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TYPE 2 DIABETES MELLITUS

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MSPharmacy-B Concepts In Clinical Pharmacy Case No. 1: TYPE 2 DIABETES MELLITUS PATIENT PRESENTATION CHIEF COMPLAINT: “I was recently diagnosed with possible diabetes and would like to have my ... blood sugar tested. I think that my blood sugar is running low because I have a terrible headache.” HISTORY HPI: Name: Sarah Martin Age: 43 yrs old Comes to the pharmacy for a diabetes education class taught by the pharmacist and would like for the pharmacist to check her blood sugar before the class begins. She was diagnosed with diabetes mellitus Type 2 about 6 months ago. She has been attempting to control her disease with diet and exercise but has had no success. Her physician has recently started her on glyburide 5 mg. She has gained 15 lb over the past year.She monitors her blood sugar once a day, per her physician, with a range of 215–260 mg/dL. Her fasting blood sugars average 170mg/dL. PMH:  Type 2 DM × 6 months  HTN × 15 years  Bipolar disorder × 25 years  Dyslipidemia × 10 years  Morbid obesity × 15 yearsFH:  Father has history of hypertension and bipolar disorder  Mother has a history of dyslipidemia  Brother has DM secondary to alcoholism SH:  Has been married for 21 years.  She has two children who are teenagers.  She works in a floral shop making deliveries.  Denies any use of tobacco products but does drink alcohol occasionally (five beers/wine per week). MEDICATIONS:  Glyburide 5 mg po BID -- 2nd gen sulphonyurea an antidiabetic  Lisinopril 20 mg po once daily -- ACE inh for HTN  Zyprexa 5 mg po Q HS -- Olanzapine: treatment of moderate to severe manic episode  Carbamazepine 200 mg po TID -- Anticovulsant  Lorazepam 1 mg po TID PRN -- for anxiety  Fluoxetine 20 mg po Q AM EC -- antidepressant known as an SSRI (selective serotonin reuptake inhibitor).  ASA 81 mg po once daily -- Antithrombotic  Pravastatin 40 mg po once daily – Dyslipidemia ASSESSMENT: The patient reports that she exercises at most once a week and her diet is difficult to maintain due to the nature of her job as a delivery person. Her glycemic control has been maintained with an 8.9% A1C 6 months ago. She has had a moderate weight gain of 15lb (6.8 kg) over the past year. Her blood pressure and cholesterol are not at goal on the current drug therapy. Her bipolar disorder is moderately controlled on the current drug therapy. When the patient is in a depression or manic phase, she tends to use food to “treat” the symptoms [Show More]

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