Nr508 Week 5: Discussion
Nr508 Week 5: Discussion. Maria is a 46-year-old woman who presents for her yearly physical examination. Her medical history is notable for mild depression and moderate obesity. Six months ago her fasting lipid profile was normal. Maria report that her mother and brother have diabetes and hypertension.
She reports that she knows she should be on a low calorie, low fat diet and exercising but with her full-time job and four children, she finds it difficult to exercise, and she eats out most of the time. She is 67″ tall and weighs 225lbs today, no current medication. She does report taking a multivitamin daily but feel tired still, biotin Vit-C when she remembers. She is a nonsmoker, only drinks sweet tea with each meal, 3-4 cups of coffee per day.
Today: BP 120/70 mm Hg, pulse 76, temperature 98.7, respirations 18, weight 219 pounds. Urine dip + glucose, fasting plasma glucose 179 mg/dl, HgbA1C is 7.4%, TSH 5.6. Physical Exam reveals notable for acanthosis nigricans at the neck but otherwise is normal.
- What are your treatment goals for Maria?
- What is your plan for drug therapy? What is the mechanism of action for each drug?
- Please give five teaching points for each drug prescribed.
- How would you change the plan if her initial HbgA1C was 10.2mg/dL and her fasting blood glucose was 305mg/dL? Provide a detailed alternative plan with the rationale
Nr508 Week 5: Discussion Answer
What are your treatment goals for Maria?
Considering Maria’s current health status and medical history, the following treatment goals should be prioritized:Nr508 Week 5: Discussion
- To reduce and control her weight: Maria’s BMI of 35.3 categorizes her as obese, and addressing weight management is crucial for overall health (American Diabetes Association, 2017).
- To control her blood sugar: Maria’s fasting plasma glucose level of 179 mg/dL indicates elevated blood sugar, necessitating interventions to manage and stabilize it within normal ranges (Forslund et al., 2015).
What is your plan for drug therapy? What is the mechanism of action for each drug?
Given Maria’s fasting plasma glucose level of 179 mg/dL, indicating type 2 diabetes, and her obese status, the proposed drug therapy includes addressing both conditions. For type 2 diabetes, Metformin emerges as the most suitable choice. As highlighted by Forslund et al. (2015), Metformin enhances insulin sensitivity in body cells, mitigates glucose release from the liver, and reduces glucose absorption from food in the gut. Additionally, for obesity management, Orlistat is recommended.
This drug therapy plan aims to address both type 2 diabetes and obesity in Maria. Metformin is recommended for type 2 diabetes, as it enhances insulin sensitivity in body cells, reduces glucose release from the liver, and diminishes glucose absorption from food in the gut (Forslund et al., 2015). Simultaneously, Orlistat is proposed for obesity management. Orlistat works by inhibiting the absorption of dietary fats in the intestines, resulting in weight loss (Padwal, Majumdar, Klarenbach, Birch, & Karmali, 2011).
References:
- American Diabetes Association. (2017). Standards of medical care in diabetes—2017. Diabetes Care, 40(Supplement 1), S1-S135.
- Forslund, T., Wettermark, B., Andersen, M., Hjemdahl, P., Alfredsson, L., & Druid, H. (2015). Differences in treatment persistence with insulin detemir and insulin glargine in people with type 2 diabetes mellitus. Pharmacoepidemiology and Drug Safety, 24(5), 583-592.
- Marín-Peñalver, J. J., Martín-Timón, I., Sevillano-Collantes, C., & del Cañizo-Gómez, F. J. (2016). Update on the treatment of type 2 diabetes mellitus. World Journal of Diabetes, 7(17), 354–395.Nr508 Week 5: Discussion
