Question

A 45-year-old male Black patient has had Type2 diabetes for 5 years. He is a long-haul truck driver. His trips frequently have him driving 12 to 14 hours per day. His current diet consists of fast food, high fat and high carbohydrate foods, high sodium intake and minimal vegetable consumption. He does not exercise and has smoked one pack of cigarettes a day since his early twenties. List all of his risk factors, modifiable and non-modifiable for his diabetes and for other health care concerns. What tests should be done to evaluate his current health status. Generate an educational plan for this patient What needs to be included in his education plan. Be specific and inclusive.

Answer 1

RISK FACTORS

MODIFIABLE	NON-MODIFIABLE
1.Diet	1.Age
2.Physical Activity	2.Genetics
3.Smoking	3.Gender
4.Sleep	4.Socio-Economic
5.Stress	5.Some Pre-Existing Medical Conditions
6.Weight	6.Ethinicity

Tests should be done to evaluate his current health status

• Physical examination including family history
• Hemoglobin A1C test
• Random blood sugar
• BMI
• Vital Signs
• Lipid Profile
• Electrolytes
• LFT
• CBC
• Troponin I
• 2D ECHO
• GFR
• Urine Routine
• Chest X-ray
• NCS test
• Eye check-up
• Dental check-up

EDUCATIONAL PLAN

• Educate the patient in simple language that type 2 DM means your body does not make or use insulin well.People with this disease often need to take pills or insulin.
• HBA1Ctest.It shows what your blood glucose has been over the last three months.The A1C goal for many people is below 7.High blood glucose can harm your heart and blood vessels,kidney,feet and eyes.
• The goal for most people with diabetes is below 130/80.High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.
• The LDL goal for people with diabetes is below 100. The HDL for men is greater than 40.The HDL for women is greater than 50.LDL or “bad” cholesterol can build up and clog your blood vessels. It can cause a heart attack or a stroke. HDL or “good” cholesterol helps remove cholesterol from your blood vessels.
• Eat healthy foods such as fruits and vegetables, fish, lean meats, chicken or turkey without the skin, dry peas or beans, whole grains, and low-fat or skim milk and cheese.
• Keep fish and lean meat and poultry portions to about 3 ounces (or the size of a deck of cards). Bake, broil, or grill it.
• Eat foods that have less fat and salt.
• Eat foods with more fiber such aswhole-grain cereals, breads, crackers, rice, or pasta.
• Get 30 to 60 minutes of physical activity on most days of the week. Brisk walking is a great way to move more.nStay at a healthy weight by using your meal plan and moving more.nAsk for help if you feel down. A mental health counselor, support group, member of the clergy, friend, or family member who will listen to your concerns may help you feel better.
• Learn to cope with stress.
• Stop smoking.
• Take medicines even when you feel good. Ask your doctor if you need aspirin to prevent a heart attack or stroke. Tell your doctor if you cannot afford your medicines or if you have any side effects.
• Check your feet every day for cuts, blisters, red spots, and swelling. Call your health care team right away about any sores that do not go away.
• Brush your teeth and floss every day to avoid problems with your mouth, teeth, or gums.
• Check your blood glucose. You may want to test it one or more times a day. I will give you a booklet to keep a record of your blood glucose numbers. Be sure to show it to your health care team. Check your blood pressure if your doctor advises.
• Report any changes in your eyesight to your health care team.
• Get routine care.See your health care team at least twice a year to find and treat any problems early. At each visit be sure you have a blood pressure checking ,foot checking and weight checking review of your self-care plan
• Two times each year have HBA1C test.
• Once each year be sure you have a cholesterol test, ntriglyceride (try-GLISS-er-ide) test a type of blood fat,complete foot examination,dental exam to check teeth and gums tell your dentist you have diabetes,dilated eye exam to check for eye problems flu shot,urine and a blood test to check kidney problems.
• At least once get a Pneumonia shot.