis Company.

Robinson, M., & Woo, T. (2015). Chapter 35: Diabetes Mellitus. In Pharmacotherapeutics for Advanced Practice Nurse Prescribers. F.A. Davis Company.

Robinson, M., & Woo, T. (2015). Chapter 18: Drugs Affecting the Endocrine System: Pancreatic Hormones and Antidiabetic Drugs. In Pharmacotherapeutics for Advanced Practice Nurse Prescribers. F.A. Davis Company.

Wadde, J. (2017). An update on type 2 diabetes management in primary care. Wolters Kluwer Health, Inc.  Endocrine Diabetes Mellitus Case Study