Question

Maria is a 46-year-old woman who presents for her yearly physical examination. Her medical history is notable for mild depression and moderate obesity. Six months ago her fasting lipid profile was normal. Maria report that her mother and brother have diabetes and hypertension. She reports that she knows she should be on a low calorie, low fat diet and exercising but with her full-time job and four children, she finds it difficult to exercise, and she eats out most of the time. She is 67" tall and weighs 225lbs today, no current medication. She does report taking a multivitamin daily but still feels tired, biotin Vit-C when she remembers. She is a nonsmoker, only drinks sweet tea with each meal, 3-4 cups of coffee per day. Today: BP 120/70 mm Hg, pulse 76, temperature 98.7, respirations 18, weight 225 pounds. Urine dip + glucose, fasting plasma glucose 179 mg/dl, HgbA1C is 7.4%, TSH 5.6. The physical exam is notable for acanthosis nigricans at the neck but otherwise is normal. What are your treatment goals for Maria? What is your plan for drug therapy? What is the mechanism of action for each drug? Please give five teaching points for each drug prescribed. How would you change the plan if her initial HbgA1C was 10.2mg/dL and her fasting blood glucose was 305mg/dL? Provide a detailed alternative plan with the rationale.

Answer 1

Answer :

Treatment goals of Maria are :

* we need to advise the anti hyperglycemic agents,  those are tab. Metformin is the first drug of choice for type 2 diabetes mellitus, which will decreases the glucose production in the liver. And body get sensitivety to insuline and the works more effectively.

* here the patient is having type 2 diabetis mellitus, because fpg is 179 mg per dl.

* and HBA1C is 7.4 % it indicates she is having diabetes mellitus.

* and thyroid medications should be start, because she is having hypothyroidism that is the value of TSH is 5.6.

here patient is having high TSH. It indicates patient is having hypothyroidism due to interactive of thyroid gland.

* Tab : levothyroxine daily od per oral, should advises.

Mechanism of action of Metformin :

It is an anti hyperglycemic agent , it decreases the hepatic glucose production and decreases the intestinal absorption, of glucose and improves insuline sensitivity by increasing peripheral glucose uptake and utilization.

Mechanism of action of Levo thyroxine :

It is a synthetic form of thyroxine , it is secreted by thyroid gland which is converted to its active metabolite, L triiodo thyronine.

Teaching points :

Metformin :

* they have to take at before taking meals,

* if any giddiness and any another side effects advice to consult doctor immediately.

* regular monitoring of glucose levels should be done.

* regular exercises should be done along with medicine taking.

* avoid to take high carbohydrate diet.

Levothyroxine :

* It is also should be taken at morning time.

* educate to abserve for any side effects or problems.

* regular health check ups must be there at doctor.