L.H. was quite motivated to improve her glucose control because her grandmother “lost a leg” to diabetes and her aunt is undergoing dialysis because “her kidneys have failed.” She is taking metformin 1,000 mg PO BID and tolerating it reasonably well (she occasionally gets some stomach discomfort, but states she is fine with it). She is proud that she remembers to take the metformin every day as instructed. She met with a dietitian who suggested an 1,800-calorie diet and 45-minute walks three times weekly. After 3 months, L.H. lost 6 pounds. L.H. stopped drinking regular sodas and juices, but eats either breads or two large tortillas at each meal. She admits to eating only small amounts of “greens” and vegetables. She has not been able to implement her walks three times weekly; more often she only walks once a week. Although her FPG fell to 130 mg/dL, a majority of her postprandial BG levels were more than 180 mg/dL. Her A1C is 7.4%, and fasting triglyceride levels are now 260 mg/dL. How should her therapy be adjusted? What factors should be considered when deciding on the next steps for pharmacologic therapy?
PLACE THIS ORDER OR A SIMILAR ORDER WITH COLLEGE NURSING PAPERS AND GET AN AMAZING DISCOUNT!
