Maria is a 46-year-old woman who presents for her yearly physical examination. Her review of systems is significant for fatigue, constipation and hair loss. Her previous medical history is notable only for obesity. She reports her understanding that she should be on a low calorie, low fat diet with moderate aerobic exercise 4-5 times per week but also notes that having a full-time job and four children makes this difficult to achieve.
She has NKDA and takes a multi-vitamin daily. Maria reports a family history of diabetes (mother) and hypertension (brother). She is a nonsmoker. Her diet largely consists of fast food meals. She drinks sweet tea with every meal and an additional 3-4 cups of coffee per day. Previous labs and exam last year are unremarkable.
Vitals today: BP 120/70 mm Hg, pulse 76, temperature 98.7, respirations 18, height 5’9”, weight 225 pounds. Urine dip + glucose, fasting plasma glucose 179 mg/dl, HgbA1C is 7.4%, TSH 8.5mU/L and Free T4 0.1 ng/dl. The physical exam i
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What are your treatment goals for Maria?
What is your pharmacologic plan and rationale? (cite with appropriate clinical practice guidelines or scholarly, peer-reviewed journals)
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.
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Case of Maria, a 46-year-old woman
Introduction
The case that is being presented is that of a 46 years old woman who has been presented to the physician for a health condition. The patient as at the time she is being presented to the physician is normotensive and has a blood pressure of 120/70. The patient is at risk of developing hypertension and since she has a family issue is that some have hypertension. She meets the criteria of being diagnosed with diabetes mellitus type 2 from the lab results that are presented. The hemoglobin level is greater than 6.5 and the fasting plasma is more than 126 a well as the addition of the lab work. The patient has a BMI of 36.4 which indicates that he is overweight.
Treatment goals for Maria
The diagnosis of the patient is type 2 diabetes and the treatment plan is as follows. There is a need for the patient to start using type 2 DM medication. The second thing that should be done is to have monitoring of HbgA1C and get comprehensive lab results, liver enzymes, and blood count. This is supposed to be carried out for the intention of reduction of weight and for addressing issues of acanthosis nigricans as argued by Karadağ et al. (2018)….
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