doc_clotaire
Forum Guru
Topics: 159
Posts: 1,301
|
Folks , I found this one very CONFUSING , please try to explain your point so we can clear our doubts . Thanks in advance
A 39-year-old Caucasian male with known type 2 diabetes mellitus visits with his family physician for the results of some recent blood work. His results are
• Total cholesterol = 230 mg/dL
• Low-density lipoprotein level = 130 mg/dL
• Triglyceride level = 200 mg/dL
• Fasting serum glucose = 130mg/dL
• Hemoglobin A1c= 6. 5%
His liver panel is normal. He is taking glyburide 5 milligram once daily. His physical examination is normal. The next best step in the treatment of this patient is
A. Add metformin to the regimen
B. Increase his dose of glyburide
C. Recommend diet and exercise only
D. Start administering simvastatin
E. Start administering simvastatin and ramipril
F. Switch his treatment to insulin therapy
___________________
The elevator to succes is broke ,you must take the stairs
|
| docnikki
Forum Guru
Topics: 93
Posts: 680
|
I think it should be E.
though his blood glucose is high but more worrisome is his bad lipid profile...LDL should be less than 100..so a statin must be added..all DM 2 should be on ACE inhibhitor which should be added too. I hope Im correct.
|
| Justice
Just signed contract
Topics: 118
Posts: 2,369
|
docnikki wrote:
I think it should be E.
though his blood glucose is high but more worrisome is his bad lipid profile...LDL should be less than 100..so a statin must be added..all DM 2 should be on ACE inhibhitor which should be added too. I hope Im correct.
I think the ACE inh-s should be started before attempt to correct lipids... They go in (E)
___________________
The winner takes it all...
|
| nadiabarati
|
D
there is no blood pressure here! We don't put all diabetic patients on ACE inhibitors, do we?
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
I am going with D...Since,the goal for LDL in diabetic patients is to reduce below 100....
There is not enough data given for the initiation of ACE-Inhibitor therapy such as proteinuria or hypertension..Moreoee Hba1c is 6.5%-(Not >7)-So,Continue the same medication and start statins...
Wat do u think clotaire??
|
| neuroblastoma
Forum Guru
Topics: 109
Posts: 1,091
|
YES D CORRECT
|
| snake0613
Forum Elite
Topics: 97
Posts: 194
|
i think E,
ace which is more important to protect renal from the DM
|
| muna
Forum Senior
Topics: 17
Posts: 126
|
A
|
| snowdrops
Forum Senior
Topics: 6
Posts: 149
|
E. AEI even can start without hypertension or proteinuria in DM2 patients.
|
| nadiabarati
|
where did you study this from? You mean we must put all DM 2 patients on ACEs?!!!
|
| muna
Forum Senior
Topics: 17
Posts: 126
|
SORRY, D
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
ACE inhibitors are not needed for all DM patients.they are indicated only when there is associated..
*Microscopic albuminuria or proteinuria
*Associated Hypertension.
|
| nadiabarati
|
I agree with sprint.
|
| docnikki
Forum Guru
Topics: 93
Posts: 680
|
Actually by the time DM type 2 are diagnosed they all have the microalbuminuria...and in DM type 1 its not the case coz they are diagnoseed very early. Even If Dm type 2 is normotensive then also we put him on ACE I..thats the latest guideline.....u can check CMDT 2007 page 1248.
doc_clotaire whats the answer by the way.
|
| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,301
|
CORRECT: E
The patient currently has good control of his diabetes mellitus based on the hemoglobin A1c and serum plasma glucose. According to the new guidelines of the National Cholesterol Education Program regarding adenosine triphosphate III, diabetes mellitus is regarded as a coronary artery disease risk equivalent, and the goals for lipid levels in patients with the disease should be a low-density lipoprotein level of less than 100 mg/dL, a total cholesterol level less than 200 mg/dL, and a triglyceride level less than 150 mg/dL. The high-density level lipoprotein should be as high as possible. Therefore adding simvastatin (An HMG-Co A reductase therapy for lipid control) is a good idea. Angiotensin converting enzyme inhibitor (ACE inhibitor) regardless of hypertension or early nephropathy is nephroprotective in patients with diabetes mellitus.
ACE inhibition therapy both reduces the degree of proteinuria in patients who have proteinuria and independently retards the progression of renal insufficiency. Some small studies and expert opinion are even recommending the prophylactic use of ACE inhibition therapy in normotensive diabetics specifically for this purpose.
Changing his current diabetic regimen, increase the dose of glyburide, or adding metformin to the regimen, or switching to insulin would not affect the lipid panel. recent meta-analysis of all studies performed between 1966 and 1991 to evaluate the efficacy of combination therapy concluded that only a modest benefit was achieved at a significant increase in cost and the risk of hypoglycemia.
Diet and exercise are a crucial component to the long term care of diabetes mellitus. Weight reduction may decrease insulin tolerance. For most patients with diabetes mellitus, diet and exercise alone is insufficient and some form of pharmacotherapy is eventually needed. The first choice is actually metformin.
___________________
The elevator to succes is broke ,you must take the stairs
|
| sachida
Forum Guru
Topics: 62
Posts: 625
|
Thank you, I di dnot know that.
Ravid M, Brosh D, Levi Z, Bar-Dayan Y, Ravid D, Rachmani R.
Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuric patients with type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med 1998;128(12 pt 1):982-8.
___________________
Past is a history. Tomorrow is a mystery. What you have today is gift of God- that is why it is called present. Enjoy it...
|
|
| |
| | | | | | | | | | | | | | | | |
Similar forum topics