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Production Assistant, Diabetes In Control

Gun Education

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With over 33,000 yearly accidental deaths from guns, should medical professionals have the responsibility to talk about safety to their patients who own guns? Follow the link to respond -- and to see what others think.

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Question #836

Test Your Knowledge

(Continued from Question #835) Mr. Fontello is an overweight, Caucasian 63-year-old patient who comes in for a 6-month check-up. He has a 12-year history of type 2 diabetes. He was diagnosed at age 33 with high blood pressure, but had never really done much about it as it was “too much of a hassle” and he felt “just fine.” At the time his diabetes was diagnosed, he was referred to a diabetes education program and was started on metformin, lovastatin, losartan and aspirin. He has an individualized A1C goal of 7%. Four years after diagnosis, pioglitazone was added to Mr. Fontello’s diabetes regimen. Three years ago, he came in for an appointment complaining of polyuria, polydipsia and fatigue with an office A1C of 9.3%. At that time he was started on nightly basal insulin detemir. Since that time, he has made concerted efforts to eat a healthy diet and get to the gym. Today, he reports his SBGM fasting plasma glucose levels are on target (FPG<130mg/dL). He also states that his feet always feel a little bit swollen. BP 128/78, HR 73, RR 19. Physical exam is remarkable for peripheral edema and mildly decreased pedal pulses. Current medications: metformin, pioglitazone, insulin detemir, lovastatin, losartan, aspirin. At today’s visit, his office A1C is 8.1%. A rapid-acting insulin analogue was added to his largest meal of the day. Labs taken last year show Mr. Fontello had a serum creatinine 1.2mg/dL with an eGFR 61mL/min. Today, his serum creatinine is 1.6 mg/dL and his eGFR is 44 mL/min. Because guidelines indicate when a patient’s eGFR falls below 60mL/min, dose reduction of medications should be considered, you decide to adjust Mr. Fontello’s medication. In type 2 diabetes, which one of the following medications does not need to be considered for dose reduction? Select one answer: A. Glyburide B. Metformin C. Insulin D. Pioglitazone E. Exenatide Are you right? Follow the link to find out!

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