Test Your Knowledge #532: A Woman with Hypertension, Obesity and Type 2 Diabetes Characterized by Prominent Postprandial Hyperglycemia Objective, Part One of Three

• She is married and the mother of 3 grown children.
• She stopped working as a waitress 6 months ago to care for her infant grandson.
• Type 2 diabetes mellitus was diagnosed 5 years ago; hypertension 12 years ago.
• She has been overweight all of her adult life, and has gained 20 pounds since quitting work.
• Mrs. Robinson feels her diet hasn't changed much since she decided to stay home with her grandson, although she admits to doing more snacking and states she loves juice and drinks it with all her meals. Her job as a waitress was very active, and she knows her activity level has decreased significantly since she quit.  While at her waitressing job, she experienced chronic knee pain caused by osteoarthritis; she expected this to improve once she quit working, but instead it has worsened with her weight gain and decreased activity. 
• Because she has been concerned about her increasing blood glucose levels, in advance of her appointment Mrs. Robinson faithfully monitored her pre-meal blood glucose levels 3 times daily, 3 days a week. She occasionally measured her blood sugar 2 hours after eating as well. She states that she does not want to go on any medications that will make her gain more weight.

Based on Mrs. Robinson's initial presentation and laboratory values, what medical issues need to be addressed at this visit?  (Please select the most appropriate response.)

1.      Hypertension and dyslipidemia

2.      Inadequate glycemic control, hypertension, and renal failure

3.      Inadequate glycemic control and renal failure

4.      Inadequate glycemic control and dyslipidemia

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