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Production Assistant, Diabetes In Control

Question #822

Test Your Knowledge

Mr. Hernandez is an overweight (BMI 30 kg/m2), 45-year-old plumber of Hispanic heritage who arrives at your office for a first-time visit. He has not been to a physician during the last 7 years because he hasn’t always had health insurance and “doesn’t like going to the doctor.” However, he has been noticing lately that his vision seems a little blurry and he’s developed a red, itchy rash in his groin. He is a non-smoker and recalls being told a long time ago that he should eat a low salt diet, but he can’t remember why. On examination, his BP is 154/96 mm/Hg, and his pulse is 72, RR 22. His physical exam is notable for signs of a yeast infection in his groin. You order a CBC, Chem 12 panel and A1C to be drawn that day before he leaves. You advise him how to treat his skin infection. When you receive the results of the Chem 12 panel, it shows a random plasma glucose of 162 mg/dL and A1C 7.3%. You call Mr. Hernandez and ask him to return the next morning, before he has eaten, for additional labs. You order the necessary labs. Mr. Hernandez labs return and are notable for A1C 7.5, FPG 137 mg/dL, LDL-cholesterol 190 mg/dL, HDL-cholesterol 38 mg/dL and triglycerides 232 mg/dL. You discuss his lab results, his diagnosis and how to manage diabetes and make referrals to the appropriate diabetes team clinicians. You start Mr. Hernandez on metformin, lifestyle modifications, an ACE inhibitor, and a statin. You are looking to achieve A1C <7%, BP<140/90 mmHg, LDL<100 mg/dL You ask Mr. Hernandez to return in 3-months time to evaluate how everything is going. However, he fails to keep his appointment. He returns 1 year after his initial diagnosis for a recurrent yeast infection. His A1C is currently 8%. Upon questioning, he admits that while he has been good about taking his “heart meds,” he has not taken the “sugar pill” because he didn’t like it. What side effect did the patient most likely find intolerable? A. Diarrhea and abdominal cramping B. Paresthesias C. Increased appetite D. Insomnia Follow the link to see the correct answer.

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Healthcare Solutions

Which of the healthcare solutions proposed by the 2016 presidential candidates do you think would be best? Follow the link to share your opinion! 1. Build on and improve the Affordable Care Act 2. Repeal and replace the ACA 3. Have a single payer “Medicare for all” system 4. Other

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When Pills Are Hard to Swallow, Find Alternatives

Woman, 67 years of age, newly diagnosed with type 2 diabetes with an A1C of 7.8%. Met with PCP who prescribed metformin ER and referred patient for diabetes education. Patient made some dietary and physical activity changes at first, but upon return visit her A1C was 8.5%. She reported she did not take the metformin. “I can’t swallow big pills. The bottle said not to crush or break the tablets. They were just too big to swallow. So then I just gave up on everything.”

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #12: Epidemiology and Geography of Type 2 Diabetes Mellitus Part 1 of 5

Age- and sex-specific prevalence of type 2 diabetes in different ethnic groups: Type 2 diabetes mellitus (T2DM) is now taking its place as one of the main threats to human health in the twenty-first century. In 1921, Dr Elliot Joslin was already concerned that according to his count there had been a doubling of diabetes in three decades. The impact of T2DM is increasingly felt around the world, with its prevalence rising dramatically over recent decades.

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Diabetes Manager

Diabetes Manager is an all-in-one insulin calculator, carbohydrate database, favorites database, and diary. It is developed for people with type 1 diabetes who inject pre-meal fast or rapid-acting insulin.

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Question #821

Test Your Knowledge

Mr. Hernandez is an overweight (BMI 30 kg/m2), 45-year-old plumber of Hispanic heritage who arrives at your office for a first-time visit. He has not been to a physician during the last 7 years because he hasn’t always had health insurance and “doesn’t like going to the doctor.” However, he has been noticing lately that his vision seems a little blurry and he’s developed a red, itchy rash in his groin. He is a non-smoker and recalls being told a long time ago that he should eat a low salt diet, but he can’t remember why. On examination, his BP is 154/96 mm/Hg, and his pulse is 72, RR 22. His physical exam is notable for signs of a yeast infection in his groin. You order a CBC, Chem 12 panel and A1C to be drawn that day before he leaves. You advise him how to treat his skin infection. When you receive the results of the Chem 12 panel, it shows a random plasma glucose of 162 mg/dL. His A1C was 7.3%. You call Mr. Hernandez and ask him to return the next morning, before he has eaten, for additional labs. In this individual, you might order all the following labs EXCEPT urine ketones. Mr. Hernandez labs return and are notable for A1C 7.5, FPG 137 mg/dL, LDL-cholesterol 190 mg/dL, HDL-cholesterol 38 mg/dL and triglycerides 232 mg/dL. You discuss his lab results, his diagnosis and how to manage diabetes, and make referrals to the appropriate diabetes team clinicians. You start Mr. Hernandez on metformin, lifestyle modifications, an ACE inhibitor and a statin. What glycemic and blood pressure parameters are you looking to achieve for most individuals? A. A1C<7%, BP<130/80 mmHg B. A1C<7%, BP<130/90 mmHg C. A1C<7%, BP<140/80 mmHg D. A1C<7%, BP<140/90 mmHg Follow the link to respond!

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