Question

LM is a 52 year old white female who was diagnosed in 2012 with Type 2 diabetes. She was treated with a diet and exercise program for a year before needing to start metformin. Her last hemoglobin A1C was 7.7% in 2013. She relocated to Fargo in 2016 and has not established with a primary care provider since she moved. She has used Quick Minute clinics to get refill prescriptions for metformin while traveling in bigger cities.
She presents to the clinic where you are a clinical pharmacist and says she knows she needs to see someone to help manage her diabetes but she is an executive and is often booked with meetings and busy travel schedules. She has been feeling fatigued but not sure if it is because of her diabetes or her busy travel schedule. She is adherent to metformin, has good insurance coverage, and is not opposed to another oral or injectable medication.
Per provider and nurse visits today:
Medications:
Metformin 2000mg XR po qd
Multivitamin po daily
Ibuprofen 200-400mg by mouth every 6 hours as needed for pain
Weight 170 pounds Ht. 5 ft 8 inches
Blood Pressure Blood glucose
124/80mmHg 304 mg/dl
Heart Rate 68 Hemoglobin A1c 9.9%
Serum Creatinine
Urine : Microalbumin (<30mg/g), Ketones (-), Glucose +4 AST/ALT Normal
TC 154, LDL 78, HDL 38, Triglyceride 160
Dilated Eye Exam Normal Foot Exam Normal Neuro Exam Normal
Lifestyle:
Exercises Occasionally (Golfs once weekly during summer, plays tennis once weekly throughout year) Diet: No special diet, watches carbohydrate intake
She does not smoke and drinks 3-4 glasses of wine or beers per week.
The provider has requested you, as the clinical pharmacist, to manage this patient’s diabetes. Please write a SOAP note reflecting what you feel is the important subjective and objective information and laying out your assessment and plan. (Don’t forget to include monitoring and follow up!)
In addition to the SOAP note, please provide three relevant counseling points to educate the patient on regarding any new medication(s) you choose to start them on.

Answer 1

Assessment::::priority 1.1)assess risk and contributing factors to unstable blood glucose level

.a)determine influence of clients cultural and religious factors affecting dietary practices,taking responsibility for own care and expectations for health care outcome::-certain risk factors like family history of diabetes,history of poor glucose,poor exercise habits,eating disorder and failure to find changes in glucose level

priority2.assist client in creating preventive strategies for unstable blood glucose level

a)ensure client is knowledgeable about using his own blood glucose monitoring device

b)educate about balancing food intake with physical activities and ask how she takes her anti diabetic medication and how it works.

c)review the patients current diet and nutritional needs.tell her about the food which cannot take for type 2 diabetes

d)educate about the importance of taking follow ups and diabetic treatment continuously.

medications:::

1)alpha glucosidase inhibitors--this will assist your body break down starchy foods and table sugar.

eg.tb.miglitol

2)biguanides ---it decreases the level of sugar your liver makes,intestine absorb and also help to your body more sensitive to insulin .and also help the muscles to absorb glucose

3)sulfonylureas----- this will help to stimulate The pancreas with the aid of beta cells.eg.glimepiride,chlorpropamide