Management of Diabetes Mellitus Essay Discussion

Diabetes Management

From the patient’s examination and tests that were done, it is clear that the patient is suffering from obesity, evident from his BMI of 39.5, peripheral neuropathy, microalbuminuria, suboptimal glycemic control, hypertension and dyslipidemia. These are some of the manifestation of Diabetes Mellitus. Therefore, to address the patient treatment in this case, I would address all these issues individually, for a successful treatment process. Management of Diabetes Mellitus Essay Discussion

To begin with, I would address the lifestyle modifications that the patient should make on his side. The patient should first quit smoking to avoid the risks such as hypertension among other cardiovascular problems attributed to smoking and diabetes (Mirzaei et al., 2020). Secondly, I would emphasize on weight reduction measures such as regular physical activities and restrictions from calories. The second approach is controlling his glycemic condition through adjustment of insulin therapy and offering the basic education concerning diabetes. Considering that the patient’s suboptimal glycemic control findings were (HbA1c 8.1%), intensifying insulin therapy would be necessary. This can be achieved through basal bolus insulin regimen such as insulin glargine and insulin analogues such as the insulin aspart and should be taken before meal (Shan et al., 2019). However, these adjustments should be made considering that the patient is able to regularly check their blood glucose levels. With regards to diabetes education, I would refer the patient to an educator who would guide them on how insulin is administered, how to manage their hypoglycemia and the techniques of monitoring their health conditions. Management of Diabetes Mellitus Essay Discussion

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The third approach of consideration towards the treatment of the patient is risk management of his cardiovascular condition. Considering that the patient’s blood pressure is 145/71 mmHg (hypertension), I would consider pharmacologic approaches such as Angiotensin-Converting Enzyme Inhibitors (such as Lisinopril) to lower their blood pressure to less than 130/80 mmHg. I would also recommend his progression with atorvastatin 40 mg daily since his lipid profile levels is at the required range. Finally the fourth treatment approach of consideration for this patient is treatment of his Microalbuminuria. From his assessment, among the findings were elevated urine albumin excretion, a good indicator of diabetic nephropathy. Glycemic and optimal blood pressure control through utilizing ACE medications such as Lisinopril are essential in slowing renal disease progression (Mirzaei et al., 2020). In addition to all these treatment approaches, I would consider scheduling the patient under some regular follow up visits for a proper monitoring of his progress. Management of Diabetes Mellitus Essay Discussion

References

Mirzaei, M., Rahmaninan, M., Mirzaei, M., Nadjarzadeh, A., & Dehghani Tafti, A. A. (2020). Epidemiology of diabetes mellitus, pre-diabetes, undiagnosed and uncontrolled diabetes in Central Iran: results from Yazd health study. BMC public health, 20, 1-9. https://doi.org/10.1186/s12889-020-8267-y

Shan, R., Sarkar, S., & Martin, S. S. (2019). Digital health technology and mobile devices for the management of diabetes mellitus: state of the art. Diabetologia, 62, 877-887. https://doi.org/10.1007/s00125-019-4864-7

A 66-year-old obese Caucasian man presented to an academic Diabetes Center for advice regarding his diabetes treatment. His diabetes was diagnosed 10 years previously on routine testing. He was initially given metformin but when his control deteriorated, the metformin was stopped, and insulin treatment initiated. The patient was taking 50 units of insulin glargine and an average of 25 units of insulin aspartate pre-meals. He had never seen a diabetes educator or a dietitian. He was checking his glucose levels 4 times a day. He was smoking half a pack of cigarettes a day. Management of Diabetes Mellitus Essay Discussion

On examination, his weight was 132 kg (BMI 39.5); blood pressure 145/71; and signs of mild peripheral neuropathy were present. Laboratory tests noted an HbA1c value of 8.1%, urine albumin 3007 mg/g creatinine (normal <30), serum creatinine 0.86 mg/dL (0.61–1.24), total cholesterol 128 mg/dL, triglycerides 86 mg/dL, HDL cholesterol 38 mg/dL, and LDL cholesterol 73 mg/dL (on atorvastatin 40 mg daily).

Questions

Based on your understanding of Diabetes Mellitus and what you have learned in this module, how would you treat this patient? Management of Diabetes Mellitus Essay Discussion