Wednesday, December 12, 2012

Key Feature Problems - CASE 1 Type II Diabetes


Mr Smith is a 50 yo male and have been diagnosed with NIDDM for the last 5 years.  He has just moved to the area and starts seeing you as his new Doctor.  His most recent bloods shows a HbA1c of 9%, Cholesterol of 6, TG 3, HDL 0.9, and LDL 3.  His BP is 145/90.  He smokes 10 cigarettes/day.  His BMI is 30.   He is currently taking Metformin XR 1000mg nocte, lipitor 40mg and ramipril 2.5mg/day

Question 1
What other investigation results would you like to find out in order to manage his condition more effectively at this point.  Fill in up to 5 from the following list.
                               
0  TSH                                                                                                          
0  Renal function: creatinine clearance                     
0  B12 and folate                                                         
0  ECG                                                                      
0  Renal USS                                                            
0  CK                                                                        
0  Urine 24 hour protein/albumin                                
0  FBC                                                                         
0  MSU                                                                        
0  Chest Xray                                                              
0  24 hour BP result
0  Liver function test
0  Serum electrolytes
0  Nerve conduction studies
0  Renal doppler USS
0  Cardiac echo
0  Waist circumference  

Question 2
What action would you consider?
List, in note form, up to four (4) steps.

1.  _______________________________________________________________________________

2.  _______________________________________________________________________________

3.  _______________________________________________________________________________

4.  _______________________________________________________________________________


Question 3
What BP target are you aiming for in this patient assuming that there is no proteinuria?

1.  _______________________________________________________________________________

Please answer in the comment link below and I will give you feedback.

Copyright written by Dr Vin
Reference NPS Type 2 Diabetes: Priorities and Targets.  2012.

6 comments:

  1. A to Q1:
    Renal function: creatinine clearance
    ECG
    Urine 24 hour protein/albumin
    Renal doppler USS
    Waist circumference

    A to Q2
    1- Good Hx
    2- GPMP
    3- Ophthalmoscopy
    4- Neurovascular examination of limbs, especially lower limb

    A to Q3
    125/85 mmHg


    ReplyDelete
  2. renal function: creatanine clearance
    ECG
    urine 24 hour protein/albumin
    LFTs
    waist circumference

    Check medication adherence
    Increase metformin to 1000mg BD, increase by 500mg/day a week until at 1000mg BD
    Encourage increased exercise - aim for 30 min moderate activity on most, ir not all, days of the week
    Encourage low Glycaemic Index diet

    ReplyDelete
  3. Q1 - So many good options
    Renal function creat clearance
    ECG
    Waist circumference
    LFT
    Serum electrolytes

    Q2 - great difficulty figuring out how to answer this
    1) Encourage Lifestyle modification (exercise/diet) with motivational interviewing
    2) Chronic disease management plan
    3) TCA - dietician, diabetic educator, ophthalmologist, podiatrist, exercise physiologist, possibly endocrinologist
    4) regular review

    Q3 <130/80

    ReplyDelete
  4. Q1
    renal function - creatinine
    LFTs
    electrolytes
    24 hr BP monitoring
    urine 24 hr protein / albumin

    Q2
    Smoking - ask, assess, advise, assist, arrange f/u

    Q3 <130/90

    ReplyDelete
  5. Q1
    Renal function :creatinine clearance
    ECG
    Renal USS
    Urine 24hr protein/albumin
    LFT

    Q2
    Advise lifestyle and dietary changes
    Smoke cessation
    Weight management
    Diabetic control

    Q3
    125/85

    ReplyDelete
  6. Q1
    Renal function :creatinine clearance
    ECG
    Urine 24hr protein/albumin
    24 hr BP monitoring
    Waist circumference

    Q2
    Diabetic management plan - referral to dibetes educator, dietician, optometrist review.
    Advise lifestyle modification - exercise and dietary changes
    Advice on smoking cessation
    Weight management - referral to exercise physiologist

    Q3
    120/80

    ReplyDelete