Essay

Multifaceted Treatment Approach for Type II Diabetes Mellitus in a Commercial Driver

Thesis Statement: Managing Type II Diabetes Mellitus in a commercial driver requires a comprehensive treatment plan that optimizes glycemic control, considers safety while driving, and addresses potential medication interactions.

Treatment Plan:

For Jose’s poorly controlled Type II Diabetes Mellitus, the treatment plan should aim to achieve rapid glycemic control to lower his elevated HgA1C and fasting blood glucose levels. Considering his occupation as a truck driver, safety and adherence to treatment are paramount.

Medication Recommendations:

1. Insulin Therapy: Given Jose’s high HgA1C and fasting blood glucose levels, initiating insulin therapy is necessary for rapid glycemic control.

Prescription:

– Drug: Insulin Lispro
– Dose: 10 units before breakfast and 15 units before dinner
– Route: Subcutaneous injection
– Frequency: Twice daily
– Special Instructions: Educate Jose on proper injection technique and storage of insulin
– Dispensed: 1 vial (10 mL)

– Refills: 0

2. Medication Review:

– Metformin: Continue Metformin but consider reducing the dose to 500 mg twice daily due to the addition of insulin therapy.
– Glipizide: Discontinue Glipizide to avoid the risk of hypoglycemia with insulin therapy.
– Diltiazem: Monitor Jose’s blood pressure closely as insulin therapy may impact blood pressure levels.

Monitoring:

1. Glycemic Control: Follow up with Jose weekly initially to monitor his blood glucose levels and adjust insulin doses as needed to achieve target glycemic control.

2. Driving Safety: Emphasize the importance of regular blood glucose monitoring, especially before driving, to prevent hypoglycemic episodes that could impair his ability to drive safely.

Education Regarding Treatment Plan:

1. Insulin Administration: Provide detailed instructions on how to administer insulin, rotate injection sites, and recognize and manage hypoglycemia.

2. Driving Safety Precautions: Educate Jose on the signs and symptoms of hypoglycemia and the importance of checking blood glucose levels before driving and during breaks.

References:

1. American Diabetes Association. (2020). Standards of Medical Care in Diabetes – 2020. Diabetes Care, 43(Supplement 1), S14-S31.

2. Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 38(1), 140-149.

3. National Highway Traffic Safety Administration. (2016). Diabetes & Driving. https://www.nhtsa.gov/risky-driving/distracted-driving#diabetes-and-driving