Learning Objectives
After completing this case study, the reader should be able to:
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Identify the goals of therapy for the treatment of type 2 diabetes mellitus (DM).
Discuss the risk factors and comorbidities associated with type 2 DM.
Compare options for drug therapy management of type 2 DM, including mechanisms
of action, combination therapies, comorbidities, and patient-friendly treatment
plans.
Develop an individualized drug therapy management plan, including dosage
regimens, therapeutic endpoints, and monitoring parameters.
Provide patient education regarding medications and the importance of adhering to
the treatment plan, monitoring the disease state, maintaining blood glucose control,
and seeking advice from healthcare providers when necessary.
Patient Presentation
Chief Complaint
“I have had diabetes for about six months and would like to have my blood sugar tested. I
think that my blood sugar is running low because I have a terrible headache.”
HPI
SM is a 45-year-old woman who comes to the pharmacy for a diabetes education class
taught by the pharmacist. She would like for the pharmacist to check her blood sugar
before the class begins. She was diagnosed with type 2 DM about 6 months ago. She had
been attempting to control her disease with diet and exercise, but had no success. Her
physician started her on metformin 1000 mg twice daily with food about 3 months ago. She
has gained 10 lb over the past year. She monitors her blood sugar once a day, and her
results have ranged from 215 to 280 mg/dL. Her fasting blood sugars have averaged 200
mg/dL.
PMH
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Type 2 DM × 6 months
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HTN × 17 years
Dyslipidemia × 12 years
Morbid obesity × 20 years
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FH
Father has a history of HTN, dyslipidemia, and bipolar disorder. Mother has a history of
dyslipidemia and hypothyroidism.
SH
Has been married for 23 years. She has two children who are teenagers and one child in
college. She works as a sales associate in the electronics department of a local mass
merchandiser. She denies any use of tobacco products after stopping smoking 10 years ago,
Meds
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Metformin 1000 mg PO BID with food
Lisinopril 20 mg PO once daily
Pravastatin 40 mg PO once daily
All
Penicillin—hives
ROS
Complains of nocturia, polyuria, and polydipsia on a daily basis. Denies nausea,
constipation, diarrhea, signs or symptoms of hypoglycemia, paresthesias, and dyspnea.
Physical Examination
Gen
WDWN severely obese, white woman in NAD
VS
BP 154/90 mm Hg, P 98 bpm, RR 18, T 37.0°C; Wt 109 kg, Ht 5′8″, waist circ 38 in
HEENT
PERRLA, EOMI, R & L fundus exam without retinopathy
Neck/Lymph Nodes
No LAN
Lungs
CTA & P
CV
RRR, no m/r/g
Abd
NT/ND
Genit/Rect
Deferred
MS/Ext
Carotids, femorals, popliteals, and right dorsalis pedis pulses 2+ throughout; left dorsalis
pedis 1+; feet show mild calluses on MTPs
Neuro
DTRs 2+ throughout, feet with normal sensation (5.07 monofilament) and vibration
Labs
Na 138 mEq/L
K 3.7 mEq/L
Cl 103 mEq/L
CO2 31 mEq/L
BUN 16 mg/dL
SCr 0.9 mg/dL
Glu (random) 243 mg/dL
UA
1+ protein, (+) microalbuminuria
Ca 9.4 mg/dL
Phos 3.3 mg/dL
AST 16 IU/L
ALT 19 IU/L
Alk phos 62 IU/L
T. bili 0.4 mg/dL
A1C 10.0%
Fasting lipid profile
T. chol 244 mg/dL
LDL 141 mg/dL
HDL 58 mg/dL
Trig 225 mg/dL
TC/HDL ratio 4.2