Nu636DMmanagementpeerresponse#1

Subjective

Chief Complaint: Diabetic management.

64-year-old Hispanic male. Reports morning blood glucose readings ranging from 150-190. Previous medical history includes an A1C of 7.4. He is taking metformin 1000mg twice a day and glipizide 5mg daily. Exercise includes walking 1-2 miles 3-5 times a week. Last eye exam showed no problems. Patient wears glasses as needed. Complains of intermittent burning sensation in both feet.

Objective

Patient is 6â€™2 and 200 lbs. BP is 118/72, P is 72, and R is 17. Dietary review showed daily total carbohydrate ranging from 75-100 grams. Heart has a regular rhythm without murmur or gallop. Lungs sound clear. Monofilament testing reveals no decreased lower extremity sensation.

Plan

Diagnosis: Uncontrolled Diabetes type 2. Per the A1C being above 7, the diabetes is not considered controlled. Interventions need to be made to lower the A1C. Pre-obesity.

Therapeutics: Metformin dose would be increased to 1500mg twice a day (Straight Healthcare, n.d.). Increase the dosage of Glipizide by 2.5mg daily.

Educational: Metformin would be instructed to be taken with meals to prevent gastrointestinal disturbances (Huang et al., 2023). Education includes information on carbohydrate counting. For diabetic patients, 45% of daily food intake should be consumed by carbohydrates. Men should have 45-75g of carbohydrates in each meal (Medical News Today, 2020). Good carbohydrates include whole grains, brown rice, and legumes. These types of carbohydrates do not cause the blood sugar to increase quickly. Bad carbs are white bread, sugar, and soda. These types of carbohydrates cause blood sugar to increase rapidly (Harvard Public School of Health, 2023). The patient has a BMI in the pre-obesity range. He is getting close to the obesity range. Increased measures need to be implemented for diet and increased exercise.

Consultation/Collaboration: The patient needs to return to their endocrinologist in regards to the burning sensation felt in the extremities and alterations medications.

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