An older patient asks a nurse: I went to my diabetes doctor and ...

[09madisonrousseau09]

An older patient asks a nurse: I went to my diabetes doctor and everything was stable. The nurse practitioner spent the entire time teaching me about decreasing my risks of heart disease.
 
  It seemed odd that she did not focus on teaching me how to better control my diabetes. Do you know why? The nurse formulates a response based on the understanding that: (Select all that apply.)
  a. promoting cardiovascular health has the potential to minimize the complications of DM.
  b. there is little evidence that demonstrates that the course of DM can be altered in an older adult.
  c. the benefits of better control of blood pressure and lipid levels are seen much quicker than the benefits of better glyce-mic control.
  d. older adults are less receptive to teaching about diabetes than they are to teaching about cardiovascular disease.
  e. diabetes is not a common chronic condi-tion in older adults.

Question 2

A nurse is caring for an older adult who is diagnosed with type 2 Diabetes. The patient is pre-scribed oral medication for diabetes. The nurse can expect that which of the following medica-tions is prescribed as a first-line therapy?
 
  a. Insulin
  b. Sulfonylureas
  c. Metformin
  d. Chlorpropramide

[meryzewe]

Answer to Question 1

ANS: A, C
While glycemic control is important, more emphasis is now on the prevention and treatment of cardiovascular diseases. Research has indicated that it may take 8 years of glycemic control be-fore benefits are seen while the benefits of better control of blood pressure and lipids are seen as early as 2-3 years. Promoting cardiovascular health has the potential to be the most efficacious in the minimization of complications in the persons with DM. Education on self-management of diabetes is important for patients of all ages. Diabetes is a common chronic condition in older adults.

Answer to Question 2

ANS: C
Metformin (Glucophage) is commonly prescribed as first-line therapy; it does not cause hypogly-cemia or weight gain. Sulfonylureas were used for many years as first-line agents for all persons with type 2 DM. However, they are associated with hypoglycemia and can only be used in per-sons who can either be aware of the signs themselves or who have a caregiver capable of doing so; therefore, Metformin is considered the first line of therapy. Insulin is used for individuals with type 2 DM; however, it is not first-line therapy. Chlorpropramide is contraindicated due to a long half-life and the fact that it can cause prolonged hypoglycemia.