- CDC
- Heart Failure
- Cardiovascular Clinical Consult
- Adult Immunization
- Hepatic Disease
- Rare Disorders
- Pediatric Immunization
- Implementing The Topcon Ocular Telehealth Platform
- Weight Management
- Screening
- Monkeypox
- Guidelines
- Men's Health
- Psychiatry
- Allergy
- Nutrition
- Women's Health
- Cardiology
- Substance Use
- Pediatrics
- Kidney Disease
- Genetics
- Complimentary & Alternative Medicine
- Dermatology
- Endocrinology
- Oral Medicine
- Otorhinolaryngologic Diseases
- Pain
- Gastrointestinal Disorders
- Geriatrics
- Infection
- Musculoskeletal Disorders
- Obesity
- Rheumatology
- Technology
- Cancer
- Nephrology
- Anemia
- Neurology
- Pulmonology
Diabetes Quiz: A 79-Year-Old With Elevated AlC Who Has Had a Stroke: How Would You Treat?
The elderly patient has had type 2 diabetes for 15 years is now home bound after a stroke. Her HbA1c is 9.6 and she takes only metformin. Review the rest of her laboratory results and propose a management plan.
Sue Jones, 79-years-old, has had type 2 diabetes for 15 years. She is home-bound after a recent stroke and now requires assistance with most of her activities. She has a daytime sitter and a weekly visiting nurse; her family provides care in the evenings and on weekends. The family has moderate means and would like to keep her at home. Sue can communicate effectively: she recognizes all of her family members and you, as her physician.
Her most recent lab tests showed an HbA1c of 9.6; a random blood sugar of 450; triglycerides, 350 mg/dL; HDL, 40; LDL, 110 (calculated); total cholesterol, 220; and non-HDL,180.
Some of her medications were stopped when she was discharged from the hospital 3 weeks ago. She now only takes metformin (2000 mg/d) for her diabetes and no medications for her lipids.
Would you consider more aggressive treatment of her elevated HbA1c? If so, why-and with what medications? What goals would you have for her A1C? Would you do anything to treat her lipids?
Please add your comments below-including your agreements and disagreements.Dr. Shahady he will respond to the comments made within the next 2 weeks.
Click here for Dr. Shahady’s discussion of options.
