Sun 240133

Current Meds:

• 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)

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

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

• Simvastatin 80 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 his meal plan of 2,200 calories (9,205 kJ) (60 g carbohydrates at each meal and 30 g for bedtime snack). He also says he is limiting saturated fat to 17 g/day and sodium to 2,000 mg/day.

Physical Activity: Started walking 4 days/week for 30 minutes at moderate intensity Plan—Next Steps

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

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

When would you want to see EP back in the office?

Patient Encounter, Part 4: Insulin Therapy

EP comes in 3 months later to assess the effectiveness of the changes that you suggested. His blood glucose, blood pressure, and lipids have been doing better. It is now 8 years since he was diagnosed, and he brings his readings in. He is discouraged because, although he has been taking his medication, following his meal plan, and is still physically active, he weighs 109 kg (240 lb). What therapeutic changes would you make and how would you teach EP to use the therapy suggested?

Fasting glucose: 180 mg/dL (10 mmol/L); BUN: 13 mg/dL (4.64 mmol/L); creatinine: 1 mg/dL (88 pmol/L); AST/SGOT: 26 IU/L (0.43 pKat/L); ALT/SGPT: 26 IU/L (0.43 pKat/L); TSH: 1.26 microunits/mL (1.26 mU/L); total cholesterol: 180 mg/dL (4.65 mmol/L); LDL: 98 mg/dL (2.53 mmol/L); HDL: 46 mg/dL (1.19 mmol/L); triglycerides: 130 mg/dL (1.47 mmol/L); A1c: 8.6%; body fat: 42%; waist circumference: 42 inches (107 cm)

Blood Glucose Results (units of mg/dL [mmol/L])

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