Maybe old is gold? Newer Insulins Might Not Be Better – Just More Expensive
Podcast URL: NPH vs Insulin Analogs
Setting Internal Medicine Clinic (Somewhere in the USA)
Patient Demographics (Initials, age, sex/gender✦, and race)
GR is a 63-year-old Asian female
Reason for Visit Initiation of basal insulin therapy
History of Present Illness and Presenting Symptoms (if any)
She was diagnosed with type 2 diabetes 5 years ago but is otherwise healthy. She has not had any complications related to diabetes and has never been hospitalized. After using metformin and sitagliptin for the past 3 years, the patient was started on a glucagon-like peptide-1receptor agonist (GLP1 RA) about three months ago. Her A1c at the time was 9.1% and the primary care physician felt that a GLP1 RA was the best option in order to promote weight loss. However, the patient has not been able to tolerate the GLP1 RA due to persistent nausea. The primary care physician has referred the patient to you to initiate basal insulin therapy. The patient checks her blood glucose every morning and records her readings in a log book. Looking at the data you see that most of her readings are in the 160-200 range with an occasional reading above 200mg and her lowest reading was 137mg/dL over the past month. Patient states she’s trying to cut down on starchy food intake and would like to lose weight. She has a pedometer and tries to get at least 7500 steps a day.
Social History including Health Insurance Coverage
She has health insurance and a prescription drug plan; co-pay on brand-name drugs is $50.
Significant Past Medical History
Type 2 Diabetes Mellitus
Metformin 1000mg PO twice daily
Sitagliptin 100mg PO daily
Lisinopril/HCTZ 20/12.5mg PO daily
Physical Exam Findings / Vital Signs
Weight = 187 lbs Height = 5’ 1” BP = 122/70
Pertinent Laboratory Findings
Last A1c = 9.1% (3 months ago)
✦Unless otherwise noted, the patient’s sex and gender are congruent.
Copyright © 2018 All rights reserved - iForumRx.org