Question

1.what is the treatment for type 2 diabetes mellitus?

2. How would you complete a focused assessment on a homeless person or veteran with type 2 diabetes mellitus?

3. How do you mix NPH insulin with regualr insulin?

Answer 1

1. Treatments for type 2 diabetis:

- Metformin: it is the first preferred treatment for most of people with type 2 diabetis melitis, it lowers the blood glucose level and improve body's response to insulin.

- sulfonylureas :It helps to secrete more insulin. eg : glipizide.

- meglitidines:thease are fast acting with shorter duration of action, eg: repaglinidine.

- Thiazolidinediones : This makes body more sensitive to insulin.eg:rosiglitazone.

- dipeptidyl peptidase (DPP )-4 inhibitors:it slows the blood glucose level. eg : sitagliptin.

- glucogon like peptide -1( GLP-1) receptor agonist: it slows digestion and reduce blood sugar. eg:exenatide.

- sodium glucose cotransporter-2 ( SGLT2) inhibitors: it prevents kidnyes from reabsorb sugars into blood. eg canagliflozine.

- Insulin: often long acting insulin , that can be taken in night are prescribed for type 2 DM.eg: glargine

Other managements includes healthy diet at regular intervals,weight control, regular exercise and blood sugar monitoring.

2. It is a great challege to diagnose and treat diabetis in a homeless individual due to lack oh healthy food, regular blood sugar monitoring.The focused assessment in these individual includes,

- obtain vital signs in each visit.orthostatic vital singns should be included to rule out autonomic neuropathy.Hypertension is purticularly common in diabetic patient.diabetic ketoacidosis must be considered immediately ,if the respiratory pattern suggest kussmaul respiration.

- perform full physical examination to cover all the body system especially cardiovascular, ophthalmic, dermatology, renal and neurologic.this helps in early diagnosis of complications.

- foot examination is very important in these patients.foot to be examined in each visit for any ulcers, infection or skin changes.Patient should be made aware of foot care , if a peripheral neuropathy is found to prevent foot ulcer and further amputation. If there is sensory neuropathy, patient may experience less sensation and it limits patient's ability tpo protect the extrimity.

3. Gently roll the NPH insulin vial inorder to resuspend insulin. Properly resuspended insulin will be cloudy or milky. Inject air ( equal to the reqiured amount of insulin) to NPH vial to make it cloudy and to regular insulin to make it clear.Draw the regular insulin first to the insulin syringe at required amount then draw the NPH insulin to it. This should be immediately used after proper mixing