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Patient Background: Kameron is 55 year old male lawyer has had high blood glucose for over a year, but only now after a random reading exceeds 300 mg/dL on an office visit is he willing to admit that he has diabetes. He has had a previous heart attack and is taking several cardiovascular and hypertensive medications. His physical exam today is normal. He has a BMI of 28. He admits to feeling a little tired, recently, and has been getting up at night to urinate at least two to three times per week. Age: 55 Weight: 211 lbs. Height: 6’0′ BMI: 28 Blood Glucose Last A1C: 10.2% Fructosamine: 429 mmoL Inl <250) Random: 358 mg/dL Lipid Profile Total: 153 mg/dL. LDL: 70 mg/dL HDL: 41 mg/dL Triglycerides: 225 mg/dL Kidney Profile Creatinine: 0.8 mg/dL Microalbuminuria: negative Liver Function ALT: normal AST: normal Blood Pressure Normal: 130/90 mmHg Cardiovascular condition Previous myocardial infarction Eye Exam Normal Foot Exam Normal pulses and sensation Compliance with meal plan? No diabetes meal plan at this time. Compliance with exercise plan? Limited activity and rare exercise. For blood glucose: none For other conditions: HCTZ, 25 mg ad Metoprolol (Toprol XL), 50 mg ad Aspirin 81 mg ad Simvastio (Zocon 20 mg ad 1) What risk factors for DM are present? Which are modifiable? 2) What signs and symptoms of DM is the patient exhibiting/ reporting? 3) Which labs are consistent with a diagnosis of DM? 4) What is the significance of the HgbA1C? 5) The doctor plans to prescribe the patients Metformin (Glucophage) 500 mg PO BID with meals. How does this medication work? What patient teaching needs to be provided?
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