32-Year-Old Diabetic Male on a Diuretic
Let’s return to Kyle Boulard, whom we met in the previous chapter. Mr. Boulard has recovered from his acute diabetic crisis. The last update on his chart before he is discharged includes the following:
•BP 150/95, HR 75, temperature 37.2°C
•Urine: pH 6.9, negative for glucose and
Mr. Boulard is prescribed a thiazide diuretic and an angiotensin converting enzyme (ACE) inhibitor. He is counseled on the importance of taking his medications regularly and keeping his outpatient follow-up appointments.
1. What is albumin? Is it normally found in the urine? What does its presence suggest?
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- Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forwardMehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forwardMehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forward
- Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forwardMehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forwardMehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forward
- Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forwardMehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forwardMehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forward
- Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forwardMehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forwardMehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…arrow_forward
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