Question: Patient Background Karen Is A 47 Year-old African-American Woman With Three Children And One Unsuccessful Pregnancy. She Has A Full-time Clerical Job For A Transportation Company. On Her Last Pregnancy Five Years Ago, She Had Gestational Diabetes. No Other Significant History, She Returns For Her Annual Check-up. Her Lab Tests Were Drawn Pre-visit. …

Patient Background Karen is a 47 year-old African-American woman with three children and one unsuccessful pregnancy. She has a full-time clerical job for a transportation company. On her last pregnancy five years ago, she had gestational diabetes. No other significant history, She returns for her annual check-up. Her lab tests were drawn pre-visit. Gender: Female Age: 47 Weight: 192 lbs. Height: 5’4″ BMI: 33 Glucose Monitoring Last A1C: 8.5% Fasting: 235 mg/dL Pre-prandial: Post-prandial: Lipid Profile Total: 215 mg/dL LDL: 135 mg/dL HDL: 53 mg/dL Triglycerides: 130 Kidney Profile Creatinine: 0.9 mg/dL Microalbuminuria: none Liver Function ALT: normal AST: normal Blood Pressure Normal: 126/78 mmHg Cardiovascular condition within normal limits Eye Exam Normal Foot Exam Normal pulses and sensation Compliance with meal plan? Does not follow any specific meal plan. Interview reveals that she tends to cook a high-fat diet with a large amount of fried foods. Compliance with exercise plan? Does not exercise regularly. For blood glucose: none For other conditions: none 1) ? 1) What risk factors for DM are present? Which are modifiable? 2) The patient is recommended to alter her diet to control her blood sugars. Describe the dietary modifications she should be taught about. What other lifestyle modifications should be made? ? 3) After 3 months of dietary and lifestyle modifications the patients has her HabA1C checked, the result is 7.6%. What does this signity? 4) The doctor plans to prescribe pioglitazone (Actos) 15 mg PO Q am. How does this medication work? What patient teaching needs to be provided?