Question

Franky, a 40 year old female patient, has been diagnosed with T2DM. She was not aware that she had any medical problems until she went for a physical. Her blood glucose test results were above 300 and her HgA1c is above 15.

1. What symptoms do you think may have been present that she might not have realized were important?

2. What role do diet and exercise play in control of glucose levels with this type of diabetes?

3. Can Franky expect to take insulin for this type of diabetes? Explain why or why not.

4. Other than insulin, what other classes of medication might be used?

5. If Franky were to become pregnant, can oral diabetic medications be used during pregnancy for gestational diabetes? Explain why or why not.

Answer 1

1. SYMPTOMS - she might neglected tiredness, headache, itchy skin, polyuria, polyphagia, and polydypsia

2. DIET & EXERCISE-

a. Diet

• the diabetic client's diet should into account weight,medication, activity level, and other health problems
• day - to - day consistency in timing and amount of food intake helps control blood glucose level.
• as prescribed by the HCP, the client may be advised to follow the recommendations as per the dietary guidelines. use the effective use of choose my plate.
• carbohydrate counting may be a simpler approach for some clients; if focuses on the total grams of carbohydrates eaten per meal. the client will be more compliant with carbohydrate counting, resulting in better glycemic control; it is usually necessary for clients undergoing intense insulin therapy.
• incorporate the die into individual client needs, lifestyle and cultural and socioeconomic patterns

b. Exercise

• Exercise lowers the blood glucose level, encourages weight loss, reduces cardiovascular risks, improves circulation and muscle tone, decreases total cholesterol and triglyceride level, and decreases insulin resistance and glucose intolerance.
• instruct the client in dietary adjustments when exercising; dietary adjustments are individualized. if the client requires extra food during exercise to prevent hypoglycemia it need not be deducted from regular meal plan.
• if the blood glucose level is higher than 250mg/dl and urinary ketones are present, the client is instructed not to exercise until the blood glucose level is closer to normal and urinary ketones are present.

3. TREATMENT

The main treatment plan for type2 diabetes mellitus are self care and oral hypoglycemic agents.

Treatments include diet, exercise, medication and insulin therapy.

Mostly Oral hypoglycemic agents are prescribed for clients with type 2 diabetes when diet and weight control therapy have failed to maintain satisfactory blood glucose levels.

Insulin is used to treat types 1 and 2 diabetes mellitus when diet, weight control therapy and oral hypoglycemic agents have failed to maintain satisfactory blood glucose levels.

4. other classes of medications - oral hypoglycemic agents

• sulfonylureas- e.g Glimepride
• Biguanide - e.g Metformin
• alpha- Glucosidase inhibitors- e.g Acarbose
• Thiazolidinediones- e.g. Pioglitazone
• Meglitinides- e.g. Nateglinide
• Gliptins - e.g Sitagliptin

5. oral hypoglycemic agents were considered to increase the potential fetal teratogenicity and hypoglycemic effects on the fetus that lead to contraindicate its use in pregnancy complicated with either type 2 DM or gestational DM. But majority of the studies suggests that oral hypogycemic agents such as glyburide and metformin as compared to insulin is the best choice. they are a natural choice because they improve insulin sensitivity or secretion. it also seems natural to use them in combination, glyburide being added to metformin if needed