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Type 2 Diabetes : Insulin binds to receptors on body cells, Damaged…
Type 2 Diabetes
:
Insulin binds to receptors on body cells
body cells develop a resistance to insulin
glucose builds up in the blood vessels, hyperglycemia, hyperinsulinemia
High HDL, Low LDL
Plaque
Atherosclerosis
Increased Afterload
Endothelial Damage
CAD/PAD
Family hx of MI, HTN, CHF
Ineffective tissue perfusion
Reduced blood flow to the feet
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decreased sensation in the extremities /peripheral neuropathy
increased risk of injury
diabetic foot ulcer- uncontrolled type 2 DM leading to neuropathy, pt could not feel foot wound
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wound infection
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limited joint mobility
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Kidney Damage
CrClearance is 45
, this is a low value. Low creatinine clearance can indicate kidney disease or kidney damage. It can also indicate heart failure. Diabetes, obesity, and hypertension can lead to a decrease in kidney function.
This would be concerning because it means that the kidneys are not filtering waste out of the body and excreting it in urine.
BUN 29
- His BUN is a little high. This elevation could indicate that he is having problems with his kidneys. This could be due to his hypertension. High blood pressure can cause the arteries to narrow so that they are unable to deliver as much blood to the kidney tissue which means that the amount of oxygen and nutrients is also decreased.
"I get up about 10 times a night to go pee"
Hydrochlorothiazide 12.5mg PO q day
- diuretic that helps to lower blood pressure by inhibiting sodium chloride transport and excreting potassium in the urin
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The patient’s
albumin is very low at 2.4
. The patient could be malnourished. He stated that he has lost 20 pounds recently. This could also indicate kidney injury if the kidney is not producing albumin protein.
Kidney damage is due to endothelial damage and HTN
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Narrowed vessels causing decreased blood flow to kidney tissue, decreasing oxygen and nutrients
RBC: The patient’s
red blood cell
count is 3.9, the normal range is 4.2-6.0. The patient's RBC is lowered due to some of the medications he is taking. Also, in patients with diabetes, kidney damage is common from the high blood sugar damaging the blood vessels in the kidneys
BP is 165/95, high blood pressure due to damage to the endothelial cells causing narrowing of vessels
Hydrochlorothiazide 12.5mg PO q day
- diuretic that helps to lower blood pressure by inhibiting sodium chloride transport and excreting potassium in the urine
2 more items...
CoQ10 100 capsule q day
Lower their BP or for his diabetic neuropathy.
Decreased Cardiac Output
Dyslipidemia
Atorvastatin 40mg PO q day
- decreases cholesterol production in the liver, taking it to treat dyslipidemia, due to his increased risk for CAD
Atorvastatin undergoes first-pass metabolism by the liver. Statins can accumulate in patients with impaired liver function. There is a potential complication for rhabdomyolysis. Patient should notify care team if they start to experience muscle aches, pain, or weakness.
The patients
HgA1C
is high. His labs reports
8.0
, when it should be in the desired range of < 5.7%. This lab test is used to screen for and diagnose diabetes. It reflects the average plasma-glucose concentration over the preceding 2–3 months and serves as a biomarker primarily of long-term glycemic control and, secondarily, of treatment adequacy.
oxidative stress
Diabetic Retinopathy
due to damaged blood vessels in the eye
Latanoprost
1 drop each eye daily
- lowers the pressure in the eye to treat glaucoma
Open-angle glaucoma
Complaints of blurred vision
Retinal blood flow changes
Retinal hypoxia, ischemia
Increased vascular endothelial growth factor (VEGF) and other growth factors
vascular damage
macular edema and hemorrhage
vision loss
Metformin 500mg PO BID
- decreases glucose production by the liver to enhance insulin sensitivity, helps to manage his type 2 DM
Renal impairment
can cause decreased excretion of metformin by the kidneys, leading to elevated levels and can lead to lactic acidosis
Decreased bicarbonate
Potassium of 3.3 (low)
Confusion -- "George was becoming more forgetful" on assessment
CO2 of 23 (acidic)
Gastroparesis
: nerve damage from high blood sugar can cause gastrointestinal muscles to slow down
“I get full so easy and my food takes forever to move and I get heartburn”
Famotidine 20mg PO q bedtime
- decreases gastric acid secretions, taking for heartburn
Acidophilus Capsule PO 100 mg qam
- Probiotic which is good bacteria that are similar to the ones in our body. Taking it to aid in digestion.
Protonix 40mg PO q am and bedtime
- Suppress gastric acid secretion and treat heartburn and upset stomach.
Bowel sounds x4
Non Modifiable Risk Factors
: relatives with DM, ethnicity, women who had a baby >9 lbs, women who had gestational diabetes, HTN, PCOS, cardiovascular disease, 45 years or older
Modifiable Risk Factors
: HDL level, obesity, inactivity, triglycerides
Situational Depression
Prozac 40mg PO q day
- SSRI used to treat depression .
Smaller or less frequent doses may be appropriate for older adults due to slower elimination of the drug.
Serotonin syndrome
: patient should be educated on symptoms including agitation, confusion, high blood pressure, tremor, fever and muscle rigidity.
St. John’s Wort q pm at bedtime
Depression management.
Labile mood, forgetfulness, getting irritated more easily
Wife passed away 1 year ago
Suicide risk
Benign Prostatic Hypertrophy (BPH)
Tamsulosin 0.4mg PO q day
- Used to reduce symptoms of BPH by improving urine flow.
May cause drowsiness or dizziness and is excreted by the kidneys. It can also cause hypotension and blurred vision.
This can put the patient at an increased risk for falls.
"I get up about 10 times a night to go pee"
occasional urinary hesitancy
Damaged endothelial cells cause blood vessels to narrow and harden, so blood supply becomes restricted