Uncontrolled Diabetes Mellitus of Patient CJ

Uncontrolled Diabetes Mellitus of Patient CJ

Specific goals for pharmacotherapy for treating C. J.

Since patient C. J. has uncontrolled diabetes type II, the key goals of treatment are to control the patient’s glycemia and achieve glycemic control. This is done by reducing the blood glucose levels to within the desirable levels and a resultant reduction in the HbA1c levels. Another goal is to reduce the risk of diabetic complications such as cardiovascular disease and neurologic damage. Hyperglycemia is the main factor in the development of these complications (Khardori, 2021). Due of the patient’s uncontrolled diabetes, it is possible that in combination with her post-menopausal state, this may have caused neuropathy of the bladder neurons which increases the risk of developing urinary incontinence. In this regard, another goal of therapy for this patient would be to achieve urinary continence and improve her quality of life. Also, long term therapy with metformin can cause vitamin B12 deficiency which may present as neuropathy. With this in mind, another goal would be to alleviate potential symptoms of neuropathy. Finally, it is important to control the patient’s blood pressure. As Khardori (2021) observe, hypertension and diabetes occurring together increases the chances of developing diabetes associated complications.

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Qaseem et al., (2018) state that the target HbA1c levels in type 2 diabetes patients ought to be between 7% and 8%. With this high target, the objective is to help patients avoid the adverse effects of stricter such as low blood sugar while benefitting from glycemic control. Early initiation of pharmacotherapy improves glycemic control and reduces tor alleviates the risks of further complications.

Drug therapy a CNP would likely prescribe and why.

Currently, the preferred pharmacologic intervention for type 2 diabetes is Metformin. Since the patient is already on metformin, a CNP can continue the patient on metformin as long as it is well tolerated. A CNP can also prescribe insulin injections because of the patient’s high HbA1c level of 12. Many type II diabetes patients eventually require insulin therapy after disease progression overcomes the effect of oral agents. The American Diabetic Association (ADA) (2019) recommends that insulin should be started as soon as there is evidence of hyperglycemia, symptoms of hyperglycemia or HbA1c level of more than 10%. The patient will therefore be on combination therapy of both metformin and insulin.

The ADA further recommends the use of basal insulin (NPH) for control of fasting glucose. The recommended dose is 10 units a day. For hypertension, the CNP could maintain her on hydrochlorothiazide. For neuropathy, the CNP could prescribe methylcobalamin (Kamath & Pemminati, 2017). This is the most bioavailable form of vitamin B12. Alpha adrenergic agonist such as Midodrine can improve symptoms of incontinence since they increase the intrinsic urethral tone (Bientinesi & Sacco, 2018).

Parameters for monitoring success of the therapy.

The patient’s blood glucose should be assessed daily to monitor the progress of therapy. The patient’s HbA1c should be checked after three months to make sure it is below 7%. Also, the patient’s blood pressure should be checked regularly to make sure it is within the acceptable range of less than 130/90 mmHg for a diabetic patient. The patient can also be asked if she has any symptoms of neuropathy or if she experiences incontinence.

Health promotion recommendations you would consider for C. J.

The patient should be comprehensively educated and involved when introducing insulin management. The main areas of focus would be diet and self-monitoring of glucose. The patient should be taught on how to self-titrate insulin doses based on her blood glucose levels. She should be able to self-monitor her blood glucose in order for this to be successful. The patient should watch her diet and avoid food which have a high glycemic index such as wheat, rice, and sugar, among others. The patient should also reduce the amount of coffee she consumes per day as the caffeine in coffee has a diuretic effect and also can cause irritation of the bladder. This can worsen urinary incontinence (Corcos et al., 2017). The patient should also do pelvic floor (Kegel) exercises to strengthen the pelvic floor muscles. This will help minimize urine leakage and control bladder action more efficiently.

Uncontrolled Diabetes Mellitus of Patient CJ References

American Diabetic Association. (2019). 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes. Diabetes Care, 42(Supplement 1). https://doi.org/10.2337/dc19-s009

Bientinesi, R., & Sacco, E. (2018). Managing urinary incontinence in women-a review of new and emerging pharmacotherapy. Expert Opinion On Pharmacotherapy19(18), 1989-1997. doi: 10.1080/14656566.2018.1532502

Corcos, J., Przydacz, M., Campeau, L., Gray, G., Hickling, D., Honeine, C., Radomski, S. B., Stothers, L., Wagg, A., & Lond, F. (2017). CUA guideline on adult overactive bladder. Canadian Urological Association Journal11(5), E142–E173. https://doi.org/10.5489/cuaj.4586

Kamath, A., & Pemminati, S. (2017). Methylcobalamin in vitamin B12 deficiency: To give or not to give?. Journal of Pharmacology and Pharmacotherapeutics8(1), 33-34. https://dx.doi.org/10.4103%2Fjpp.JPP_173_16

Khardori, R. (2021). Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia. Retrieved from https://emedicine.medscape.com/article/117853-treatment#d20.

Qaseem, A., Wilt, T. J., Kansagara, D., Horwitch, C., Barry, M. J., & Forciea, M. A. (2018). Hemoglobin A1C targets for glycemic control With Pharmacologic therapy for Nonpregnant adults with type 2 Diabetes MELLITUS: A Guidance statement update from the American College of physicians. Annals of Internal Medicine, 168(8), 569. https://doi.org/10.7326/m17-0939