RT Book, Section
A1 Kennedy, Martha S. Nolte
A1 Masharani, Umesh
A2 Katzung, Bertram G.
SR Print(0)
ID 1148439639
T1 Pancreatic Hormones & Antidiabetic Drugs
T2 Basic & Clinical Pharmacology, 14e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9781259641152
LK accessmedicine.mhmedical.com/content.aspx?aid=1148439639
RD 2024/04/19
AB CASE  STUDYA  66-year-old  obese  Caucasian  man  presented  to  an  academic  Diabetes  Center  for  advice  regarding  his  diabetes  treatment.  His  diabetes  was  diagnosed  10  years  previously  on  routine  testing.  He  was  initially  given  metformin  but  when  his  control  deteriorated,  the  metformin  was  stopped  and  insulin  treatment  initiated.  The  patient  was  taking  50  units  of  insulin  glargine  and  an  average  of  25  units  of  insulin  aspartate  pre-meals.  He  had  never  seen  a  diabetes  educator  or  a  dietitian.  He  was  checking  his  glucose  levels  4  times  a  day.  He  was  smoking  half  a  pack  of  cigarettes  a  day.  On  examination,  his  weight  was  132  kg  (BMI  39.5);  blood  pressure  145/71;  and  signs  of  mild  peripheral  neuropathy  were  present.  Laboratory  tests  noted  an  HbA1c  value  of  8.1%,  urine  albumin  3007  mg/g  creatinine  (normal  <30),  serum  creatinine  0.86  mg/dL  (0.61–1.24),  total  cholesterol  128  mg/dL,  triglycerides  86  mg/dL,  HDL  cholesterol  38  mg/dL,  and  LDL  cholesterol  73  mg/dL  (on  atorvastatin  40  mg  daily).  How  would  you  treat  this  patient?