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Medicine Matters diabetes


Medications

  • Enalapril 10 mg bid
  • Furosemide 40 mg bid
  • Warfarin 5 mg daily (Monday, Wednesday, Friday)
  • Warfarin 7.5 mg (Tuesday, Thursday, Saturday, Sunday)
  • Spironolactone 25 mg bid
  • Amiodarone 100 mg daily
  • Metformin 1000 mg bid
  • Glyburide 5 mg bid
  • Atorvastatin 40 mg daily
  • Insulin glargine 64 units daily

Allergies

  • No medication, latex or food allergies

Social history

  • Lives alone, but her daughter visits twice a week to help set up her medications
  • On a fixed income and cost of her medications is an issue
  • Enjoys walking but has been too tired to engage in this activity
  • Struggles with diet as it seems like all foods are in her exclusion list for one of her conditions

Review of systems

Pertinent positives

  • Generally does not feel well
  • Feels tired most of the time, occasional headaches
  • Palpitations and exertional dyspnea
  • Thirsty a lot of the time but does not urinate as much as she thinks she should
  • Intermittent nausea and decreased appetite, some constipation
  • Swelling in her legs, which worsens as the day goes on
  • Bilateral hip and knee pain from arthritis

Physical exam

  • Weight: 100 kg
  • Height: 163 cm
  • BMI: 38.9 kg/m2
  • Pulse: 78–110 bpm and irregular
  • Respirations: 14 breaths per minute
  • Pulse oximetry: 96% on room air
  • Pain: 4/10
  • Head, eyes, ears, nose, and throat: Wears glasses, has dentures
  • Cardiovascular: Heart rate and rhythm is irregular with the rate below 100 bpm most of the time
  • Respiratory: Bi-basilar crackles noted
  • Abdomen: Rotund, non-tender, injection sites not visualized on inspection
  • Extremities: Peripheral pulses intact, plus edema in both lower extremities up to the knees and including the feet
  • Neurological: Alert and oriented to person, place, and time, no central nervous deficits, patchy sensory loss to monofilament exam both feet

Laboratory results

  • Glycated hemoglobin (HbA1c): 7.6%
  • Blood urea nitrogen: 46 mg/dL
  • Creatinine: 2.8 mg/dL
  • Estimated glomerular filtration rate (eGFR): 33 mL/min per 1.73 m2
  • Na: 142 mEq/L
  • K: 4.9 mEq/L
  • Cl: 100 mEq/L
  • Glucose: 188 mg/dL (10.4 mmol/L; non-fasting)
  • Urine microalbumin: 368 mg/g
  • B-type natriuretic peptide (BNP): 268 pg/mL
  • Home glucose monitoring:
    • Fasting: 60–220 mg/dL (mean: 88 mg/dL)
    • Random: 54–280 mg/dL (mean: 164 mg/dL)