Question

K. W. calls the clinic several days later complaining of having the “flu”. She says that she has been nauseated and vomited once during the night. She sats she has had two loose stools. On questioning she states she does have a few hills and might have a low grade temperature but does not have a thermometer to check her temperature. She states she did not check her glucose level this morning or take her insulin because she has not eaten.

1. Describe the instruction that you need to give K.W. regarding the management of her illness and Diabetes Mellitus.

  

2. Write below how you would document the phone call with K.W. in progress note format.

Answer 1

Ans)

Adherence to therapy is defined as the extent to which a person’s behavior in taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider.

- Patients presenting with type 2 diabetes mellitus are initially encouraged to maintain a healthy diet and exercise regimen, followed by early medication that generally includes one or more oral antidiabetic drugs and later may include an injectable treatment.

- Recommended glycemic goals are achieved by less than 50% of patients, which may be associated with reduced adherence to therapies, and may lead to complications of diabetes over time.

- Adherence to long-term exercise programs can vary between 10% and 80%. Data from different studies show that adherence to oral hypoglycemic agents (OHA) ranged from 36% to 93% in patients remaining on treatment for 6–24 months. In retrospective insulin studies, adherence was 62% and 64% for long-term and new-start insulin users, respectively.

- Reasons for nonadherence to therapies include age, information, perception and duration of disease, complexity of dosing regimen, polytherapy, psychological factors, safety, tolerability and cost.

- Measures to increase therapy adherence in type 2 diabetes include reducing complexity by fixed-dose combinations and less frequent dosing requirements, using medications with improved safety profile, educational initiatives, improved patient-healthcare provider communication and social support, which may help to reduce costs.

- Follow your healthy eating plan. Take your medicines and check your blood glucose levels as usual. Tell your teachers, friends, or close coworkers that you have diabetes and teach them about the signs of low blood glucose. You may need their help if your blood glucose levels drop too low.