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Case study Diabetes Sample Paper

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Case study Diabetes Sample Paper

Introduction

Diabetes is a chronic condition characterized by elevated glucose levels resulting from failure of production of the hormone insulin from the pancreas or failure to effectively utilise the insulin produced (Rafacho et al., 2017). Due to adoption of a sedentary lifestyle by majority of the people globally, there has been an increase in the number of diabetes cases reported. Elevated blood glucose that is not controlled causes marked damage to majority of the body’s organ systems.

Primary diagnosis.

            The primary diagnosis is diabetes. Elevated glucose levels circulating in blood normally presents with increased thirst and urgency of urination, fatigue and blurred vision. The patient is markedly obese weighing 185 pounds and has a history of alcohol consumption taking 1-2 glasses on weekends. There is a small amount of protein in the patient’s urine. The pertinent negative findings include normal pulse rate and blood pressure (Whelton, et al., 2018). Absence of ketones is another negative finding. There is also no history of diabetes in the patient’s family. The patient presented with fatigue, increased thirst, nocturia and weight gain. Glucosuria and proteinuria confirm the diagnosis of diabetes.

Secondary findings.

            Anaemia can be one of the secondary findings. This results from an imbalance in red blood cells destruction in comparison to their production. Positive pertinent findings include fatigue. Negative pertinent findings include the absence of headaches and no shortness of breath (Hakim et al., 2017). The presence of fatigue and slightly reduced haemoglobin levels below the normal range are indicative of anaemia.

Diagnostics.

Random Plasma Glucose Test is one of the first laboratory tests to order. This test is used to diagnose diabetes when the symptoms are present (Punthakee et al.,2018). The patient does not need to have fasted for this test to be conducted. This blood test can be done at any time. Glucose levels above 200 mg/dl when a RBS test is done is indicative of diabetes mellitus. Fasting Plasma Glucose Test is another confirmatory test for diabetes. This test measures blood glucose levels at a particular time and is most suited to be conducted in the morning (American Diabetes Association, 2017). This is after a fast of about eight hours without intake of any food or drinks. Blood glucose levels of more than 126mg/dl on two separate tests is indicative of diabetes.

The haemoglobin A1C test is another test used in the diagnosis of diabetes. This test provides the average blood sugar levels over a period of around three months (American Diabetes Association, 2017). The test, also referred to as glycosylated haemoglobin test, is conducted after a period of fasting where the patient is advised not to eat or drink before the test. The doctor takes into consideration several factors such as the patient’s age or whether the patient has anaemia. This is because the test is likely to give inaccurate results in anaemia patients. A 6.5% result and above is indicative of diabetes.

Oral Glucose Tolerance Test (OGTT) is also used in the diagnosis of diabetes. A health care professional is first tasked with the duty of drawing blood. After this, the patient drinks a liquid containing glucose and the health care worker draws blood after one hour and again after two hours. This test is however more expensive when compared to the other tests. Glucose levels above 200mg/dl indicate diabetes. Complete blood count should also be conducted. The patient’s haemoglobin level is 12.5 g/dl. This is below the normal range in males. Subsequent tests should be done to monitor and to ensure that the levels do not drop further as this can lead to severe anemia (Mazer et al., 2017). Anaemia gradually develops in people with diabetes due to kidney damage which consequently interferes with erythropoietin production that is essential in red blood cell formation.

Medications.

One of the drugs to be used is acarbose. 25 g of Precose taken PO 3 times a day (q8hr) at meals is recommended. The dose can gradually be raised to 50 or 100 g taken PO 3 times a day. This drug lowers the rate of food breakdown to glucose ensuring that there is no sudden rise in blood glucose levels after a meal. Metformin is another drug used in the treatment of diabetes. It is the recommended drug for type 2 diabetes (Sanchez-Rangel et al, 2017). The initial dosage of the drug is 500 mg orally every 12 hours or 800 mg orally taken once a day with meals. This is gradually increased every two weeks with a maintenance dosage of 1500 to 2550mg orally taken once every 8-12 hours with meals. Caution is taken not to administer more than 2550 mg every day.

For the management of anaemia, iron supplements are indicated to counter iron deficiency. Ferrous sulphate is the main supplement used to counter anaemia. 65 g of iron sulphate taken 3 times a day are recommended though 15-20 g have proven to be as effective with fewer side effects (Pereira et al., 2018). 500 units of Vitamin C taken once daily have shown to increase absorption of iron sulphate.

Education.

i)Diagnosis.

Inform the patient that his symptoms are indicative of diabetes. The increased passing of urine is because of increased urine production, which reflects the body’s attempt to excrete the extra glucose. This increased loss of fluids leads to an increased urge to replace the lost fluid resulting in the increased thirst. The elevated blood glucose levels are also responsible for the fatigue being experienced. The excess weight gain is because of increased food uptake resulting in elevated glucose levels that are deposited in tissues as fat causing the weight gain.

ii)Medication.

