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Posted: May 15th, 2023
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You have been following your patient for the past 2 years. You have worked with them to lose weight by changing lifestyle and nutritional habits. They continue to be overweight (body mass index [BMI] of 33) and have tried to cut down carbohydrate and fat intake, but now presents with polyuria, polydipsia, and an elevated random blood sugar of 164. You have ordered anHbA1c test in the past, and the values were less than 6.2%. However, the most recent test indicated an HbA1c greater than 7%. They are not on any medications, but does have a sulfa allergy.
You officially have enough evidence to officially start treating this patient for Type II Diabetes Mellitus. Their 3 P symptoms, their random blood sugar (BS), and A1C are all evidence ofT2DM.
Answer the following questions.
What is the first medication you would prescribe? Discuss how you determined which one to give first and how you based this decision on specific factors.
What education regarding medication management would you need to do?
__________________________
In this case, since the patient has a confirmed diagnosis of Type 2 Diabetes Mellitus (T2DM) based on their symptoms and elevated HbA1c, the first medication that is commonly prescribed is typically metformin. Metformin is an oral antidiabetic medication that is considered the first-line treatment for T2DM due to its efficacy, safety profile, and beneficial effects on cardiovascular outcomes.
The decision to prescribe metformin as the initial medication is based on several factors:
Efficacy: Metformin is known to effectively lower blood glucose levels by reducing hepatic glucose production and improving insulin sensitivity in peripheral tissues.
Safety: Metformin is generally well-tolerated and has a low risk of hypoglycemia when used as monotherapy. It is also associated with a lower risk of cardiovascular events compared to other antidiabetic medications.
Side Effect Profile: Given that the patient has a sulfa allergy, metformin is an appropriate choice as it does not contain sulfa compounds and is not contraindicated in patients with sulfa allergies.
Weight Management: Metformin can help with weight management, which is beneficial for overweight or obese individuals.
Regarding medication management education, you would need to discuss the following points with the patient:
Dosage and Administration: Explain how to take metformin, including the recommended starting dose, frequency of administration, and whether it should be taken with or without food.
Monitoring: Discuss the importance of regularly monitoring blood glucose levels using a glucometer and tracking the results. Emphasize the significance of maintaining glycemic control.
Side Effects: Inform the patient about common side effects of metformin, such as gastrointestinal symptoms like nausea, diarrhea, and abdominal discomfort. Advise them to report any severe or persistent side effects to their healthcare provider.
Hypoglycemia: Although metformin has a low risk of hypoglycemia when used as monotherapy, educate the patient about the signs, symptoms, and management of hypoglycemia, especially if they later require additional medications that may increase the risk.
Lifestyle Modifications: Reinforce the importance of continuing lifestyle modifications, including regular exercise, healthy eating habits, and weight management, as these are crucial for managing T2DM effectively.
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