doc_clotaire
Forum Guru
Topics: 159
Posts: 1,240
|
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
|
| Ivil
Forum Senior
Topics: 8
Posts: 169
|
D. Start administering simvastatin
as DM is considered as equivalents of coronary artery disease.. LDL should be maintained <100... if CAD is present then target LDL is <70mg/dl
___________________
Even if you are on the right track, you will get run over if you just sit there...KEEP RUNNING
|
| Kamsi
Forum Guru
Topics: 103
Posts: 347
|
D Has DM a CAD equivalent.Target LDL with CAD is also 100mg/dl ,I'm not sure abt 70mg/dl
|
| Ivil
Forum Senior
Topics: 8
Posts: 169
|
CAD + DM or smoking makes him a high risk pt.. so LDL should be controlled below 70
___________________
Even if you are on the right track, you will get run over if you just sit there...KEEP RUNNING
|
| MAGY17
Forum Elite
Topics: 30
Posts: 234
|
C
the target LDL WITH 0-1 risk (DM) is <160
the first intervention in this pcte will be diet and exercise
|
| MAGY17
Forum Elite
Topics: 30
Posts: 234
|
OOOOOOOOHHHHHHHHHHHH NOOOOOOOOOOOTTTTTTT
SORRY YOU`RE RIHG
DM IS A CAD OR RISK EQUIVALEN
the target is <70, this pcte need stard simvastatin
ans is D
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
How about AAA since his fasting serum glucose is 130??
|
| Ivonne
Forum Guru
Topics: 51
Posts: 1,392
|
I will go with D, since controlling dyslipidemia may lead to a better glucose level control. The HbA1c is in the limit of the goal <6.5 so it is not bad, now this patient may have metabolic syndrome but there is not enough info to met the criteria in which case metformin may be very useful. I think we may need more fasting glucose readings to make the decision to add metformin to avoid the risk of hypoglycemia in this patient.
___________________
If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)
|
| Doc750
transfer:step 3 prison
Topics: 52
Posts: 636
|
I say D b/c Ivonne is always right. 
j/k total chol is 240, need to start therapy. He doesn't have CAD equivalent. He only has one risk factor, and they didn't give the HDL (if high enough then we can remove one risk factor). So he needs his LDL to be <130.
___________________
Experience is a hard teacher because she gives the test first, and the lesson afterwards.
|
| Aashi
Forum Moderator
Topics: 112
Posts: 917
|
E------>Start administering simvastatin and ramipril
An ACE inhibitor is added ,without evidence of early nephropathy or HTN in diabetic pts, as they r found to be nephroprotective...
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,208
|
D
___________________
When men make the rules, God decides the exceptions.
|
| MAGY17
Forum Elite
Topics: 30
Posts: 234
|
doc750
DIABETES MELLITUS IS A CAD EQUIVALENT
and pcte with cad equivalent the target LDL will be <70
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
magy what do u mean by pcte?
|
| ing
Forum Guru
Topics: 45
Posts: 435
|
D or E??
___________________
Never give up!!
|
| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,240
|
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
|
| Ivonne
Forum Guru
Topics: 51
Posts: 1,392
|
Nice question!!!!!!!!!!
___________________
If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)
|
|
| |
| | | | | | | | | | | | | | | | |
