Case #1 Questions:

  1. What is HbA1c?
  2. 1a. What’s The Optimal glycemic (HbA1c) goal for this patient?
  3. Is there a role for diet and exercise in this patient who has failed on maximum dose of sulfonylurea medicine (glimepiride)? 
  4. How does metformin work?
  5. Besides metformin, what are other classes of antidiabetic agents?
  6. Besides reemphasizing the importance of diet, exercise, and education what else might you do for this patient at this time?
  7. After 2 months of diet and exercise limited by his intermittent claudication, his HBGM results averaged ~225 mg % and HbA1c was 9.5%. What now? 
  8. BP=155/94. Is this patient’s blood pressure adequately controlled?
  9. BUN=17, Creat=1.3, ACR=16mg/g, U/A normal except 1+ glucose. Has kidney function been satisfactorily evaluated?
  10. TC=205 mg %, HDL = 32 mg %, LDL = 140 mg %,TG= 210 mg %. Is his lipid control adequate? 
  11. What is the standard of eye care for this patient?
  12. The patient’s neurologic symptoms have not resolved (pain in his toes, worse at night). What can be done?
  13. What is the cause of his night sweats?
  14. What is the cause of the patient’s impotence?
  15. Pharmacologically, can anything else be done for this patient?