What thing did you need to consider in choosing his insuling

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Reference no: EM133629501

Problem

Jim, a 55 yo, was last seen in your practice 18 months ago. At that time, he was moderately well controlled on Metformin ER 500mg, 4 tabs a day, Sitagliptin 100mg a day and was walking about 10,000 steps a day. You ask him where he has been and he replies: "I just got tired of all the work involved in managing my diabetes so I just took a break." He is 5'10" and weight is 260lbs.

I. How would you respond to his statement?
II. His in-office A1C is 11.4. What medications would you order for him and why?
III. What additional labs would you order?
IV. Besides his labs, what else do you need to assess?
V. What immunizations does he need to have?
VI. How often should he have an eye examination?
VII. Once you initiate his medication plan, when do you need to see him again?

Despite all of your education and management skills, Jim does not return for his follow-up visit. Then you get a call from the NP in the ER. Jim is arrived vis 911, confused and dehydrated, His FS glucose is >800.

I. What is his diagnosis?
II. How would you treat this initially?

After 2 days in the hospital, his blood sugar is down to 250 and he is referred back to you for management. They started him on Metformin again and you need to initiate insulin.

I. How much insulin would you start Jim on? What type?
II. What things did you need to consider in choosing his insulin?
III. His fasting cholesterol is 230. What medication would you order?
IV. Since he is otherwise healthy, what is his target A1C?
V. What would you tell him his target goals are for his FBG and his PPG?

Reference no: EM133629501

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