Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
A 42-year-old man with a body mass index (BMI) of 28 and no significant past medical history is volunteering at a diabetes fundraiser where he is found to have a fasting blood glucose level of 152 mg/dL. He had you repeat his fasting blood glucose and it was 149 mg/dL. You have referred him to a dietitian for diabetic diet education, as well as advised him on an exercise program. The patient returns to you 2 months later and states he has been compliant with the diet, is exercising vigorously, and has lost about 5 pounds since his last visit. On physical examination, his vital signs are all within normal limits and his BMI is 26. Complete physical examination is unremarkable. Which of the following is the best next step in management?
A. Continue diet and exercise alone
B. Start insulin
C. Start metformin
D. Start a sulfonylurea
E. Start troglitazone
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
Hey guys, forgot ot add one more detailto this qs: his FBS now is 146mg/dl. So, best next step in management?
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
c start metformin cos of BMI
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
I think it is..C because his body mass index is now near normal 26 !!!!
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
D,,,, sulfonylureas preferred in those that aint obese...BMI of 26 is not obesity.
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
is BMI 25-29 considered to be overweight, and over 30 obese?
Correct me plz
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
agreed he is not obese but he is still overweight.
yes u are right uterus.
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
The correct answer is D. If the patient™s BMI is less than 30, the initial drug of choice to start treating a diabetic patient who has been recently diagnosed is going to be sulfonylureas.
Starting metformin would be an appropriate choice in a patient whose BMI is greater than 30; this patient™s BMI is below 30. The reason for using metformin and not sulfonylureas is that metformin produces gastrointestinal side effects, including nausea, which cause the patient to lose weight (which can be beneficial in the treatment of a patient with diabetes who is also obese).
