nursing

Answer

Glucose Management and Diabetes

Case 1

            The weight status, especially obesity in cats is determined using the body condition score (BCS). BCS is a visual assessment of the amount of fat as well as muscle covering the bones. BCS score range from 1 (very underweight) to 9 (very overweight). An ideal score is approximately 5 (Ohlund, Palmgren, & Holst, 2018). Paty developed hyperglycemia due to availability of foods at all time as well as its sedentary lifestyle. High dietary calorie intake and lack of exercise increases the risk of hyperglycemia (O`Connell et al., 2018). Fructosamine level in pets is important for determining blood glucose concentration since concentration of fructosamine is directly proportional to the concentration of glucose in blood. The concentration of fructosamine is not affected by stress (Animal Health, 2019). Similarly, fructosamine is an important marker of glucose control since it reflects the average blood glucose levels in humans. It can be used for determining the efficacy of a given therapeutic plan (Nansseu et al., 2015).

            Paty is less handsome than Grumpy cat. Although Grumpty cat displays a permanent “grumpy” facial appearance, it is still more handsome than Paty since Paty is obese (InsideHook, 2019). Due to obese looks, Paty does not deserve his own commercial. Paty is not envisioned to appear in the Got Milk commercial since it may create an impression among viewers that the advertised product can cause obesity (Fast Company, 2019).

Case 2

            Management plan to reach the goal of hemoglobin A1C levels of <7% will focus on pharmacotherapy. The patient needs to be administered basal insulin or oral hypoglycemic agents. The specific therapeutics to target postprandial hyperglycemia in JH’s case includes Repaglinide and Voglibose, which will be used in combination. The combination therapy is not associated with any notable adverse events such as hypoglycemia (Faruqui, 2017). Increased physical activity and exercises is also indicated to help her loss weight.

            JH should be involved in her own management. First of all, patient education is indicated to promote self-care and self-management of the condition. The patient’s knowledge about diabetes and treatment strategies helps in improvement of outcomes. Secondly, patient engagement in care is important helps promote medication adherence, which can also promote treatment outcomes. The last, but not the least, rationale is that patient education will enable JH to recognize signs and symptoms of the disease and report to the hospital whenever there is any need (Huang et al., 2019).

Case 3

            The three options, including thiazolidione, exenatide, or insulin, are associated with pros and cons. The pros of use of thiazolidione is that it can target insulin resistance, can be used a monotherapy or can be used in combination with other agents. Cons of thiazolidione use include adverse reactions including heart failure, visual impairment, bone fractures, macular edema, and hepatic encephalopathy (Prescribers’ Digital Reference, 2019).  The pros of using exenatide is immediate-release incretin mimetic effective in treatment of type 2 diabetes mellitus in adults. it can be administered as monotherapy or in combination with other anti-diabetic agents. It may be given together with basal insulin but not rapid/short-acting insulin or prandial insulin. However, exenatide may cause renal failure, pancreatitis, new primary malignancy, angioedema, and anaphylactoid reactions (Prescribers’ Digital Reference, 2019).   The pros of insulin include the fact that it is rapid-acting prandial insulin and can be used for treatment of both type 1 and type 2 diabetes. The cons of insulin include the fact that it is not recommended for people who smoke and those patients who present with a chronic lung disease (Prescribers’ Digital Reference, 2019).

            PK’s case emphasizes more control of postprandial hyperglycemia rather than fasting glucose. PK may be administered  a rapid-acting insulin (onset 5-15 min and lasting 3-4 hours), a short-action insulin (onset 30-45 minutes and lasting 6-8hours), an intermediate-acting insulin (onset 2 hours and last 16 to 24 hours), or a long-acting insulin (onset 2 hours and lasting 14-24hours).  PK ought to be administered a short-acting insulin regulator preferably Humulin R to better manage postpradiandial glucose that may ideally rise after 30 to 45 minutes following a meal. The antiglycemic effect will last for 6-8 hours (Mayo Clinic Staff, 2019).