04-14-2007, 06:07 AM
A 50-year-old male comes in for follow up. You had met the patient three months prior to this visit and discovered that he had diabetes for the past two years. His previous physician had placed him on Glipizide 5 mg/day. At the visit three months ago, you found that his recent ophthalmologic visit revealed no retinopathy, his renal function was stable, and his physical exam was negative except for morbid obesity. He had visited a nutritionist at your recommendation and he had modified his diet further based on her suggestions. At that time, his hemoglobin A1C was 6.8%. You had elected to make no changes in his medical regimen.
At this visit, you discover that his weight has gone up 5 lbs. and his hemoglobin A1C has gone up to 7.3%. He denies drinking any alcohol, taking any herb supplements, or following any fad diets. His only medications are the Glipizide and one multivitamin. At this point, you tell the patient that you would like him to
a Add metformin to his glipizide
b Start Insulin therapy
c Add one of the thiazolidinediones
d Change his glipizide to metformin
e Increase his level of exercise
At this visit, you discover that his weight has gone up 5 lbs. and his hemoglobin A1C has gone up to 7.3%. He denies drinking any alcohol, taking any herb supplements, or following any fad diets. His only medications are the Glipizide and one multivitamin. At this point, you tell the patient that you would like him to
a Add metformin to his glipizide
b Start Insulin therapy
c Add one of the thiazolidinediones
d Change his glipizide to metformin
e Increase his level of exercise