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Case Study - Diabetes Mellitus - Coggle Diagram
Case Study - Diabetes Mellitus
Problem Identification
Patient is diagnosed and identified to be having Type 2 Diabetes Mellitus at the beginning stage with a slightly above normal range blood glucose level, 7.85 mmol/L.
Patient have other medical history such as hypertension with a reading 140/92 mmHg which is also a borderline level and moderate obesity contribute to DM Type 2
She may prone to get coronary artery disease
Desired outcome of patient
Goals of Treatment
To prevent tissue damage caused by too much sugar in the blood stream.
To get reduction in body weight and get normal BMI reading.
To keep the blood sugar as normal as possible without serious high or low blood sugars
From borderline hypertension to within range and control blood pressure.
Outcome of overall treatment
Patient is expected to have a lower blood glucose level which is the outcome of DM Type 2 medication therapy.
Reduction in weight at normal BMI with the follow up on advises from dietitian or fitness coach
Lesser reading of hypertension and within normal range.
Minimal symptom of getting coronary artery disease.
Disappearance of external symptoms such as acanthosis nigrican on skin.
Prevention to enhance goal of treatment
Patient need to maintain healthy lifestyle to prevent this disease with actively do exercise or other type of fitness activity.
Proper consumption of diet plan with low calorie and fat to manage weight
Daily activity to enhance active body and control hypertension as well as moderate obesity to normal BMI.
Take artificial sugar if necessary, reduce eating outside and cook healthy food green vegetables at home
Optimal plan for patient
Hypertension is to be detected and treated early in course of Diabetes Mellitus.
Treatment is initiated in patients with blood pressure is exceeding 130mmHg systolic and 80 mmHg diastolic
Pharmacological management
ACE inhibitors are drugs of choice.
ARBs are superior to conventional non-ACE inhibitor hypertensive.
ACE inhibitors / ARBs help patients with diabetes
Non Pharmacological management
Diet counseling
Moderate dietary sodium restriction
Pharmacological treatment for patient
Insulin therapy
Combining insulin and the following OAD agents has been shown to be effective in T2DM
If targets have not been reached after optimal OAD therapy
Dose of the insulin can be increased every third or fourth day (2-4 units each time) until target FPG is achieved. ‘fix the fasting first’.
If HbA1c target is not achieved in 3- 6 months, intensify insulin regime by adding prandial insulin with the biggest meal initially or adding premixed insulin at breakfast
Types of Insulin Regimes
Metformin + premixed insulin more than once a day
Metformin + basal insulin + prandial insulin
OAD agents + basal insulin or premixed insulin once a day
Intensive insulin therapy
Intensive insulin therapy is a treatment approach designed to keep your blood sugar levels closer to the levels of someone who doesn't have diabetes
Newer methods of blood sugar monitoring and insulin delivery may make it easier and safer to maintain more normal blood sugar levels
Monitoring Parameters
Fasting plasma glucose test
The patient will have their blood drawn for the test
Requires fasting
Then, the plasma is combined with other substances to determine the amount of glucose in body
Unit : mg / dL
Oral glucose tolerance test
Measures how well the body handles a standard amount of glucose
Draw the blood before and after 2 hours the patient drinks large, premeasured beverage containing glucose
Compare the reading before and after to see how well their body has processed the sugar
HbA1C Test
Diagnose pre-diabetes and diabetes
Measures the patient's average blood glucose control for the past 2-3 months
Blood sugar is measured by the amount of glycosylated hemoglobin (A1C) in the blood
An A1C of 5.7- 6.4% indicates that the patient is prediabetic and if it's more than 6.5%, then the patient is having diabetes.
Patient Education
Weight management
A 5-10% weight loss from initial body weight over a 6-month period is advised in all individuals who are overweight or obese who have or are at risk of diabetes mellitus.
Enough sleep
All patients should be advised to sleep approximately 7 hours per night to maintain energy levels and well-being
Physical activity
Improve glycaemic control, assist with weight maintenance, and reduce the risk of CVD
Also improves quality of life by improving functional capacity and sense of well-being and prevents the development of type 2 diabetes mellitus in individuals who are at high risk.
Smoking cessation
It has been found that smoking may have a role in the development of type 2 diabetes mellitus
Diet
Advise the patient to avoid missing meals and it should be synchronized with time actions of medication
Balanced diet with individualized based on glucose and lipid targets is recommended
Reduce alcohol consumption
Limit to ≤1 drink/day for women and ≤2 drinks/day for men to reduce diabetes mellitus, coronary heart disease and stroke risk.