Sun 240 133

Current Medications

• Metformin 1,000 mg (take one tablet twice daily to lower blood sugars)

• Glipizide 10 mg (take two tablets 30 minutes before breakfast daily to lower blood sugars)

• Byetta 10 mg (inject twice daily to lower blood sugars)

• Diovan 320 mg (take one tablet daily to lower blood pressure)

• Chlorthalidone 25 mg (take one tablet daily to lower blood pressure)

• Lipitor 40 mg (take one tablet daily to lower cholesterol)

• Tricor 145 mg (take one tablet daily to lower cholesterol)

• Cymbalta 60 mg (take one capsule once daily for peripheral neuropathy)

Meal History: EP says he is following a meal plan of 2,000 calories (8,368 kJ) (60 g carbohydrates at each meal and 20 g for bedtime snack). He also says he is limiting saturated fat to 15 g/day and sodium to 2,000 mg/day.

Physical Activity: Increased walking to 5 days/week for 45 minutes at moderate intensity.

Plan—Next Steps

What are your treatment goals for EP regarding blood glucose, blood pressure, and lipids?

Are his readings within target? What questions would you askEP? Has a pattern been established?

What therapeutic options would you consider if you determine that lifestyle or stress is not the cause of the changes in his results?

Should insulin therapy be considered for EP?

What type of insulin and dose would you recommend, and how would you transition EP to insulin?

What does EP need to know about insulin therapy before he leaves, and when should he return?

• Patient care plans should include a number of daily evaluations to be performed by the patient, such as examination of the feet for any sores, cuts, or abrasions; checking the skin for dryness to prevent cracking and chafing; and monitoring blood glucose values as directed. Weekly appraisals of weight and blood pressure are also advised.

• Until A1c levels are at goal, quarterly visits with the patient's primary health care provider are recommended. Table 43-7 summarizes the specific ADA goals for therapy. The practitioner should review SMBG data and a current A1c level for progress, and address any therapeutic or educational issues.

• At minimum, yearly laboratory evaluation of serum lipids, urinary microalbumin, and serum creatinine should be performed.

Abbreviations Introduced in This Chapter

A ACE A me rit an Assoc i at ion of Cl i n ical

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