Patient Case Studies: Diabetes Medication Management

Patient case study
As while I was working on MMT working in the ward this was the only opportunity where I
could speak to the patients about their medications. I found this rotation the most useful
chance to do this as I would be talking to the patient about their medication history and if
they know what they are using their medication for.
As my first patient was a diabetic patient which was 63 years of age. He was currently using
tablets to control his diabetes. They were already using two separate medications which was
both tablets at the time. Metformin and gliclazide. He was admitted into hospital as he was
brought in by a family member he lives with as he had complaints of feeling dizzy and light
headed. He had these symptoms for a week. He also mentioned to me it felt like when he
found out when he was first diagnosed with diabetes. He currently is using metformin twice a
day and gliclazide once daily. As it seemed as the medication wasn’t controlling his diabetes.
He also told me he doesn’t go to his diabetic review appointments at his gp often. I advised
him that these appointments are important and also referred him about lifestyle advice while
having diabetes. This was to do with diet (Horsburgh, 2019).
As when the patient came into hospital his blood level was also too high. I gained this
information via his notes and handover sheet which I can gain access to on the ward. As the
patient came in as a diabetes type 2 patient. He was later diagnosed type 1 diabetes as his he
also confirmed that he did not follow the lifestyle change advice that he was advised by his
local gp.
The patient was prescribed insulin while on the ward, while his blood was still being
monitored. The insulin which was prescribed was novorapid flexpen. As when it was
prescribed for the ward the nurses on the ward will be administering to the patients. The dose
of novorapid will always change as it depends on the patients’ blood levels. This was checked
daily on the ward by the nurses. Three days once the patient was on the ward and receiving
the insulin and his condition started to become more stable. Me and the ward pharmacist

prepared the TTA for the patient to prepare them to go home. When we prepare the TTA
insulin we label the any insulin we dispense without the instructions of how many they
should inject as this will always change depending on the patients’ blood results which they
are able to check at home after being discharged. We also included all of the information that
was needed for the doctor’s discharge summary for the patient and with the valid medication
they left the hospital with.
The patients regular was not changed as they still continued taking the metformin and
gliclazide while starting the new medication novorapid. All of this information was given to
their regular GP (Degner, 2018).
Metformin is defined as a diabetic drug that is used in order to prevent the increasing
scenarios of the risk factor with diabetes. Metformin has been the mainstay of therapy that is
associated with diabetes mellitus for a number of years. Moreover, it is also analysed that
they have various mechanistic properties and that show action in order to prevent the causes
and symptoms of diabetes. The mechanistic aspect of metformin action remained ill-defined.
In addition to this, various advance studies indicate that the drug has their mode of action and
clinical implications that is useful in order to reduce the rising cases of diabetes among the
people. In addition to this, it is analyzed that the glucose-lowering action is performed by
metformin which is specifically promising the specifically targeting metabolic differences
that is associated between normal and abnormal metabolic signaling. To do this, the
knowledge which is usually acquired in order to meet the mechanism with the help of
metformin works that help to formulate a particular treatment which is called Novel
treatment. The centre of the metformin mechanism of action is to alter the metabolism which
is based on the energy formation within the cell. The metformin usually exerts its prevailing
glucose-lowering effect by restricting the hepatic gluconeogenesis and completely opposing
the action of glucagon. In addition to this, the restriction of mitochondrial complex results in
order to create defective AMP and protein kinase signaling in the action to glucagon.
Therefore, the secretion of 5-AMP activated protein kinase are usually dispensable for the
glucose-lowering effect of metformin (Kalafat,, 2018). They usually confess the insulin
sensitivity that mainly focus on modulating lipid metabolism. In addition to this, the make
form might influence the tumorigenesis directly or indirectly with the help of systematic
reduction of insulin level in the body. While taking the aspect of direct way, they are usually

creating induction of energetic stress. In addition to this, it shows the effect that requires for
the investigation that create an understanding of the anti-gluconeogenic action of metformin
within the liver and show various implications of metformin target for the treatment of the
diabetic patient and in the cancer cells.
Gliclazide is a drug which is usually used in the treatment of diabetes with a combination of
metformin. It is useful in order to reduce the complications and risk factors which may be
created during the diabetes or in cancer. Moreover, the drug is a sulphonylurea with an
intermediate half-Life of around 11 hours. They are extremely metabolized and shows that
renal clearance account for only 4% of the total drug clearance. Various studies show the
various mode of action and mechanisms aspect that is relative with the molecules which is
contained and the Azabicyclo-octyl group which consist of some special properties of the
aspect on the basic sulphonylurea moiety. In addition to this, the drug stimulates insulin
secretion through the beta cell of the sulphonyl urea receptor and they show a direct effect on
intracellular calcium transport channels. Moreover, they show their mechanism property in
the normal way by creating some of the physiological alterations in the calcium factors that
they are responsible for the transportation. They show their significance by improving the
abnormal first phase of insulin release in type 2 diabetes and also show the various necessary
effect on the second phase of secretion. The pattern of the secretion of insulin is usually
explained with the help of lower incidence of hypoglycaemic episodes and weight gain
compared with some other sulphonylurea. There is a wide range of reduction in hepatic
glucose production and improvement in the glucose clearance without changing any factor
within the insulin receptors. It is also recommended that the post-receptor effect on insulin
action is generated by the release of hepatic fructose 2-6 diphosphatase and muscles glycogen
synthase. Gliclazide usually minimizes the platelets addition, hyperactivity and increases the
fibrinolysis within the body. These actions are independents on their hypoglycaemic activity
that may be useful for the drug in order to highlight the progression of diabetic
microangiopathy (El-Baz, 2021).
Novorapid is also a drug that is usually used for the treatment of diabetes. While taking the
contrast of the case study, the drug is recommended after the change in the formation of the
combination of metformin and gliclazide. The novorapid shows various therapeutic
indication for the treatment of diabetes mellitus in adults, adolescents, and children age 1 year
and above. Moreover, the major mechanism of action that is associated with the novorapid is
recognised for the treatment in adults, adolescents, and children who has faced the issues of