You are seeing a 64-year-old Hispanic male for his diabetes management.

You are seeing a 64-year-old Hispanic male for his diabetes management.

You are seeing a 64-year-old Hispanic male for his diabetes management. He reports that his morning

capillary blood sugar readings are ranging in the 150 to 190 range.

Last month his Hgb A1C was 7.4

He is on Metformin 1000mg twice a day and Glipizide 5mg daily.

He walks a couple miles three to five times a week.

A dietary review reveals that his daily total carbohydrate intake is in the range of 75 to 100 grams.

Last eye exam did not reveal any problems. He wears reading glasses when needed.

He does report some intermittent burning sensation in his feet.

Ht 6’2”, Wt 200 lbs, BP 118/72, P 72, R 17

Heart regular rhythm, without murmur or gallop

Lungs clear

Monifilament testing does not reveal any decreased sensation in the feet

Subjective (S): The patient is a 64-year-old Hispanic male. He has come in for a scheduled office visit for

his diabetes medication management. The patient takes medications daily, but blood glucose levels in

the mornings are in the range of 150-190. The patient leads an active lifestyle and walks a couple of

miles 3 to 5 days per week. The patient reports that he maintains his carbohydrate intake between 75 to

100 grams per day. The patient takes 1000 mg of Metformin twice daily and 5 mg of Glipizide once daily.

The patient states this his last eye exam was routine, and he wears reading glasses when needed.

Patient reports some intermittent burning sensations in his feet.

(O): Hgb A1C 7.4 a month ago. Ht. 6’2”. Wt. 200 pounds. BP 118/72. Pulse 72. RR 17. Lungs clear.

Heart rhythm regular, no murmur or gallop noted. Monifilament testing does not reveal any decreased

sensations in his feet.

(A): Based on the patients’ morning blood sugars, his diabetes is not well managed due to his elevated

A1C and blood sugar levels. Based on the patients’ symptoms of burning sensations that he has diabetic

neuropathy.

(P): Therapeutics: Based on the patient’s lab results, his current medication regimen is not regulating his

blood glucose levels. The lowest dose of Metformin is 500 mg once or twice daily and the maximum

dose is 2550 mg (Arcangelo et al., 2017). The evening dose of Metformin will be increased to 1500 mg.

Patient will continue to self-monitor blood glucose in the morning. Patient will maintain a food diary for

each meal until the follow-up appointment. Hgb A1C will be rechecked in 3 months. Although the Hgb

A1C goal for most patients is generally less than 7% per ADA guidelines, a more stringent goal of 6.5%

may be established for some patients if there is no significant hypoglycemia or adverse effects (Woo &

Robinson, 2016). Neuropathic pain conditions do not react to analgesic medications since peripheral and

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You are seeing a 64-year-old Hispanic male for his diabetes management.

 

central triggers cause it. (Arcangelo et al., 2017). Gabapentin or pregabalin can be useful in controlling

the discomfort from neuropathy. (Arcangelo et al., 2017). Patient education will focus on understanding

the pathophysiology of diabetes and prevention of complications, and the role of lifestyle modification.

Consultation: Patient will be referred to a diabetes self-management education (DSME) program.

Follow-up with patient in 2 weeks to review blood glucose and food diaries. Hgb A1C recheck in 3

months. If the hgb A1C is still elevated, then practitioner will start patient on long-acting or

intermediate-acting insulin. Initial dose of LAI or IAI is administered in a single dose at bedtime or in the

morning; the typical starting does is 6 to 10 units or 0.1 to 0.2 units/kg of body weight/d (Woo &

Robinson, 2016).

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced

practice: A practical approach (4th ed.). Wolters Kluwer.

Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advanced practice nurse prescribers

(4th ed.). F. A. Davis.

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You are seeing a 64-year-old Hispanic male for his diabetes management.

**Creating Change Through Advocacy Template**

 

**Identified Problem or Concern:**

 

The problem identified is the suboptimal management of diabetes in a 64-year-old Hispanic male, leading to elevated morning blood sugar levels and symptoms of diabetic neuropathy despite current medication regimen and lifestyle modifications.

 

**Research on the Issue:**

 

Research indicates that diabetes management involves a multifaceted approach including medication therapy, lifestyle modifications, and patient education. However, despite adherence to medication and exercise, some individuals still experience suboptimal glycemic control and complications such as neuropathy.

 

**Advocacy Plan:**

 

**Advocating for Individualized Treatment Plans:** Advocate for healthcare providers to assess patients holistically and tailor treatment plans based on individual needs, considering factors such as age, ethnicity, comorbidities, and medication tolerance.

 

**Promoting Access to Diabetes Self-Management Education (DSME) Programs:** Advocate for increased accessibility and affordability of DSME programs to empower patients with knowledge and skills for effective diabetes management, including medication adherence, dietary modifications, and symptom recognition.

 

**Supporting Policy Changes for Reimbursement of Diabetes Education and Counseling:** Advocate for policy changes at the local, state, and federal levels to ensure reimbursement for DSME programs and diabetes counseling services by insurance providers, Medicare, and Medicaid, thereby promoting equitable access to essential diabetes education services.

 

**Raising Awareness about Cultural Considerations in Diabetes Care:** Advocate for culturally competent diabetes care by raising awareness among healthcare providers about the unique cultural beliefs, practices, and barriers to diabetes management among diverse populations, such as the Hispanic community, and promote strategies for culturally tailored interventions.

 

**Advocating for Research Funding:** Advocate for increased funding for diabetes research aimed at developing novel therapies, treatment strategies, and interventions to improve glycemic control, prevent complications, and enhance quality of life for individuals living with diabetes.

 

**Expected Outcomes:**

 

– Improved glycemic control and reduced risk of diabetes-related complications among patients receiving individualized, culturally competent diabetes care.

– Increased participation in DSME programs leading to enhanced self-management skills and improved health outcomes for individuals with diabetes.

– Policy changes resulting in improved reimbursement for DSME services, thereby increasing access to essential diabetes education and counseling for underserved populations.

– Heightened awareness among healthcare providers about the importance of cultural competence in diabetes care, leading to more patient-centered approaches and improved patient-provider communication.

– Advancements in diabetes research leading to the development of innovative therapies and interventions to address the evolving needs of individuals with diabetes.

 

**Conclusion:**

 

Through advocacy efforts focused on individualized care, increased access to DSME programs, policy changes for reimbursement, cultural competence in diabetes care, and research funding, positive changes can be achieved in diabetes management, ultimately improving the health outcomes and quality of life for individuals living with diabetes.

**Creating Change Through Advocacy Template**