Teaching Patients by Using Their Health History

Introduction

Over 100 million people suffer from type 2 diabetes or prediabetes in the United States (U. S.) according to the Center for Disease Control and Prevention (CDC) (CDC, 2017a).  Diabetes is a “growing health problem” according to the CDC (2017a) (para. 1).  About 10% of the American population has either prediabetes or type 2 diabetes.  It is the seventh cause of death for Americans in the year 2015 (CDC, 2017a). While type 2 diabetes presents in all age groups, it mostly affects those 45 years of age and older.  The CDC (2017a) reports that “among those ages 45-64 years, 17 percent had diabetes. And among those ages 65 years and older, 25 percent had diabetes” (para. 7).  Most people do not know that they suffer from the disease.  According to the CDC (2017a) “nearly 1 in 4 four adults living with diabetes – 7.2 million Americans – didn’t know they had the condition. Only 11.6 percent of adults with prediabetes knew they had it” (para., 5).  Thus, medical professionals must do a better job of diagnosing and treating their patients who have a family history of type one and type 2 diabetes by educating them and helping them plan to treat the disease before it does damage to the patient.

Discussion

Signs and Symptoms of Type 2 Diabetes 

If a person has prediabetes, they are more likely to develop type 2 diabetes.  If a person is overweight, they also can develop the disease.  The risk of developing type 2 diabetes is higher at age 45 and over.  If a person has a close family relative, such as a mother, father, sister or brother, who has developed the disease, they are more likely to develop the disease.  A sedentary lifestyle is also a factor in the development of diabetes.  There are also several physical symptoms a person may have that will tell them they have diabetes.  For example, if a person gets up to urinate a lot at night, it is a symptom of diabetes, not an overactive bladder.  Dry, itchy skin is also a symptom as is thirst.  A person may eat more than usual but lose weight and feel very tired.   The symptoms may ones that go unnoticed over time but putting them all together means the person should get their blood sugar level checked for diabetes as soon as possible (CDC, 2017b).  It is also a known factor that certain people are predisposed to get type 2 diabetes – among them, African-Americans, Mexican-Americans, and Native Americans (CDC, 2017b).  

Most surprising is a new study by Swerdlow et al. (2015) reporting using statins to lower cholesterol levels in the blood can cause type 2 diabetes.  As the researchers explain, statins lower cholesterol levels and thereby reduce heart disease.  Statins interact with blood sugar levels and cause them to rise, which in turn causes type 2 diabetes, which then can cause heart problems.  With this new information, medical professionals should keep track of cholesterol levels and blood sugar levels to determine if the statin influences the patient’s blood sugar level.

History  

The patient’s (BW) history for this purpose is that he is a male, 65, who is overweight and has high blood sugar level of 157.  His last fasting blood test revealed his glucose level to be 149.  Thus, the test was not an aberrant one, but a result of high glucose levels and has turned the patient from prediabetic to diabetic.  His cholesterol level is also high at 235.  He is of Mexican-American descent.  His father also had type 2 diabetes and died after having his leg removed below the knee due to gangrene.  BW does not want to lose any limbs to the disease, so a plan is worked out for him.

The plan. BW had a job where he did not get much exercise.  Primarily, BW must understand what the disease can do to the blood system, so he can avoid amputation.  That seems to be his main concern.  Because BW’s weight borders on obese, the priority is to inform BW how to eat for health with his diabetes.  There are excellent websites, such as the Mayo Clinic website that educates readers on what a good diabetes diet consists of and what not to include in one’s diet.  One should avoid beef and pork products and eat more fish in their place.  Type 2 diabetics can have complex carbohydrates which include fresh fruits.  One must eat three regular meals a day at the same time.  This way blood sugar levels can remain static (The Mayo Clinic Staff, 2018).  

The other part of the plan is to get BW moving.  Since he is now retired, he can be more active.  Once he gets more active, he will be able to lose weight, which will help lower his blood sugar level too.  Since BW has not really exercised beyond mowing his lawn, he can start his exercise program by walking for 30 minutes three times a week.  Once his stamina is built up, BW should join a gym and start building muscles.  

Medical staff provided BW with pamphlets about type 2 diabetes and what he can do to control the disease.  His main fear now is amputation, so telling him to follow a sensible meal plan and exercise plan is the first order to control blood sugar and to avoid amputation.  Because BW is so fearful of being like his father, it is likely he will follow the plan medical staff made for him.  The staff also directed BW to many different diabetes diet websites, so he can vary his food choices and still control his glucose level.  The staff also has recommendations for exercise and gyms with personal trainers if BW chooses to work on his weight with a trainer.  

BW is also given a prescription for metformin.  He must take this pill daily and check his blood sugar several times a day and record his results.  The doctor wants to see him again in a month, with his blood sugar log, to see if there must be an adjustment in the medication.  It takes a while to get medications correct, so it is important that BW return for this next appointment.

Summary

BW is one of the 100 million Americans who suffer from type 2 diabetes or prediabetes.  His family had a history of diabetes as BW’s father died of the disease.  Because BW fears amputation, he will be more likely to follow the medical staff’s meal ideas and exercise suggestions.  A new study on the effects statin drugs has on blood sugar levels suggests that the medical staff should also monitor BW’s statin intake and blood sugar levels.

References

CDC.  (2017a).  New CDC report: More than 100 million Americans have diabetes or prediabetes.  Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

CDC.  (2017b).  Who’s at risk?  Retrieved from https://www.cdc.gov/diabetes/basics/risk-factors.html

Mayo Clinic Staff. (2018).  Diabetes diet: Create your healthy eating plan.  Retrieved from https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295

Swerdlow, D. I. et al.  (2015).  HMG-coenzyme a reductase inhibition, type 2 diabetes, and body weight: evidence from genetic analysis and randomized trials.  The Lancet, 385(9965), 351-361.  Retrieved from https://www.sciencedirect.com/science/article/pii/S0140673614611831