Additional subjective or objective information needed
I would need a complete set of vital signs and scrutinize all her medical records as written by the former primary care provider. I would further inquire about her family medical history, any evidence for using illegal drugs or alcohol, and smoking. I would determine the duration over which she has been diagnosed and the types of medications that have been prescribed in the past. Additionally, I would check if she has been involved in any lab work to examine her PT INR and associated bruising and excessive bleeding. Also, I would question any kind of medications she takes for DMII with respect to blood sugar controls and how they impact her overall health and wellbeing.
Position on the use of alternative supplements for diabetes and memory
I would recommend that Ms. GM should stop using Ginseng and Cassia Cinnamon. This is because these supplements negatively interact with Coumadin and cause fluctuations in blood sugar levels. For example, they interact with insulin due to either increased or reduced coagulations that result in hypoglycemia in diabetic individuals (King, 2009). The contraindications, in this case, involve the higher than normal quantities of coumarins in Cassia cinnamon, which increase the amounts of toxins in the body when taken in high doses.
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Additional tests
Yes. There are additional tests to complete for the patient. Such include clotting times like PT & INR and PTT, as well as blood sugar levels that are inclusive of A1C. This assessment would ensure close monitoring of these conditions. Also, I would comprehensively explain to the patient how to use the current supplements like cinnamon and ginseng. For example, I would inform her that the Cassia Cinnamon is known to aggravate liver disease risks. Hence, the need to perform liver function checks in addition to an examination of the complete blood cell count to ascertain that she is free from infections, anemia, and has the correct platelet count.
How my treatment plan would differ
I would recommend that she starts using Jardiance as a medication for diabetes. This is due to her history of lab tests and control measures for glucose. My treatment plan would reduce the risk of cardiovascular mortality, as evident in most adults with type 2 diabetes (Packer & Crasto, 2015). Notably, Jardiance tablets are effective for treating type 2 diabetes since they contain empagliflozin. Therefore, 10 mg oral tablet per day, especially in the morning before food can be effective. However, this dosage will be increased slowly to 25 mg although it has various side effects, which I will inform the patient about.
Health maintenance and preventive education
In case the client insists on continuing with the supplements, I would advise her that the Cinnamon is only effective for a short period, especially if consumed in smaller quantities. Also, she might as well develop allergic reactions to the supplements since they contain undefined quantities of coumarin that can worsen liver disease conditions (King, 2009).
References
King, M. (2009). Diabetes Mellitus: Pharmacology and Disease Management. Diabetes Care , Vol. 32, 193-203. https://www.cecentral.com/assets/2634/045-King.pdf
Packer, M. E. & Crasto, W. (2015). Type 2 diabetes: pharmacological management strategies. The Pharmaceutical Journal . https://www.pharmaceutical-journal.com/learning/learning-article/type-2-diabetes-pharmacological-management-strategies/20069631.article
