DIABETES

Clinical Management Plan

Clinical Management Plan (Diabetes)

Anonymised case identification:

AB

Medical history:

Uncontrolled type 2 diabetes

Hyperlipidemia

Peripheral neuropathy

Needle length 8mm

Current medication:

Avandia 10mg

Prandin 40mg

Glyburide

Atorvastatin

Presenting problem/s:

Obesity

Hypertension

Elevated urine Microalbumin level

Observations/Examinations/tests + results/findings :

Glucose (fasting): 178 mg/dl (normal range: 65-109 mg/dl)

Total cholesterol: 162 mg/dl (normal: <200 mg/dl)

AST: 14 IU/l (normal: 0-40 IU/l)

Alkaline phosphotase: 56 IU/l (normal: 35-125 IU/l)

Urine microalbumin: 45 mg (normal: <30 mg)

Prescribing/treatment decision :

Refer to a dietician

Review Patient's Lifestyle

medical nutrition therapy assessment

Reflection/discussion with mentor group:

lose weight

Improve exercise

Control glucose

Control carbohydrate intake

Part 2: Critical Justification (with Supporting Evidence)

A.B. has a five history of type 2 diabetes. He was initially diagnosed in 2005; he started to show symptoms of hyperglycaemia two year prior to diagnosis. When Mr. AB took initial diagnosis, his physician asked him to control weight (at least 8kg); however, no further treatment was provided.

Afterwards, AB was referred to physician by his family to medical clinic where he presented problems related to foot pain, suboptimal diabetes control and weight gain. AB has been working on weight reduction by increasing time for exercise in past six months. However, his efforts have been unsuccessful. As a result of dizzy feeling Mr. AB has stopped taking glyburide (Diabeta), which he was taking 2.5 mg each morning. He also felt mild agitation and experienced sweating during afternoon. He also takes Lipitor (atorvastatin) 10mg per day for hypercholesterolemia (Ahern et.al 1989, pp.15).

AB does not prefer testing his levels of blood glucose at home and expresses concern that this will not assist in improving his condition. He states that “knowing these numbers would not help me as the doctor already knows that my sugar level is high”.

Mr. AB's father and mother were diagnosed with type-2 diabetes and even then Mr. AB has inadequate knowledge about self-care (Clement 1995, pp.18). He also argues that he has never over used sugar than why does he has sugar. Previously, his wife advised him to treat his diabetes with weight loss supplements and herbal remedies and she also frequently surfs internet to search regarding diabetes and its remedies.

However, AB has tolerated his wife's advice and follows his daily schedule. In the past six months, AB has also used a “pancreas elixir”, gymnema sylvestre, and chromium picolinate in order to improve his diabetes condition. However, as he did not observe any positive results, he stopped taking these medications. Also in the past year, he has gained around 10kgs. His diet history shows heavy intake of carbohydrates in form of pasta and bread (Ahmann & Riddle 2002, pp.111). Mr. AB is diagnosed with type-2 diabetes (uncontrollable) with a set of multiple comorbidities. All of his problems require continuous treatment and monitoring.

According to the medical documents of AB, his haemoglobin A1C has never reduced below 8 percent. His blood pressure diagnosis at different occasions during the year, illustrates levels at 149-71, 147/91 and 165/87 mmHg, during last year at a local screening clinic. AB was told that his blood pressure was higher than normal, he was not told to keep it under 131/80 mmHg for renal health and cardiovascular ...