Metformin used acts as a metabolic inhibitor and causes a change in energy breakdown to glucose, thus lowering the blood glucose levels. The drug is the mainstay treatment of type 2 diabetes. The drug however has several side effects that include the risk of hypoglycaemia, abdominal discomfort, upper respiratory tract infections, physical weakness, diarrhoea, reduced levels of Vitamin B-12 and lactic acidosis (Sanchez-Rangel et al., 2017). Acarbose is another drug used for type two diabetes. It works by slowing down the action of chemicals responsible for the breakdown of food to produce glucose and consequently stops a sudden spike in blood glucose after a meal. The drug, however, has several side effects that include abdominal discomfort, diarrhea, bloating. Other side effects which are rare include rectal bleeding, unusual fatigue, yellowing of the eyes and darkly colored urine.

Ferrous sulphate is used to counter iron deficiency anemia. These medications work by replacing body iron. Iron is essential for the production of red blood cells. Some of the side effects associated with ferrous sulphate include constipation, diarrhea, dark stools, gastrointestinal irritation and obstruction (Pereira et al., 2018). Gastrointestinal hemorrhage and perforation may occur in some rare instances. It is therefore vital to monitor for the emergence of these side effects and inform the healthcare professional.

iii)Diet.

The patient should consume a diet comprising of non-starchy vegetables such as broccoli, carrots, peppers, tomatoes and other green leafy vegetables. Starchy vegetables such as potatoes and corn are also highly recommended. Patient should also be advised to take fruits such as oranges, lemons, apples and berries. Grains including wheat and rice are also highly recommended. Lean meat, eggs, fish and nuts among other rich protein sources are also recommended (Tan, 2019).

Green leafy vegetables, liver and seafoods are recommended to counter the anemia. Patient should also take plenty of water. It is critical for the patient to alter his diet as he is obese. He should take meals at regular intervals and avoid snacking. Losing between ten and fifteen pounds can go a long way in managing the patient’s weight for better outcomes. A good diet plan coupled with regular exercise can go a long way in enabling the patient lose weight.

iv)Exercise.

Diabetes predisposes most patients to cardiovascular disease. Cardiovascular exercises also referred to as aerobic exercises are highly recommended in diabetes patients. These exercises include walking, swimming, cycling, jogging and dancing. It is recommended that the patient completes about thirty minutes of moderate to vigorous intensity exercise for at least five days in a week (Liguori, 2020). This helps in lowering the body weight and regulating the blood pressure.

v)Warning Signs of Diagnosis.

If left unchecked, the diabetes may result in cardiovascular disease, damage to the nerves, kidney injury, eye damage which may potentially cause blindness, and damage to the feet causing serious infections in the case of cuts or blisters. Other complications that may emerge include hearing impairment and increased risk of developing Alzheimer’s disease that may lead to depression. As observed by Clare (2017). anemia left unchecked can cause cardiovascular complications. Prolonged metformin use can lead to lactic acidosis which is a serious condition characterized by lactic acid accumulation in the blood. Prolonged use of ferrous sulphate leads to gastric hemorrhage and perforation which can predispose one to sepsis, malnutrition, adhesions and bowel obstruction, delirium and in the worst-case scenario, multiorgan failure.

Referral.

            An endocrinologist is key in helping the patient with his treatment plan. An ophthalmologist may also be needed since individuals suffering from diabetes regularly experience complications with their eyes including cataracts, glaucoma and diabetic neuropathy. A nephrologist is needed as diabetic patients are predisposed to developing kidney complications. A dietician will help with recommending the appropriate diet for the patient.

Follow up.

            It is advisable for the patient to visit the healthcare professional after one month. This is to ensure that the patient has been compliant to his medication and has adhered to his diet and exercise plan. Studies such as that of Li et al. (2020) among others have shown that a number of patients are often non-compliant and it is therefore critical to see them regularly in order to educate them about their condition and further assess their compliance.

Assessment of comorbidities.

It is critical to first confirm and classify the diabetes the patient has. Next is to detect any complications and potential comorbid conditions that may arise from the diabetes. As Norhammar et al. (2019) observes, it is important to review the previous treatment and risk factor control in patients with established diabetes. After these steps, one can then begin to engage the patient with the goal of formulating a care management plan to enable provision of continuing care.

Medication Cost.

Topol (2019) estimates that individuals suffering from diabetes incur an average cost of 16732 dollars annually in medical expenditure. This cost is distributed among inpatient hospital care which uses around 30%, and prescription medications which translate to about 30% of the total cost. Further, antidiabetic agents and doctor office visits account for 15% and 13% of the total cost respectively.

Conclusion

Diabetes incidence has gradually increased over the years due to sedentary lifestyles. Diabetes is associated with several complications including cardiovascular injury, kidney damage and damage to the eyes. It is therefore critical to prevent and manage diabetes in order to avoid the complications it is associated with and also to reduce the cost of management which is quite high. Adoption of a good diet plan and regular exercise helps to prevent the development of diabetes and also helps in management of those with diabetes and consequently reduces complications.

References.

  • American Diabetes Association. (2017). 2. Classification and diagnosis of diabetes. Diabetes care, 40(Supplement 1), S11-S24. https://doi.org/10.2337/dc17-S005
  • Clare, E. (2017). Brilliant imperfection: Grappling with cure. Duke University Press.
  • Hakim, A., De Wandele, I., O’Callaghan, C., Pocinki, A., & Rowe, P. (2017, March). Chronic fatigue in Ehlers–Danlos syndrome—Hypermobile type. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1), 175-180. https://doi.org/10.1002/ajmg.c.31542
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