You have been following Mr. Miller for the past 2 years. You have worked with hi

Question

You have been following Mr. Miller for the past 2 years. You have worked with him, trying to get him to lose weight by changing his lifestyle and nutritional habits. He continues to be overweight (body mass index [BMI] of 33) and has tried to cut down his carbohydrate and fat intake, but now presents with polyuria, polydipsia, and an elevated random blood sugar of 164. You have ordered an HbA1c test in the past, as he is at high risk for diabetes, and the values have been less than 6.2%. However, his most recent test indicated an HbA1c greater than 7%. You diagnose him with type 2 diabetes mellitus and talk to him about medications.

1. What is the first medication you would prescribe? Discuss how you made decisions as to determine which one to give first and base it on specific factors. 2. What education regarding Mr. Miller’s medication management would you need to do? Think of motivational interviewing to help set personalized goals.

Explanation / Answer

1. Mr.Miller can use Metformin as a first drug of choice because

                     * he is a obese patient with sugar of 164mg/dl (Type 2 DM).metformin is a drug which

                       does notcause weight gain and it reduce appetite and make patient euglycemic so it is

                       useful for him.

2. Education about millers medication management

                    * Diabetic melitus type 2 is a controllable lifestyle disease with regular exercise,dietry

                      mordifications and drugs so without being anxious try to adapt new changes.

                   * Metformin taken along with meals to reduce stomach or bowel effects occur during

                      first week of treatment.

                  * You will get improvement of blood sugar control in 2 to 3 weeks and complete control

                    need two to three months so follow doctors instructions.

                  * Fiber rich foods like fruits,vegetables,legumes and fish can include in preparing a diabetic

                    diet plan.

                  * Avoid use of saturated fats and sugar containing foods(cheese,butter,ice chocholate).

                  * Regular check up as per doctors order needed to know current sugar level.

                   * Daily spend 1 or 2 hour for exercise which enhance body metabolism and reduce

                      blood sugar level if needed seek help of a body weight planner.

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