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After completing this case study, the reader should be able to:
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.
“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.”
Sarah Martin is a 45-year-old white 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.
Bipolar disorder × 25 years
Morbid obesity × 20 years
Father has a history of HTN, dyslipidemia, and bipolar disorder. Mother has a history of dyslipidemia and hypothyroidism. Brother has DM thought to be secondary to alcoholism.
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, but does drink alcohol occasionally (three beers or glasses of wine per week).
Metformin 1000 mg PO BID with food
Lisinopril 20 mg PO once daily
Carbamazepine ER 200 mg PO BID