Class Case Information
CC
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SS is a 50 yowf who comes to your office with a 3-day history of not feeling well. She complains of sneezing, stuffy nose, fatigue, slight fever, and a non-productive cough. She has taken pseudoephedrine (Sudafed®) for the past 48 hours to help relieve some of the sinus congestion. PMH:
SS has a 7-year history of Type II diabetes which has been relatively well controlled. She brought in her log book of home blood glucose results over the past month. She suffered a MI 5 years
ago with subsequent heart failure (most recent ejection fraction = 45%). She also has a history of GERD.
Allergies: NKDA
Medications:
Glyburide (Diabeta®) 5 mg two times daily
Metformin XR (Glucophage XR®) 500 mg – 4 tablets daily before breakfast Metoprolol tartrate (Lopressor®) 12.5 mg two times daily
Furosemide (Lasix®) 40 mg daily Potassium chloride (K-dur®) 10 mEq daily Omeprazole (Prilosec®) 20 mg daily
SH: no alcohol, 1 pack per day cigarette habit
Physical Exam:
GEN: ill-appearing female
VS: BP 150/85, HR 62, RR 16, Temp 99.5, Wt. 62kg, Ht. 5’5”
HEENT: nasal membranes red and irritated, watery eyes, clear nasal discharge CHEST: CTA
COR: NMRG, RRR NEURO: WNL
EXT: +1 pitting edema
Laboratory:
| Na 140 | Cl 100 | BUN 18 |
| K 4.0 | HCO3 25 | SCr 0.8 (stable) |
BG 260 | A1C: 7.8% | Urine microalbumin/creatinine:45 |
Blood glucose log:
| Date | Fasting | Post-prandial | Bedtime | Notes | |||
| Lunch | Dinner | ||||||
| Time | BS | Time | BS | Time | BS | Time | BS |
| 1/1 | 8:00 | 132 | 7:00 | 200 | |||
| 1/2 | 1:45 | 210 | 9: 00 | 160 | |||
| 1/3 | 6:58 | 125 | 7:45 | 220 | |||
| 1/4 | 1:49 | 198 | |||||
| 1/5 | 7:20 | 135 | 7:36 | 250 | Ate Dinner out | ||
1/6 | 7:56 | 160 | 8:09 | 202 | Glucose reading of 66 mg/dL with shaking/sweatingat 4:00pm (skipped lunch) | ||
| 1/7 | 2:07 | 189 | 10:32 | 153 | |||
1/8 | 8:00 | 124 | 7:33 | 209 | Glucose reading of 64 mg/dL with shaking/sweating at 3:30pm(skipped lunch) | ||
| 1/9 | 1:34 | 210 | |||||
| 1/10 | 7:50 | 120 | 7:23 | 195 | |||
| 1/11 | 1:53 | 192 | 9:45 | 140 |
1/12 | 8:05 | 115 | Glucose reading of 60 mg/dL with shaking/sweatingat 2:00pm (skipped lunch) |
| 1/13 | 1:40 | 201 | |
| 1/14 | 7:56 | 232 | |
| 1/15 | 10:00 | 135 | |
| 1/16 | 7:45 | 118 | |
| 1/17 | 2:40 | 172 | |
| 1/18 | 7:32 | 190 | |
| 1/19 | 9:54 | 129 | |
| 1/20 | 7:32 | 111 | |
| 1/21 | 2:05 | 206 | |
| 1/22 | 7:59 | 193 | |
| 1/23 | 9:25 | 134 | |
| 1/24 | 7:06 | 113 |
| 1/25 | 2:20 | 179 | |||
| 1/26 | 8:05 | 229 | Sick | ||
| 1/27 | 7:45 | 170 | 7:30 | 210 | Sick |
| 1/28 | 8:05 | 200 | 1:46 | 229 | 7 |