CC: My blood sugars have not been very good lately. I’m doing everything I am supposed to be doing HPI: A 24-year-old male patient comes to your primary care clinic to establish care. He has type 1 diabetes mellitus diagnosed at age 11. He has not seen a provider in about 9 months. Currently, he is taking NPH insulin 30 units bid (8 a.m. and 6 p.m.) with 10 units Humalog before each meal. He does not take any other medications. He does not use tobacco products but does drink alcohol on the weekends. He reports checking blood glucose (BG) levels three to four times daily but did not bring his glucose log or meter. He reports his fasting blood sugar runs 150 to 190 and prandial glucose readings are 140- 250. He reports hypoglycemic episodes one to two times per week. He exercises intermittently but is not on a regular schedule. He does not eat on a regular schedule every day although he says he knows that he should. He works at a light-activity job 8 hours daily. Reports fatigue and nausea at times. Unsure of polydipsia or polyuria. Denies fevers, chills, weight loss, malaise, SOB, palpitations, dizziness, headache, constipation, and diarrhea. PmHx: DM type 1 Meds: NPH insulin 30 units BID and Humalog 10 units with meals Allergies: NKDA Vital Signs: BP = 128/78 HR = 76 RR = 20 Wt = 200 lbs Ht= 5’10” Physical Exam: no abnormalities except Labs: Na 136 Hgb 13.8 TSH 2.4 K 4.8 Hct 39.4 Total chol 209 BUN 23 WBC 4.5 LDL 103 Creatinine 1.4 A1c 9.8 HDL 55 Glucose 240 TG 180 Question: What changes/titrations would you recommend to the patient’s diabetic medication regimen? Would you add anything new?
CC: My blood sugars have not been very good lately. I’m doing everything I am supposed to be doing
HPI: A 24-year-old male patient comes to your primary care clinic to establish care. He has type 1 diabetes mellitus diagnosed at age 11. He has not seen a provider in about 9 months. Currently, he is taking NPH insulin 30 units bid (8 a.m. and 6 p.m.) with 10 units Humalog before each meal. He does not take any other medications. He does not use tobacco products but does drink alcohol on the weekends. He reports checking blood glucose (BG) levels three to four times daily but did not bring his glucose log or meter. He reports his fasting blood sugar runs 150 to 190 and prandial glucose readings are 140- 250. He reports hypoglycemic episodes one to two times per week. He exercises intermittently but is not on a regular schedule. He does not eat on a regular schedule every day although he says he knows that he should. He works at a light-activity job 8 hours daily. Reports fatigue and nausea at times. Unsure of polydipsia or polyuria. Denies fevers, chills, weight loss, malaise, SOB, palpitations, dizziness, headache, constipation, and diarrhea.
PmHx: DM type 1
Meds: NPH insulin 30 units BID and Humalog 10 units with meals
Allergies: NKDA
Vital Signs: BP = 128/78 HR = 76 RR = 20 Wt = 200 lbs Ht= 5’10”
Physical Exam: no abnormalities except
Labs:
|
Na |
136 |
Hgb |
13.8 |
TSH |
2.4 |
|
K |
4.8 |
Hct |
39.4 |
Total chol |
209 |
|
BUN |
23 |
WBC |
4.5 |
LDL |
103 |
|
Creatinine |
1.4 |
A1c |
9.8 |
HDL |
55 |
|
Glucose |
240 |
|
|
TG |
180 |
Question: What changes/titrations would you recommend to the patient’s diabetic medication regimen? Would you add anything new?
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