sprint123
Forum Guru
Topics: 129
Posts: 870
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A 60-year-old man with a 7-year history of type 2 diabetes mellitus is evaluated for cardiovascular risk factors. His only medication is glyburide, 5 mg/d. His physical examination shows: weight, 94 kg (207 lb); height, 175 cm (69 in); blood pressure, 152/96 mm Hg; background retinopathy, and a mild peripheral neuropathy.
Laboratory Studies
Hemoglobin A1c 12.3%
Triglycerides (fasting) 225 mg/dL
Total cholesterol 231 mg/dL
HDL cholesterol 35 mg/dL
LDL cholesterol 152 mg/dL
What is the most appropriate next step?
( A ) Begin a low-sodium, low-saturated fat, reduced-calorie diet
( B ) Begin lovastatin
( C ) Begin hydrochlorothiazide
( D ) Increase the glyburide dosage
( E ) Begin insulin
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| vradojc1
Forum Elite
Topics: 21
Posts: 309
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Wow! He needs everything!
What is the most important? Control DM first? Since improved glycemic control can offset some of the findings present here, I'd increase his glyburide first. However since sequels of DM are present and DM is high risk category for CAD I'd go with B since his LDL has to go below 100. And...
Wow, this is a complete mess! Maybe talk to undertaker?
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| usmle12
Forum Senior
Topics: 19
Posts: 194
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WELL TAKLING HIS DM IS FIRST BCZ THIS IS MOST DANGEROUS RISK FACTOR I THINK ELSE COMES NEXT...BUT IAM CONFUSED..
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| Justice
Forum Fanatic
Topics: 106
Posts: 2,140
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As all the other colleagues, I'm concerned about DM-control in this guy...
I start with ( E ) Begin insulin
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Don't live in a town where there are no doctors
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| vradojc1
Forum Elite
Topics: 21
Posts: 309
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But glyburide is at really low dose?
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