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

Obesity

Hypertension

Current Medications

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.

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