Mike's Diabetes Journey: Examining and Managing Type 2 Diabetes - Essay Sample

Introduction

Mike is 58 years a white man who has been referred for pharmacologist for pharmacotherapy for examination and managing of diabetes. Her health condition is that he was diagnosed with diabetes type 2 in 1995. His health history includes atrial fibrillation with cardioversion, anemia, knee replacement, and several charges in the emergency room due to Asthma.

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Mike said "My diabetes is currently been treated with premixed preparation of 75% insulin lispro protamine suspension with 25% insulin lispro preparation 33 units before breakfast and 23 units before supper. (Pfister,2017)" He says he rarely "takes a little more" insulin when he notes high blood glucose evaluations. However, he has not been trained to practice an insulin adjustment algorithm.

His other routine medication includes fluticasone metered-dose inhaler, two wisps two times a day; enteric-coated aspirin,325mg everyday rosiglitazone,4 mg daily; furosemide and 80 mg diltiazem. "There is another medication that has been prescribed to take as I need," he said.

He was denied the usage of liquor, nicotine, leisure drugs. Mike complains about increased exacerbations of asthma hence there is a need for prednisone therapy. The doctor said," there is a need to decrease the intake of carbohydrates and to increase the intake of fluticasone, salmeterol, and albuterol to four times a day."

Her wife has been out of the job for the last year and the only basis of income is his social safety check. Thus, he has been not able to buy fluticasone and salmeterol, he reports that he has been taking prednisone and albuterol for the recent acute asthma exacerbations.

Mike reports that he has not to exercise for several weeks due to bad weather conditions and his asthma situation. "I eat three meals a day with a snack between supper and bedtime," he says. For the last 30 days, his glucose meter shows a total of 53 test with a mean blood glucose of 241mg/dl. There is no reading below the target, with a premeal glucose target set at 70-140 mg/dl.

Physical Exam

Mike is well-appearing with no acute distress and obese. His physical examination reveals that mike weight 302 lb. and height of 5'1'. The blood pulse is 88bpm; respirations are 22 per minute. The blood pressure is 130/78 mmHg. (Lourenco,2019) The lung is clear and without any wheezing. Mike said," My feet swell during the daytime then the following morning is skinny again." Due to the situation, he reports that he takes one extra furosemide table during lunchtime to reduce the swelling and pain. Mike says that the side effect of the drug is that it prevents him from sleeping due to nocturnal urination.

Laboratory Results

Mike reports that he has visited the laboratory test for the last six months and his hemoglobin 7% and the normal range usually lies between <5.9%-<7%. His creatine is 0.7 mg/dl which is around the normal range. Liver function is within the normal range despite the uptake of several drugs. Urinary albumin is less than 30mg. sodium, potassium, and calcium are within the normal range. Blood urea nitrogen is 16mg/dl which is within the normal range (Manna, 2016). Lipid panel such as total cholesterol, high-density lipoproteins, triglycerides, and low-density lipoprotein are within the normal range.

DISCUSSION

After Mike spending several weeks in Tata memorial hospital in India their doctor proposed a systemic method for assessment of patient's pharmacotherapy by using a method known as work-up -drug therapy. The disease impacted Mike negatively as some of the drugs were expensive and it was decided to tackle his asthma and high glucose level first. Mike was advised about the part of the maintenance of asthma and the use of drugs. Due to his condition, Mike had to leave his occupation until the gets better. This condition impacted negatively on their economic status, making me substitute expensive drugs with cheaper ones.

To reduce regular hospital visit mike was instructed to use a peak flow meter to display his interpretations and signs. In the succeeding visit to the hospital, the data he obtained was used to obtain his maximal expiratory energy and obtain an asthma plan.

Mike's insulin transformed to basal based treatment making him use pre-meal lispro only. He was also educated on the dose concept. (Al-Quteimat,2016) He was advised on how this regime can give him the flexibility of dose in order to respond to change in diet, exercise, and disease medication. He was also given an extra algorithm to precise for any temporal rise in blood glucose. He decided to examine the glucose four times a day and record the blood glucose level, carbohydrate consumption, and insulin dosages. So that in the following visit to the hospital those data will be used to adjust the change algorithm and construct his algorithm for comparing the premeal bolus insulin to carbohydrate intake and express it as an insulin-to-carbohydrate ratio.

The last intervention was to his visit was to raise the potassium chloride and calcium. To reduce low lipid lipoprotein the doctor recommended him use Fluvastatin.

Mike's medication-related problems are as follows; the use of calcium supplements has been related to reduced bone density and excessive use of these drugs can lead to Hypocalcemia. ( Krul-Poel,2017)Mike was not required to use magnesium supplement in diabetes is absent as hypomagnesemia is a risk factor for atrial fibrillation which is associated with hypertension, glucose tolerance, insulin resistance, and increased platelet accumulation. Magnesium supplements are lead to elevated blood glucose and asthma hence he was supposed to use drugs that depleted magnesium in the bones.

Problems associated with the drugs; some drugs lead to drug-related response for example the use of Albuterol in hypertension increased blood glucose. (Kaufmann,2018) Salmeterol and prednisone lead to an increase in digoxin toxicity due to the hypokalemic effect. Other drugs such as Fluvastatin that he used increased the serum digoxin level due to their ability to be reductase inhibitors. Other side effects of the drugs included gastrointestinal effects such as gastritis and gastric mucosa injury especially to potassium chloride drugs as Mike had a history of anemia. Mike had no adverse allergic reaction. The use of drugs every day had diuretic resistance which can result in nephron blockage.

Patients Situation

Mike had to leave the hospital with few attainments with medication changes and self-care goals to address his medical condition. He had the confidence and knowledge that his health status will improve.

Conclusion

Diabetes patients with several comorbidities such as anxiety concerning their health complications the doctor must discover all the complications of comorbidities as well as the patient's emotional state. Mike is a good example even though his medical appointment was diabetes managing his greatest concern at the visit was his asthma exacerbations.

Reference

Al-Quteimat, O. M., & Amer, A. M. (2016). Evidence-based pharmaceutical care: The next chapter in pharmacy practice. Saudi Pharmaceutical Journal,

Kaufmann, C. P., Stampfli, D., Mory, N., Hersberger, K. E., & Lampert, M. L. (2018). Drug-Associated risk tool: development and validation of a self-assessment questionnaire to screen for hospitalized patients at risk for drug-related problems. BMJ Open, 8(3).

Krul-Poel, Y. H., ter Wee, M. M., Lips, P., & Simsek, S. (2017). Management of endocrine disease: the effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. European journal of endocrinology, 176(1), R1-R14. 24(4), 447-451.

Lourenco, L., van Mil, J. F., & Henman, M. (2019). Pharmaceutical Care and Dispensing Medicines. The Pharmacist Guide to Implementing Pharmaceutical Care (pp. 251-259). Springer, Cham.2

Pfister, B., Jonsson, J., & Gustafsson, M. (2017). Drug-related problems and medication reviews among old people with dementia. BMC Pharmacology and Toxicology, 18(1)

Manna, P., & Kalita, J. (2016). The beneficial role of vitamin K supplementation on insulin sensitivity, glucose metabolism, and the reduced risk of type 2 diabetes: A review. Nutrition, 32(7-8), 732-739.