Case Study Analysis: A Comprehensive Review of Diabetes Patient Care

This case study analyzes a 58-year-old diabetic patient presenting with uncontrolled blood sugar levels, weight gain, and a history of complications. The assessment includes vital signs, physical examination, and medical history, revealing a diagnosis of diabetes. The analysis evaluates the patient's current pharmacologic therapy (Novolin N and R, Bactrim DS), identifies potential drug interactions, and proposes additional pharmacologic interventions, including Carvedilol, to manage hypertension. Recommendations for non-pharmacologic therapies, such as lifestyle modifications and self-management strategies, are provided. Referrals to a nutritionist, physical trainer, and psychotherapist are suggested to address weight management, blood glucose control, and stress. Additional testing, including mental state and nutritional assessments, is recommended. The patient will be educated about diabetes, lifestyle risk factors, and medication adherence. Follow-up recommendations include regular evaluation of weight, medication logs, and blood glucose levels. References from credible sources are provided to support the analysis and recommendations.

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS
Name of the Student:
Name of the University:
Author Note:

1CASE STUDY ANALYSIS
Introduction:
This paper intends to critically analyse the provided case study and make use of the
evidence base to propose recommendations that could improve the overall health outcome of
the patient.
Assessment:
The general physical assessment of the patient states that patient weighs around 216.2
lbs and the height of the patient is documented to be 68”. The vital assessment of the patient
states that his blood pressure is elevated and has been documented to be 164/79. Further, the
respiratory rate is recorded to be 18, the heart rate has been reported to be 79 and the oxygen
saturation has been documented to be 97%. The body temperature of the patient has been
documented to be 97.1̊ F. The general assessment of the patient reveals that the patient is
normotensive and is devoid of any acute stress. The head to toes assessment states that that
head is devoid of any lesions and is normocephalic in appearance. PERRLA, EOM are
reported to be intact while assessing the eyes. Ear assessment suggest EAC’s are clear and the
TM’s are normal. Nose assessment reveals that mucosa is normal. Throat assessment has also
been reported to be clear with no presence of lesions or exudates. Neck assessment suggests
no presence of masses or bruits. Chest assessment reveals clear lungs with no rales, rhonchi
or wheezes. Heart assessment suggests normal respiratory rate devoid of murmurs, rubs or
gallops. Bilateral LE edema in 1+ ankle has been reported. Abdominal assessment revealed
soft, mild tenderness in the RUQ on palpating. Bowel sound was reported to be normal.
Assessment of the extremities reported amputation of the left toe and approximate 1x1 cm
left ball of foot stage 2 ulcer. No sign of discharge or infection was noticed. Skin assessment
suggested no presence of rashes or lesions and physiological assessment suggested no
localizing findings.

2CASE STUDY ANALYSIS
Diagnosis:
The case study reports symptoms that include significant weight gain within one year
up to 20+ pounds, frequent urination, experiencing numbness in feet and stress. In addition
to this, the previous medical history also suggested slow healing of a spider bite 10 years ago
on the left leg in the anterior tibialis region and a toe blister which advanced to sepsis and
MRSA osteomyelitis that eventually had to be amputated. The patient also reports
experiencing intermittent vertigo, intermittent RUQ pain, experiencing pain accompanied
with inflammation of the joints. The clinical investigation reports Glucose level to be 146,
LDL to be 71, LDL/HDL Ratio to be 2.09 and triglyceride level to be 78.
Upon considering the presenting symptoms, the previous medical history of the
patient and comparing it with the clinical investigation results, the diagnosis for Diabetes can
be confirmed. The evidence base suggests that the normal level of glucose in the blood during
fasting should be less than 100 mg/dL. The amount of blood glucose equivalent to or higher
than 126 mg/dL is treated as elevated and confirms the diagnosis of Diabetes (American
Diabetes Association, 2018). In addition to this, the evidence base suggests that elevation of
Glucose level in blood interferes with the normal wound healing process. Also, the symptoms
of frequent urination, hypertension, weight gain is directly associated with the diagnosis of
Diabetes (Zaccardi et al., 2016; Baynes, 2015).
Evaluation of current Pharmacologic Therapy:
The current prescribed medications include, Novolin N 100 unit.ml suspension 25
units BID, Novolin R 100 unit/ml subcu solution 25 units BID-TID meals and Bactrim DS
800/160 mg, 1 tab BID. The case scenario suggests that the patient had been under the
prescribed medication for the previous 20 years but the blood glucose level of the patient has

