The patient has type 2 Diabetes that hasn’t been controlled for a long time. The patient has an increased amount of melatonin that has suppressed bone autophagy and increased the risk of bone fracture (Zhang et al., 2016). Uncontrolled diabetes is also a cause of nerve damage and peripheral neuropathy. It appears that her hyperglycemia is a cause of her muscle cramps, numbness, and pinching pain in her legs. The patient’s osteoporosis condition is also a problem and the risk of bone fracture and leg and the hip area further increases as the patient’s uncontrolled type 2 diabetes also affected her bone density.
Medication
The patient needs several medications and therapies to control her diabetes and nervous problems. The patient needs to check her blood glucose level regularly, an HbA1c test may help in regularly checking the blood sugar level. For chronic pain in the legs and hip area, high dosage of opioids is recommended (Dowell, 2016). The patient is prescribed to have a high dosage of Duramorph for chronic pain. The initial dosage of Duramorph is 5mg taken in the form of an injection whenever the pain becomes unbearable; caution should be taken while injecting Duramorph and it must be done with care. The patient has also been prescribed Prednisone as they are proven more effective in pain relief. The dosage of Prednisone is low as it is a steroid. The patient has been prescribed a 10mg tablet to be taken orally once a day to avoid an increase in pain. For neuropathic pain, several anti-depressants and anticonvulsants can be used. Less dosage of Tricyclic antidepressants like amitriptyline is recommended because of the high side effects of increased dosage. Because of the reaction of this medicine with diabetic patients sticking to the prescribed dosage is essential to avoid any severe effects.
Patient education plan
- Duramorph 5mg, injection only if the pain is unbearable.
- Prednisolone 10 mg is to be taken orally once daily.
- Amitriptyline 75 mg is to be taken orally for feet numbness and neuropathic pain.
References
Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain— the United States, 2016. Jama, 315(15), 1624-1645.
doi:10.1001/jama.2016.1464
Finnerup, N. B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R. H., … & Kamerman, P. R. (2015). Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology, 14(2), 162-173.
doi: 10.1016/S1474-4422(14)70251-0
Zhang, W., Meng, H., Yang, R., Yang, M., Sun, G., & Liu, J. et al. (2016). Melatonin suppresses autophagy in type 2 diabetic osteoporosis. Oncotarget, 7(32). doi:10.18632/oncotarget.10538
