KH is a 48-year-old male diagnosed with type II diabetes 1 year ago. He has controlled his blood glucose through dietary changes.

KH is a 48-year-old male diagnosed with type II diabetes 1 year ago. He has controlled his blood glucose through dietary changes.

SCENARIO 2

KH is a 48-year-old male diagnosed with type II diabetes 1 year ago. He has controlled his blood glucose through dietary changes. He has hypertension and is currently on lisinopril 10 mg po daily. He has no known allergies. His lab work today includes: fasting BG is 175 mg/dL; HgA1C = 7.5%. Basic Metabolic Profile (BMP) is normal except for Cr 1.8 and eGRF 28. What treatment plan would you implement for KH (include complete medication order)? What education would you provide regarding his treatment plan? How would you monitor the effectiveness of this plan? What is the goal A1C?

SCENARIO 2

Patient KH is a 59-year-old female with uncontrolled type 2 diabetes (HbA1C=7.5%); stage 4 chronic kidney disease (CKD); eGFR=28 mL/min; diabetes management changes are indicated. Metformin is contraindicated in patients with CKD because this condition increases the risk of lactic acidosis. Therefore, an SGLT2 inhibitor like empagliflozin is preferential for its glucose and renal management (Bakris et al., 2020).

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For managing KH’s condition, empagliflozin 10 mg once daily is prescribed to optimize glycemia and CKD progression. Lisinopril is still used to control the patient’s hypertension and renal dysfunction. However, the current medications include empagliflozin orally using a dosage of 10mg-tab. Secondly, the refill program for lisinopril monthly with thirty which ensures the patient takes a tablet a day (Chertow et al., 2021). Lisinpril is an effective antihypertensive medication in controlling malignant hypertension.

In the case of KH is based on high health illiteracy. KH needs to understand that empagliflozin has shown effectiveness in his  process treatment of T2DM and that the possible side effects including frequent urination and extreme rarely, ketoacidosis will be explained to KH and how KH required to make lifestyle changes especially in diet, hydration, and be taught how to monitor their blood glucose levels (Bakris et al., 2020). In discussions the focus was on the fact that CKD progresses and that control of hypertension helps to slow it down.

This will be done every three months together with renal function and electrolytes while targeting an HbA1c ≤6.5-7%. Acute kidney disease is also more frequent in diabetic patients, so it is necessary to monitor for the symptoms of ketoacidosis and urinary tract infection. Empagliflozin provides better glycemic control, reduced cardiovascular risk and slow CKD progression in addition to improved outcomes for KH (Jitraknatee et al., 2020).

References

Bakris, G. L., Agarwal, R., Anker, S. D., Pitt, B., Ruilope, L. M., Rossing, P., … & Filippatos, G. (2020). Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. 
New England journal of medicine
, 
383
(23), 2219-2229.

Chertow, G. M., Vart, P., Jongs, N., Toto, R. D., Gorriz, J. L., Hou, F. F., … & Heerspink, H. J. (2021). Effects of dapagliflozin in stage 4 chronic kidney disease. 
Journal of the American Society of Nephrology
, 
32
(9), 2352-2361.

Jitraknatee, J., Ruengorn, C., & Nochaiwong, S. (2020). Prevalence and risk factors of chronic kidney disease among type 2 diabetes patients: a cross-sectional study in primary care practice. 
Scientific reports
, 
10
(1), 6205.