Application of Course Knowledge: Type 2 Diabetes Mellitus (T2DM)

Type 2 Diabetes is a condition where the body doesn’t use insulin properly or doesn’t make enough of it. Insulin is what helps sugar move out of the blood and into the cells to be used as energy. When the body becomes resistant to insulin or isn’t making enough, sugar builds up in the blood (Galicia-Garcia et al., 2020; Mayo Clinic, n.d.). This buildup in the blood vessels can lead to several health complications, including atherosclerosis, which increases the risk for cardiovascular disease.

Over time, high blood sugar can cause damage to major organs—especially the heart, kidneys, eyes, and nerves. Some of the early signs of Type 2 Diabetes include drinking a lot of water, peeing more than usual, blurry vision, feeling really tired, and getting infections more easily—particularly urinary tract infections (Mayo Clinic, n.d.).

In Bayani’s case, the signs are definitely pointing toward something like Type 2 Diabetes. His wife says he’s been drinking a lot of water and using the bathroom more, which are both classic symptoms. She also mentioned that his urine smells bad, and she’s concerned about a UTI. That’s a valid concern—people with diabetes often get UTIs because the sugar in their urine creates a perfect environment for bacteria to grow. His confusion could also be from dehydration or elevated blood sugar levels (Galicia-Garcia et al., 2020).

Based on all these symptoms, Type 2 Diabetes is a possible cause.

Diagnostic Tests

To evaluate Bayani and investigate Type 2 Diabetes, I would recommend the following tests:

• Fasting blood glucose – A result of 126 mg/dL or higher supports a diabetes diagnosis.
• Hemoglobin A1c – Reflects average blood sugar over the past 2–3 months. A level of 6.5% or higher confirms the diagnosis.
• Random blood glucose – A value over 200 mg/dL with symptoms is also diagnostic.
• Urinalysis – To check for glucose in the urine and any signs of infection.
• Urine culture – To identify bacteria and confirm a UTI.
• Basic metabolic panel (BMP) – To evaluate kidney function and hydration status.

If Bayani has Type 2 Diabetes, we would expect to see high blood glucose, sugar in the urine, and possibly signs of infection.

References:

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal of Molecular Sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275Links to an external site.

Mayo Clinic. (n.d.). Type 2 diabetes – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193

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Sustainable Strategies for the Treatment of Chronic Pain While Reducing Opioid Misuse and Overdose

As the opioid epidemic sweeps the silver states of the United States, it emphasizes the need for healthcare trainees, especially advanced practice nurses, to implement safe and evidence-based techniques to treat chronic pain. Moreover, although opioids can be effective in the right setting, their potential for misuse, dependence, and overdose requires a judicious and multifaceted approach to patient care. Advanced practice nurses specializing in pharmacology must be aware of strategic approaches that enhance pain relief while decreasing adverse effects.

Risk-Benefit Assessment and Patient-Centered Care.

Conducting a comprehensive assessment of the patient’s pain condition, medical history, and risk factors for opioid misuse is an important and necessary first step in the safe management of chronic pain. The Opioid Risk Tool (ORT) as well as the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) are tools that can help identify high-risk individuals (Butler et al., 2008). Shared decision-making is important: Patients should be informed about both opioid and non-opioid approaches and be involved in choosing the most appropriate treatment approach.

Use of Non-Opioids and Multimodal Pain Management

Doctors suggest multimodal pain management to decrease opioid use. Non-opioid pharmacologic options include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants (i.e., duloxetine), anticonvulsants (i.e., gabapentin), and topical agents (Dowell et al., 2022). The treatment of chronic pain includes non-pharmacologic options like physical therapy, cognitive-behavioral therapy (CBT), acupuncture, and interventional procedures (e.g., nerve blocks), among others.

Opioid Prescribing Practices That Are Safe

Guidance on evidence-based prescribing practices is imperative for patients who need opioids. The Centers for Disease Control and Prevention (CDC) advises initiating treatment with the lowest effective dose of narcotics possible and, when practical, an immediate-release formulation (Dowell et al., 2022). Regular monitoring through urine drug screening, prescription drug monitoring programs (PDMPs), and reassessment of pain and function facilitates early detection of opioid misuse. Co-prescribing naloxone for patients at risk of overdose is also an important harm reduction strategy.

Conclusion

By applying safer chronic pain management strategies, advanced practice nurses are pivotal to combating the opioid epidemic. In the absence of early detection and treatment through multimodal pain approaches and adherence to evidence-based guidelines on opioid prescribing, however, the risk for misuse and overdose becomes exceedingly high.

References

Butler, S. F., Fernandez, K., Benoit, C., Budman, S. H., & Jamison, R. N. (2008). Validation of the revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R). The Journal of Pain, 9(4), 360-372. https://doi.org/10.1016/j.jpain.2007.11.014

Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., Chou, R., & Paulozzi, L. (2022). CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. MMWR Recommendations and Reports, 71(3), 1–95. https://doi.org/10.15585/mmwr.rr7103a1

With opioid deaths increasing, AMA urges expansion of proven treatment | American Medical Association. https://www.ama-assn.org/press-center/press-releases/opioid-deaths-increasing-ama-urges-expansion-proven-treatment

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