Question

DMTM 2020: Oral and Injectable Agents for Diabetes Type 2

Patient #1

Carlos is a 58 y/o Hispanic American male. He shows up at your clinic wanting to learn how to use his inhaler because he just got diagnosed with exercise-induced asthma. He is also complaining of increasing urination that he thinks may be due to his prostate.

PMH: HTN, Exercise-induced asthma, BPH, HFrEF

FH: Mom deceased 2° myocardial infarction at age 72

Dad: Alive at 88 with DM2, HL, HTN

No siblings  

SH: Drinks alcohol socially (2-3 glasses of wine/week); No tobacco or illicit substances

Medication List:

1. HCTZ 25mg every morning

2. Metoprolol ER 50mg daily

3. Lisinopril 20mg daily

4. Furosemide 20mg bid

5. MVI daily

6. Albuterol PRN  

Vitals:   

Temp: 97.2 BP: 148/72 (BP for last week’s visit – 144/74)   

HR:74 Weight:191lbs Height:5’9”

Other Labs (from yesterday):

A1c: 9.2% Potassium: 3.4 Repeat A1c 9.4%

Scr: 1.4 eGFR: 65

  

1. Today – what medication(s) do you recommend for Carlos

2. What are the monitoring parameters (safety and efficacy-both things Carlos can watch out for at home as well as any labs/assessments)?

   1. Patient can monitor over urination due to water pill.

3. When do you want Carlos to follow-up – and for what? Describe your dose titration plan, if you have one.

   1. When changing regimens/stepping up therapy, patients should be followed up within 2 weeks.

   2. Once on a controller regimen, patients should be followed up within 4 – 8 week intervals.

Patient #2

Sam is a 40 y/o female who has had diabetes for 10 years. She is currently taking metformin 1000mg BID and glimepiride 8mg daily. Her most recent A1c = 10.2%. Sam’s BMI = 38. She checks her blood sugar once a week in the morning and the numbers are usually 200 something.

1. What are your thoughts at this time about Sam’s management and what questions do you have for her?

   1. Patient is checking blood sug

2. What medication(s) do you recommend for Sam?

3. What are the monitoring parameters (safety and efficacy-both things Sam can watch out for at home as well as any labs/assessments).

4. How often and when would you like Sam to monitor his blood glucose at home?

5. When do you want Sam to follow-up – and for what? Describe your dose titration plan, if you have one.

Answer 1

Ans) Lab Test Considerations: Monitor electrolytes (especially potassium), blood glucose, BUN, and serum uric acid levels before and periodically throughout course of therapy.

- The step-wise approach to asthma management must be considered in multiple contexts, as loss of asthma control has variable presentations.

- It is likely that other approaches will be found to be useful clinically as well. It is important to emphasize, however, that the most important factor in the successful utilization of a stepwise approach to asthma management that will achieve the greatest degree of control with the least amount of medication possible is scheduled follow-up care rather than crisis management alone.

- When to test blood sugar
Before each meal.
1 or 2 hours after a meal.
Before a bedtime snack.
In the middle of the night.
Before physical activity, to see if you need a snack.
During and after physical activity.
If you think your blood sugar might be too high, too low or falling.

- Titration of diabetic medication & insulin sliding scale must be done in order to manage the blood glucose levels.