3CASE STUDY ANALYSIS
not been under control. The rationale for the prescription of Bactrim DS 800/160 mg can be
explained as prevention from the probability of a bacterial infection.
Evaluation of Possible Current Drug Interactions:
The evidence base suggests that Novolin R acts as a potential hazard that could lead
to renal dysfunction. Research studies mention that the requirement for Insulin could
potentially be diminished in patients who have a previous medical history or hepatic or renal
impairment (Drugs.com, 2019). The plausible cause for the same can be explained as poor
glucose metabolism and reduced mechanism ability to carry out gluconeogenesis. Research
studies also mention possible disease interaction triggering episodes adrenal insufficiency and
autonomic neuropathy (Drugs.com, 2019).
Plan:
Additional Pharmacologic Therapy Required:
Additional pharmacological therapy would comprise of prescribing Carvedilol for the
management of elevated blood pressure. Carvedilol is basically the combined formulation of
alpha /beta blocker and acts on the heart to reduce the blood pressure (Carvedilol, 2019). The
prescribed medication dose would include 3.125 mg twice daily for 2 weeks and the patient
would be advised to consume the drug with food so as to slow down the absorption of the
drug (Carvedilol, 2019). If the prescribed dose is tolerated well by the patient, the dose could
be increased to 6.25mg twice daily (Carvedilol, 2019). However, prior to initiating the drug,
the patient must be asked to reduce fluid retention. The rationale for the prescription of the
drug can be explained as its effect on reducing the blood pressure and no adverse drug
interaction with Novolin N and Novolin R. In addition to this the dose of Novolin R could be
changed to regular U-500 instead of 100 units/ml as it exhibits a longer duration of action
(Drugs.com, 2019).

4CASE STUDY ANALYSIS
Interactions of proposed additional therapies:
The prescribed medication are safe to be administered together and do not elicit
adverse drug interaction or any potential side effects as informed by the evidence base
(Drugs.com, 2019).
Recommendations for non-pharmacologic therapies:
Non-pharmacological therapies would include, training the patient self-management
strategies to control symptoms and make lifestyle changes such as diet management to
control the blood glucose level. In addition to this, other non-pharmacological intervention
would include training the patient to monitor his blood glucose level by using the glucometer
strips (De Boer et al., 2017).
Referrals:
In order to ensure symptoms management the patient would be referred to a
nutritionist and a physical trainer. The rationale for the referral can be explained as weight
management which would directly help to control blood glucose level and elevated blood
pressure level (Gabb et al., 2016). Other referral would include organising a referral to a
psychotherapist in order to alleviate the symptoms of stress.
Additional testing:
Referral to additional testing would include conducting a mental state evaluation
assessment for devising an appropriate intervention for stress and conducting a nutritional
assessment for developing an appropriate diet plan to optimise the blood glucose level
(American Diabetes Association, 2018).
Education/Counselling:

5CASE STUDY ANALYSIS
The patient would be educated about Diabetes and the lifestyle risk factors that result
in elevation of the blood glucose level (Reusch & Manson, 2017). In addition to this, the
patient would be made aware about the medication chart so as to ensure that the patient does
not skip medications as it would deteriorate the physiological effect of the symptoms.

6CASE STUDY ANALYSIS
Recommendations for follow up:
Recommendations for follow up would include evaluation of the body weight for six
months after implementing lifestyle changes such as making diet changes and adhering to
exercise routine (Reusch & Manson, 2017). In addition to this, the patient would also be
provided a medication log book which would be evaluated during the follow up which would
help to track whether the patient has consumed the medications regularly (Gabb et al., 2016).

7CASE STUDY ANALYSIS
References:
American Diabetes Association. (2018). 4. Lifestyle management: standards of medical care
in diabetes—2018. Diabetes Care, 41(Supplement 1), S38-S50.
Baynes, H. W. (2015). Classification, pathophysiology, diagnosis and management of
diabetes mellitus. J diabetes metab, 6(5), 1-9.
carvedilol, G. (2019). Coreg (Carvedilol): Side Effects, Interactions, Warning, Dosage &
Uses. [online] RxList. Available at: https://www.rxlist.com/coreg-
drug.htm#indications [Accessed 2 Aug. 2019].
De Boer, I. H., Bangalore, S., Benetos, A., Davis, A. M., Michos, E. D., Muntner, P., ... &
Bakris, G. (2017). Diabetes and hypertension: a position statement by the American
Diabetes Association. Diabetes Care, 40(9), 1273-1284.
Drugs.com (2019). Novolin R Disease Interactions - Drugs.com. [online] Drugs.com.
Available at: https://www.drugs.com/disease-interactions/insulin-regular,novolin-
r.html#hypoglycemia [Accessed 2 Aug. 2019].
Gabb, G. M., Mangoni, A. A., Anderson, C. S., Cowley, D., Dowden, J. S., Golledge, J., ... &
Schlaich, M. (2016). Guideline for the diagnosis and management of hypertension in
adults—2016. Medical Journal of Australia, 205(2), 85-89.
Reusch, J. E., & Manson, J. E. (2017). Management of type 2 diabetes in 2017: getting to
goal. Jama, 317(10), 1015-1016.
Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2016). Pathophysiology of type 1 and
type 2 diabetes mellitus: a 90-year perspective. Postgraduate medical
journal, 92(1084), 63-69.