Tori McCormick

NURS 6903

February 10, 2021

Elaine is a 50-year-old Hispanic female who presents in follow-up of recent screening labs. Her
fasting blood sugar was 159 and additional testing of HgbA1c result was 8.5. She is not taking
any medications or supplements besides a daily multivitamin. She has no other pertinent medical
history. She wears a pedometer and consistently has logged 10,000 steps per day. CBC and
metabolic profile were within limits.

What would you identify as initial treatment (diet ,medications, activity) for Elaine? Explain
your response and detail your

Criteria for the diagnosis of diabetes mellitus includes fasting plasma glucose greater or

equal to 126, random plasma glucose greater or equal to 200, oral glucose tolerance test with a 2

hour plasma glucose of greater or equal to 200, or a hemoglobin A1c of greater than 6.5%

(Rosenthal & Burchum, 2021). The patient in this case study exhibits 2 of the criteria listed for

diabetes mellitus. This patient has a fasting blood sugar of 159 and a hemoglobin A1c of 8.5%.

This patient is active every day logging at least 10,000 steps per day. Intensified exercise

regimen along with a strict low-calorie diet will be suggested.

To treat this patient, I would recommend a four-step approach. Step one with diagnosis,

encourage lifestyle modifications along with metformin. I would begin this patient on Metformin

500 mg twice a day. With improved diet and exercise and monitor the patient’s blood sugar, I

would reassess the hemoglobin A1c, and fasting blood sugar along with a glucose tolerance test

and random plasma glucose. Once reassessed, if the goal is not achieved moving on to step two

with continuing lifestyle changes plus metformin and a second drug such as either a

thiazolidinedione, a dipeptidyl peptidase-4 inhibitor, a sodium-glucose contransporter 2 inhibitor,

a glucagon-like peptide-1 receptor agonist. Or possibly Repaglinide 0.5 mg three times a day 15-

30 minutes before each meal (Rosenthal & Burchum, 2021). A sufonylurea or basal insulin may

be considered if the patient does not make the goal with the drugs listed above (Rosenthal &

Burchum, 2021). The next step would be a three-drug combination inclusive of metformin. If the

three-drug regimen doesn’t work after 3 to 6 months it is recommended to proceed to a

combination injectable regimen inclusive of insulin and possibly a GLP-1 receptor agonist

(Rosenthal & Burchum, 2021).

 References

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne's pharmacotherapeutics for advanced practice

nurses and physician assistants. St. Louis, MO: Elsevier.