atthew is a 59-year-old civil engineer diagnosed with Type II diabetes in the fall of last year. He presents today for follow up. His BS are better—he tells you that they are all still running a bit high—from 170-200 mg/dL— regardless of the time of day taken. He says his fasting BS is about 170 mg/dL. He is trying to follow his diet—and he feels like he has really come a long way in managing his diabetes. He states that when his NP diagnosed him, he was drinking about 4 liters of regular coke every day and eating junk food—his A1C at the time of diagnosis was 14 % Currently, his A1C is 8.0%. Other PMH is CAD, Dyslipidemia and Diabetic neuropathy. His current regimen of medications is: Metformin ER 1000 mg BID; ASA 325 mg daily; Lisinopril 10 mg daily Coreg 6.25 mg BID; Crestor 20 mg daily; Multivitamin [1] daily Vitamin D3 10,000 IU daily; Lyrica 50 mg at HS His CBC and electrolytes are normal; creatinine 1 mg/dL; [calculated GFR 115 cc/minute] thyroid function tests are normal. TC = 200 mg/dL; HDL 50 mg/dL; LDL 90 mg/dL; trigs 98 mg/dL; Vitamin D level 45 mcg; no microalbumin in his urine. Last eye exam was 3 months ago, and it was normal. Matthew is 69 inches tall, and he weighs 210 pounds; BMI 42.4 Exam reveals truncal obesity but is otherwise normal. His 2-hour post- prandial BS today in your office is 223 mg/dL. He requests that you alter his diabetic therapy regimen, as he desires his BS to be better. He feels that his diet compliance and his one hour of daily walking plus the Metformin ER is not getting him to goal. What do you prescribe for
Matthew is a 59-year-old civil engineer diagnosed with Type II diabetes in
the fall of last year. He presents today for follow up. His BS are better—he
tells you that they are all still running a bit high—from 170-200 mg/dL—
regardless of the time of day taken. He says his fasting BS is about 170
mg/dL. He is trying to follow his diet—and he feels like he has really come
a long way in managing his diabetes. He states that when his NP
diagnosed him, he was drinking about 4 liters of regular coke every day
and eating junk food—his A1C at the time of diagnosis was 14 %
Currently, his A1C is 8.0%. Other PMH is CAD, Dyslipidemia and Diabetic
neuropathy. His current regimen of medications is:
Metformin ER 1000 mg BID; ASA 325 mg daily; Lisinopril 10 mg daily
Coreg 6.25 mg BID; Crestor 20 mg daily; Multivitamin [1] daily
Vitamin D3 10,000 IU daily; Lyrica 50 mg at HS
His CBC and electrolytes are normal; creatinine 1 mg/dL; [calculated GFR
115 cc/minute] thyroid function tests are normal. TC = 200 mg/dL; HDL 50
mg/dL; LDL 90 mg/dL; trigs 98 mg/dL; Vitamin D level 45 mcg; no
microalbumin in his urine. Last eye exam was 3 months ago, and it was
normal.
Matthew is 69 inches tall, and he weighs 210 pounds; BMI 42.4
Exam reveals truncal obesity but is otherwise normal. His 2-hour post-
prandial BS today in your office is 223 mg/dL. He requests that you alter
his diabetic therapy regimen, as he desires his BS to be better. He feels
that his diet compliance and his one hour of daily walking plus the
Metformin ER is not getting him to goal. What do you prescribe for
Matthew?
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