Clinical Problem and Clinical Goals
Manjeet’s main clinical problem is Type II Diabetes. This disease influences the level of glucose and sugar in the blood. In addition, she is overweight. Such clinical goals to control glucose level, prevent cardiovascular problems and lose weight are established.
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Type II Diabetes and overweight are the problems that have to be treated with the help of non-pharmacological interventions. The patient may improve her overall health and meet the clinical goals by changing her diet and practicing physical activities. Physical activities including fresh air walks or swimming have to be properly supervised (Kirkman et al., 2012). Diets and a number of calories have to be discussed with a nutritionist. These interventions should make the patient feel better and avoid cardiometabolic risks.
Clinical Practice Guideline
International Diabetes Federation (2017) introduces the clinical practice guideline for managing Type II Diabetes in primary care. The latest published guidelines for T2D patients from different parts of the world were used and strengthened by the use of multiple databases, including Medline, Embase, and SciELO where different clinical trials and studies were discussed. A consensus meeting in Brussels in March 2015 was organized to discuss the information for the final version of the guidelines. Diabetes is a global issue, and the chosen guidelines are effective for people with T2D anywhere in the world (International Diabetes Federation, 2017). There are nine sections with 3-10 questions for discussions to manage this disease.
Metformin is one of the most frequent drugs to treat patients with T2D (International Diabetes Federation, 2017). It belongs to the biguanide class. Metformin is usually offered as first-line therapy for female patients (American Diabetes Association, 2014; Kirkman et al., 2012). Oral medication and lifestyle changes are the best treatment for adult patients.
Metformin dose may vary from 500 to 2000 mg per day (International Diabetes Federation, 2017). For example, it is possible to use 1000 mg of metformin as the first dose, and then it can be reduced to 500 mg two times per day (Kirkman et al., 2012). If no negative reactions are observed, a stable dose is 1000 mg per day.
According to the International Diabetes Federation (2017), the phenotype of a patient influences the choice of the first drug. However, metformin has been defined as one of the best options for overweight people for ages. This drug can be offered for patients of different ages and races and may be an effective supportive decision for patients who have to follow non-pharmacological treatment, change their lifestyle, and keep to new diets (American Diabetes Association, 2014). Metformin is the choice of millions of patients with T2D and their doctors in the world.
Metformin’s low cost is one of the main benefits of this drug for many patients (Kirkman et al., 2012). In Walmart, it is possible to buy 60 tablets of metformin (500 mg) for $4 with no coupons available. Target sets the price of $8, but it is possible to use free coupons.
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The efficacy of the chosen medication can be monitored through the changes in blood sugar levels. If metformin intolerance is observed, the drug should be immediately replaced (International Diabetes Federation, 2017). Still, the patient has no allergies, and metformin may be a good option for her to rely on.
Nausea, vomiting, and diarrhea can be observed. Weight changes are expected. Trouble breathing may challenge the patient. Still, all these effects usually disappear with time.
Metformin and ethanol interaction may cause lactic acidosis. It is necessary to avoid diatrizoate and iodamide due to their contrast agents. Interactions with iohexol should be controlled through X-rays and scanning.
- The importance of lifestyle changes should be explained.
- Family involvement is important for the established appropriate beliefs and attitudes (International Diabetes Federation, 2017).
- Regular control and monitoring cannot be neglected.
American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(1), 81-90.
International Diabetes Federation. (2017). IDF clinical practice recommendations for managing Type 2 Diabetes in primary care. Web.
Kirkman, M.S., Briscoe, V.J., Clark, N., Florez, H., Haas, L.B., Halter, J.B., … Swift, C.S. (2012). Diabetes in older adults. Diabetes Care, 35(12), 2650-2664. Web.