Question

Patient case: A 56 year old white male is referred to you by his provider for uncontrolled T2DM. He was diagnosed with diabetes 6 months ago.

SMBG last 7 days:

Fasting (mg/dL): 156, 168, 176, 138, 210, 146, 142

2hr post supper (mg/dL): 210, 190, 148, 168, 220, 280, 300

Past Medical History: T2DM, HTN, CVA

Medications:

ASA EC 81mg daily

Pravastatin 20mg daily

Metformin 1000mg bid

HCTZ 25mg daily

Allergies: NKDA

Vaccine history: yearly influenza, Shingrix Jan 2018, Tdap 2016

Social history: alcohol user; smokes cigarettes 1 ppd

Vitals today: BP 152/94 (148/90 one month ago) HR 80; Ht: 5’11” Wt: 254 lb.

Labs: A1C: 8.2%, TC 216, LDL 140, HDL 24, TG 260; CBC wnl; liver function w

164 serum creatinin

Address the following issues and treatment goals for this patient:

1. Diabetes Management

2. Hypertension

3. Hypersensitivity lung disease

4. Obesity

Answer 1

Diabetes Management

Keeping the blood sugar stages inside the variety optional by your medic can be stimulating. That's since numerous things brand your blood sugar stages alteration, occasionally unpredictably. Subsequent are approximately issues that can disturb your blood sugar stages. The following should be considered:

-Study about starch totaling and helping dimensions

-Type every mealtime well stable

-Organize your mealtimes and medicines

-Circumvent sugar sweet drinks

-Workout

-Insulin and other diabetes pills are intended to inferior your blood sugar stages when régime and workout unaccompanied be situated adequate for handling diabetes.

Hypertension

The goalmouth of hypertension conduct is to decrease BP below 140/90 mm Hg; though, in patients with hypertension and diabetes or renal illness, the BP goalmouth is even inferior, targeted at ≤130/80 mm Hg. Non pharmacologic interferences should be introduced in altogether patients with hypertension. Once used early, existence alterations can reduction other illness dangers and might evade the essential for medication treatment. Upholding a fit existence, though, is not adequate or is problematic to obey with, and maximum patients will need pharmacologic interferences to switch their BP.

Hypersensitivity lung disease

Preliminary indications of hypersensitivity pneumonitis are alike to the flu, but will be able to take numerous months to an amount of years to grow aversion to the dust. Definite jobs might upsurge your danger of emerging hypersensitivity pneumonitis. Hypersensitivity pneumonitis is totally reversible in the initial phases, so the solitary most significant thing that you can do is circumvent the dust that reasons the illness.

Obesity

Management of obesity can comprise routine variations, medicines, or operation. The chief conduct for obesity contains of fasting and bodily workout. Operation for severe obesity is related with long period weight loss and reduced general mortality.