Question

• Mr. A is a 46 y/o Hispanic male presenting for the first time to your practice. He denies any medical history but states he was once told by a doctor that if he did not control his risk factors he would be a diabetic. He presents with complaining of excessive thirst, hunger and complains of “urinating a lot”. Upon assessment, Mr. A presents with a sedentary lifestyle, central obesity and a history of tobacco use. His VS are as follow: Temp 98.4F, BP 152/91, HR 104, RR 20, O2 SAT 95%, weight 203 lbs, Height 5’5”, BMI >30. Random glucose 112 mg/dl. He is requesting today “a pill to lose weight”.

Please addess the following and state your rationale.

1. Is Mr. A at risk for developing diabetes? Type 1 or type 2? Explain your rationale.
2. List 3 modifiable risk factors for diabetes. Explain your rationale
3. What are the five components of diabetes management? Explain the role each play.
4. If this patient begins pharmacotherapy, what would be an important plan of the teaching plan?

Answer 1

1) yes, there is risk for devoloping diabetes.

2) type 2 diabetes

3) it's type 2 diabetes, because,

Let's see the main difference between type 1 and type 2 diabetes,

Type 1

. Type 1 isn’t affected by your lifestyle. Or your weight. That means you can’t affect your risk of developing Type 1 by lifestyle changes.

People up to the age of 40 are more likely to be diagnosed with it, especially children. In fact, most children with diabetes have Type 1. But, although it’s less common, people over 40 can also be diagnosed with it.

Type 2

Risk factors include:

family history

ethnic background

age

overweight or obesity

We also know that there are things you can to reduce your risk of developing Type 2 diabetes. Things like eating healthily, being active and maintaining a healthy weight can help you to prevent Type 2.

3) modifiable risk factors

Consider the given case,

Here, Weight is 203 ibs, bmi is more than 30,which is overweight.

It is a modifieble risk factor, because,

.Being overweight puts you at a higher risk of developing diabetes.

.Losing 5 percent to 7 percent of your body weight can cut your risk of developing prediabetes in half,

.and your risk decreases even more as you lose more weight.

*The next factor is hypertension, in the given case, bp is, 152/92, which is high.

It is a modifiable risk factor, because it is proved that;

.In addition to causing damage to the cardiovascular system, untreated high blood pressure has been linked to the development of diabetes.

*the third factor is Physical inactivity

In the given case, it is evident that the patient is not willing to do any exercise, (requested for a pill to loose weight)

Along with being overweight and obese, physical inactivity ranks among the top modifiable risk factors for prediabetes and Type 2 diabetes.

To avoid this risk, patient need to do:

At least 150 minutes per week of moderate-intensity aerobic physical activity

Or 75 minutes per week of vigorous-intensity aerobic physical activity

Or a combination of the two with muscle-strengthening at least two days per week.

Components

1. Exercise

.the most important components of diabetes management.

.Exercise lower the blood sugar level by increasing the demand of glucose by the body muscles.

.during exercise the glucose is utilized more due to the increased demand which help in lowering the amount of glucose in the body.

.It also increases insulin absorption by the cells.

. it alter blood lipid concentrations, increasing levels of high density lipoproteins (good cholesterol) and decreasing levels of total cholesterol and triglycerides levels.

2. Nutrition

The nutritional management of diabetes should includes the following;

• The food should contain all the essential nutrients like vitamins, mineral which are necessary for optimal nutrition.

• The food that patient eat should meet the energy needs.

• The food should help the patient in achieving and maintaining a reasonable weight.

• The food should be taken almost the same time, same amount to prevent wide fluctuations of blood glucose which can lead to high glucose levels.

• Avoid high fat diet and soft drinks. This help to decrease lipid level in order to decrease the risk of macro vascular diseases.The sugar level in soft drinks is so high almost enough to provide day’s supply of sugar.

• Do not skip meal and eat small frequent meals.Skipping meal or placing long gaps between meals will make you hungrier, thus increasing the tendency of eating more.Instead, have a regular mealtime to maintain a healthy blood sugar level.

3. Monitoring

This allows for detection and prevention of hypoglycemia and hyperglycemia and plays a crucial role in normalizing blood glucose levels, which in turn may reduce the risk of long-term complication.

Blood sugar monitoring should be done before and after exercising and any other time that deem necessary.

. Medication

In type 2, insulin may be necessary on a long term basis to control glucose levels if meal planning and oral agents are not effective.

In additions, some patient in whom type 2 is usually controlled by meal planning alone or by meal planning and an oral antidiabetic agent may require insulin temporary during illness, infection, pregnancy, surgery, or some other stressful event.This is because at this time there is an excess secretion of stress hormones leading to increased glucose in the blood.

In many cases, insulin injections are administered two or three times daily to control the blood glucose level and because the insulin dose required by individual is determined by the level of glucose in the blood, accurate monitoring of blood glucose level is essential.The other important thing is knowing the way the diabetic medication interact with other medicine to avoid taking medications that can increase the blood sugar levels.

5.Education

Diabetes Mellitus is a chronic illness that requires a lifetime of special management behaviors.Because physical activity, physical and emotional stress affect diabetic control, patient must learn to balance a multitude of factors.

They must learn daily self care to prevent acute fluctuations in blood glucose, and they must also incorporate into their lifestyle many preventive behaviors for avoidance of long term diabetic complications.

The patient must be knowledgeable about nutrition, medication, effects and side effects, exercise, disease progress, prevention strategies, blood glucose monitoring techniques and medication adjustments.

In addition they must learn the skills associated with monitoring and managing diabetes and must incorporate many new activities into their daily routine.