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Q.1. A 61-year-old woman is seen in cardiology clinic for evaluation of a new-onset
cardiomyopathy. She has had diabetes since 1986 and has been managed with
glipizide 5 mg twice daily and metformin 1000 mg twice daily. At her initial visit,
she was noted to have fasting triglycerides of 565 mg/dL, HbA1c of 8.8, and
creatinine of 2.8. Her heart failure was stable, and she had returned to her normal
level of functioning. What should be done with her therapy?
A. Continue glipizide and metformin and add an injection of insulin at bedtime
B. Discontinue metformin and substitute pioglitazone
C. Discontinue metformin and substitute rosiglitazone
D. Discontinue metformin and add an injection of insulin at bedtime
E. B or D

d,

Answer: E. This case illustrates the importance of considering underlying comorbidities in selecting therapy. The patient™s renal insufficiency necessitates discontinuation of the metformin. Given her HbA1c, however, she clearly needs to substitute another agent. Because her heart failure is stable and her triglycerides are so high, pioglitazone is a good choice. Pioglitazone lowers triglycerides and raises HDL, whereas rosiglitazone raises LDL and HDL. Discontinuing metformin and adding insulin at bedtime would also be a correct option.

yeah but as he has h/o heart failure, and he failed on 2 oral drug , i thoutht d is the best option, what do u think

yes, your choice is correct,however, giving insulin to someone who is already on 2 oral medications and he started to have organ damage, then I think insulin injection would be a good choice also.

if u choose b then why not c too

rosiglitazone raises LDL and HDL
Dude, we need to know about oral hypoglycemic agents. They are important.