Class Case Information
CC
SS is a 50 yowf who comes to your office with a 3-day history of not feeling well. She complains of sneezing, stuffy nose, fatigue, slight fever, and a non-productive cough. She has taken pseudoephedrine (Sudafed®) for the past 48 hours to help relieve some of the sinus congestion. PMH:
SS has a 7-year history of Type II diabetes which has been relatively well controlled. She brought in her log book of home blood glucose results over the past month. She suffered a MI 5 years
ago with subsequent heart failure (most recent ejection fraction = 45%). She also has a history of GERD.
Allergies: NKDA
Medications:
Glyburide (Diabeta®) 5 mg two times daily
Metformin XR (Glucophage XR®) 500 mg – 4 tablets daily before breakfast Metoprolol tartrate (Lopressor®) 12.5 mg two times daily
Furosemide (Lasix®) 40 mg daily Potassium chloride (K-dur®) 10 mEq daily Omeprazole (Prilosec®) 20 mg daily
SH: no alcohol, 1 pack per day cigarette habit
Physical Exam:
GEN: ill-appearing female
VS: BP 150/85, HR 62, RR 16, Temp 99.5, Wt. 62kg, Ht. 5’5”
HEENT: nasal membranes red and irritated, watery eyes, clear nasal discharge CHEST: CTA
COR: NMRG, RRR NEURO: WNL
EXT: +1 pitting edema
Laboratory:
Na 140 Cl 100 BUN 18
K 4.0 HCO3 25 SCr 0.8 (stable)
BG 260
A1C: 7.8% Urine microalbumin/creatinine:
45
Blood glucose log:
Date Fasting Post-
prandial Bedtime Notes
Lunch Dinner
Time BS Time BS Time BS Time BS
1/1 8:00 132 7:00 200
1/2 1:45 210 9: 00 160
1/3 6:58 125 7:45 220
1/4 1:49 198
1/5 7:20 135 7:36 250 Ate Dinner out
1/6
7:56
160
8:09
202 Glucose reading of 66 mg/dL with shaking/sweating
at 4:00pm (skipped lunch)
1/7 2:07 189 10:32 153
1/8
8:00
124
7:33
209 Glucose reading of 64 mg/dL with shaking/sweating at 3:30pm
(skipped lunch)
1/9 1:34 210
1/10 7:50 120 7:23 195
1/11 1:53 192 9:45 140
1/12
8:05
115 Glucose reading of 60 mg/dL with shaking/sweating
at 2:00pm (skipped lunch)
1/13 1:40 201
1/14 7:56 232
1/15 10:00 135
1/16 7:45 118
1/17 2:40 172
1/18 7:32 190
1/19 9:54 129
1/20 7:32 111
1/21 2:05 206
1/22 7:59 193
1/23 9:25 134
1/24 7:06 113
1/25 2:20 179
1/26 8:05 229 Sick
1/27 7:45 170 7:30 210 Sick
1/28 8:05 200 1:46 229 7
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