M. K. is a 40-year-old male with chief complaints of fatigue, frequent urination, and weight loss during the last four weeks. There were several moments with sharp and short abdominal pain, and the man took Ibuprofen to manage his pain. He reports smoking for the last 20 years and drinking beer regularly on weekends. Regarding his family history of type 2 diabetes and hypertension, a sedentary lifestyle, and a lack of physical exercise, he is diagnosed with diabetes.
Diabetes is provoked by a deficiency of insulin secretion or the body’s insulin resistance, depending on its type and the severity level. Type 2 diabetes is a heterogeneous disorder that is characterized by different metabolic conditions in regard to the existing environmental and genetic factors (Galicia-Garcia et al., 2020). In addition, β-cell functioning is declined, hepatic glucose production is impaired, and β-cell failure is observed.
One of the main diabetes complications is the necessity to follow regular diabetes care requirements. For example, the patient has to change and improve his eating habits. Monitoring the blood glucose level is another obligation that cannot be ignored. Finally, physical changes like fatigue and unpredictable weight changes lead to the development of mental health problems like depression and anxiety about the possibility of complications.
Medications and Nursing Implications
Non-insulin pharmacologic therapy in the form of the most common biguanide – metformin (500 mg per day with the evening meal) is the first-line treatment for diabetes patients. Nurse implications aim at educating the patient about metformin’s possible adverse effects like nausea, weight changes, diarrhea, and lactic acidosis. Therefore, monitoring of the man’s renal function and his general well-being is critical during the first treatment week.
Diagnosis and Procedures
A diabetes-focused examination includes the glycated hemoglobin (A1C) test when the patient is allowed to eat and drink. The Oral Glucose Tolerance Test (OGTT) is prescribed to measure sugar level with fasting the night before. Several additional procedures are recommended not to miss other important conditions. The assessment of vital signs is necessary to check height, weight, and blood pressure. A funduscopic evaluation helps reveal the problems in the retina.
Laboratory Results and Interpretation
The A1C test is ordered to indicate blood glucose level. The A1C result is 11%, which is high and proves diabetes (normal range is below 5.7%; prediabetes is between 5.7% and 6.4%) (Centers for Disease Control and Prevention, 2019). Some patients report no use of A1C tests and need additional tests to prove their diagnosis. The OGTT is offered and shows 250 mg/dL, which is also high (normal range is below 140 mg/dL; prediabetes is between 140-199 mg/dL) (Centers for Disease Control and Prevention, 2019). Both tests prove that the patient has diabetes, and specific therapy is required.
The creation of an interprofessional team is a crucial step in diabetes care. The current patient needs to cooperate with several healthcare providers. A family physician evaluates a family history and makes necessary assessments. A pharmacist explains the peculiarities of metformin dosage and its interaction with other medications. A nurse educates about common care steps and the importance of monitoring glucose levels regularly. A dietitian shares several recommendations about eating habits and regimes.
Services and Equipment
Diabetes means regular monitoring of glucose levels in the blood. Therefore, to be discharged home, a glucometer has to be obtained. It is a portable electronic device to measure blood sugar levels at any moment. Another A1C test is planned within the next three months to check the effectiveness of metformin. When the decision to take insulin is made, insulin pumps are necessary to deliver the hormone to the system.
Clinical Learning Objectives
During this week, the goal was to pay attention to the patient’s family history and the impact of genetics and the environment on human well-being. Diabetes is a chronic condition with no specific cure, and people have to learn how to live with it. Therefore, another clinical learning objective is to know how to support the patient and choose between the most appropriate aspects of education.
Centers for Disease Control and Prevention. (2019). Diabetes tests. CDC.
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal of Molecular Sciences, 21(17). Web.