Question

James is a 51-year-old male Hispanic truck driver with a long history of diabetes and hypertension. His current medication regimen is Lisinopril 20mg QD, metformin 1000mg QD, Lipitor 40mg QHS, and ASA 81mg QD. His A1C is 7, BP is 144/80, total cholesterol is 266, HDL 44, LDL 177, and Trig 199.

What other information should you know about this patient to feel confident that his care is fairly well optimized?

What parameters would you like to see improved?

What clinical guidelines should you adhere to when managing this patient?

Are there any changes to treatment you should consider? Support your decisions with evidence.

Answer 1

Diabetes : A medical disorder characterised by high blood sugar level due to zn inability to produce or inability to metabolize sufficient quantities of the hormone insulin.  

Hypertension

The disease or disorder of abnormally high blood pressure is called Hypertension. The normal blood pressure is 120/ 80 mm of Hg.

HDL: High density lipoprotein

LDL: Low density lipoprotein.

1. To know the care is well optimized or not:

Information regarding:

* Fasting blood sugar level ( FBS) and Post prandial Blood sugar level ( PPBS), even though his A1C shows 7 ( Diabetic condition, need the medications. Above 7 need insulin therapy).

* Cardiac functioning: monitor an Electrocardiogram to assess the cardiac functioning. Stress test also can be performed as the patient is having high cholesterol level , 266. Normal total cholesterol level is 177 mg/ dl.

2. Parameters that should be improved:

Cholesterol level: Mr. James' cholesterol level is not normal. His total cholesterol level is high , 266. He has to maintain it beow 170 mg/ dl. His HDL is 44 , that should be above 50 and his LDL is 177 , that should be below 100mg/ dl.

His triglyceride level also should improve. The normal triglyceride level is < 150 , His level is 199mg / dl, that is borderline high.

His systolic pressure is slightly high and A1c level is 7 . He should try to maintain this at or below 6.5 . A1c test reflects the average blood sugar level of a person, for the past 3 months.  

3. Clinical guidelines :

When a patient suffering with Diabetes along with Hypertension, certain Guidelines have to follow by Health professionals as this multiple condition may cause many complications such as stroke, cardiac failure, Coronary artery disease etc.

* patients, who hve Diabetes and blood pressure, should check blood pressure frequently at home.

* Blood pressure should be monitored at every routine clinical visit.  

* Assess for any Orthostatic Hypotension as a result of any diabetic neuropathy .

* Ensure that the patient is following the medication regimen properly, without missing of any dose or overdose.

* Chech the patient' s knowledge regarding medications and its actions.  

* Ensure that the client os following strict dietary measures to control Diabetes, blood pressure and cholesterol level. Heart healthy diet with low calorie( sugar) and less salt and fat.

* Ensure that patient includes more whole grains, vegetables and fruits in the diet.

* Monitor lab values frequently.

4. Changes in treatment :

* Recommendation: ASA 80 mg can be changed or stopped slowly and he can adapt to non pharmacological measures like dietary changes and exercises as the drug possess major side effects like Gastrointestinal bleeding, gastric ulcer etc. Many medicines possess risk for renal and hepatic cell damage. As the client at 55 years, he can relie on non pharmacological measures more, as per physician's order.

Health professionals can encourage patient to adapt healthy lifestyle such as heart healthy diet, exercise or regular physical activity, Adequate drinking of water etc. He can try a very low gat diet to decrease his cholesterol level and include Greens, melons, berries and whole grains to improve A1c level.