I recently met with a Type 2 patient (Jim/52y/o) with an A1c of 9.5%. The first thing I did was to review his medications: he stated he was on 40u of Lantus BID, Glucophage SR 750mg , 2 tablets BID, and Victoza 1.8mg, Lipitor 20mg, and Aspirin 81mg, each taken once daily….
I asked him what his last fasting blood glucose was and he stated that he had not checked his blood sugars for 3 months. I then asked him when he takes his insulin and he mentioned to me that he tries to take his insulin on a regular basis, but usually forgets to take his evening dose and when his pen gets down to less than 40 units, he just takes what’s left in the pen.
When questioning him further, he stated that he was under the impression that since he was taking insulin, he could eat whatever he wanted.
I immediately reduced his metformin to 1000 mg bid, and had him take his insulin on a regular basis. I had him monitor his blood sugars fasting, pre and postprandial 3 times a day and at bedtime for the next three days.
Always confirm with the patient that they are compliant with taking their medications and at the appropriate dosages and times. This needs to be done before adjusting any medication.
Note: According to a recent study1, when it comes to medicine, as many as half of Americans don’t stick to their regimens. They fail to fill about 20% to 30% of prescriptions written by doctors, don’t take drugs as directed, and don’t refill medications when they run out.
Consequences of non-adherence can be dire. Studies of heart-attack patients show those who don’t fill prescriptions to help prevent another heart attack have a higher rate of death one year later. Meanwhile, patients who adhere to their medications have better health outcomes, and require less care, than those with similar conditions and poor adherence, research shows.
1PhRMA; National Council on Patient Information and Education; WSJ reporting
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