Respond to the 2 following discussion posts: Citations: At least one high-level scholarly reference in APA per post from within the last 5 years.
1. [Paige Coffee] The presentation of a patient with new onset diabetes or type two Diabetes requires the advanced practice nurse to be diligent. There is a lot of education that the patient requires and needs to successfully manage their new illness. The goal should be to reach their highest level of wellness, and possibly reverse their condition. Providing all the required information at once can be overwhelming so it is important to set up a series of appointments and provide referrals to nutritionists for example to help the patient to learn and decrease their risk of atherosclerosis and cardiovascular diseases.
Initial medications that this patient can take in combination with lifestyle and diet changes will help to protect her wellness and through proper management achieve her goal of not requiring insulin injections. A first line drug that works well is metformin extended release 500mg by mouth twice daily (Micromedex, 2022). The brand name for this medication is Glucophage and its class is a biguanide. This is the first line treatment recommendation for new onset diabetics. The risks of this medication should be discussed with the patient which include diarrhea, gas, nausea, vomiting, indigestion, abdominal discomfort, anorexia, headache, rash, and ovulation reduction (Micromedex, 2022). It is important to explain this medication works by reducing the amount of hepatic glucose production and intestinal absorption and increasing the sensitivity to insulin itself (Micromedex, 2022).
When the patient returns in the following month with complaints of fatigue, dry hair and nails, constipation, and heavy irregular menstruation it is important to order the necessary lab work to create a differential diagnosis. Hyperthyroidism would not be suspected here as it typically presents with increased and or irregular heartbeat, palpitations, weight loss despite increased appetite, nervousness, anxiety, and or irritability (Hyperthyroidism – Symptoms and Causes – Mayo Clinic, 2020). The lab work that should be ordered should include a TSH, T4,T3, TGB, Auto-antibodies, thyroid ultrasound, ECG, and VBG (Hypothyroidism, 2019). Hyperthyroid would show low TSH High T3 and T4 (Hypothyroidism, 2019, Table 4.2). Hypothyroidism is the exact opposite. Initial treatment for hypothyroidism should be levothyroxine which should be started at a concentration of 1.7-15 mcg/kg/day until therapeutic dose is found (Micromedex, 2022). The mechanism of action for this medication is synthetic thyroid hormone (T4). This medication is known by brand name as Synthroid, it should be taken by mouth once daily. It is important to explain to the patient that this medication must be taken exactly as directed and that changes in health should be immediately reported, around .1 percent of the population especially older adults can have the adverse effect called myxedema coma (Hypothyroidism, 2019). They should watch for symptoms as should their family that include feeling cold and a body temperature of 95.9 or less, bradycardia or slow heart rate, low blood pressure, decreased respiratory rate, upper airway obstruction, unusual behavior, or coma (Hypothyroidism – Symptoms and Causes – Mayo Clinic, 2020).
It is important to continue to order serial lab work and patient follow-up appointments. Monitoring both the patients A1C and thyroid levels to determine that therapies are effective. The patient should be asked if they have continuing symptoms or new symptoms to determine if therapeutic levels have been achieved. Caring for people with multiple comorbidities is important to understand that they are new to these processes and treatments, and continued appointments helps to determine medication compliance and effectiveness.
Hyperthyroidism – symptoms and causes – mayo clinic. (2020, November 14). Mayo Clinic. Retrieved March 30, 2022, from https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659
Hypothyroidism – symptoms and causes – mayo clinic. (2020, November 14). Mayo Clinic. Retrieved March 30, 2022, from https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20373659
Hypothyroidism. (2019, December 17). WikEm. Retrieved March 30, 2022, from https://wikem.org/wiki/Hypothyroidism
Micromedex. (2022, February 13). (Version 3.1.1) [Mobile app]. Google Play Store. https://www.ibm.com
2. [Nuray Gercek] Week 5: Discussion Question – Case Study
Q1. Which classes of diabetes medications are either weight neutral or cause weight loss? Please give one (1) example of a drug’s generic and trade name in that class.
The class of Biguanides: Metformin, Fortamet, Glucophage, Glumetza, Fiomet can help with weight loss due to their adverse effects of decreased appetite, nausea, and diarrhea (Rosenthal