Female, 24 years of age, type 2 diabetes and obesity, wants better glucose management and to lose weight. Most of her meals consist of high carb, fast food take out, she skips breakfast and overeats during the evening hours. She has a sedentary lifestyle. She reports being an “all or nothing” person.
The patient’s medication regimen consists of metformin (not long acting) 1,000mg twice daily and glimiperide 4mg every morning. The patient, however, does not take the metformin, stating it upsets her stomach, so she decided to take 8mg of glimiperide daily instead…
The patient checks her glucose sporadically. When she does, usually fasting, her glucose levels are 120-150mg/dL. A1C 7.6%. Visit included history and physical assessment, and diabetes education.
- Simple explanation of relationship of type 2 diabetes and obesity
- Factors that may be causing her condition, including the meds she was and was not taking. She was informed that some people tolerate long acting metformin more than the form she had tried, and glimeride can increase her hunger and cause weight gain.
- The importance of setting realistic goals
- Making one change at a time
- Asked the patient to choose one factor
The Patient chose to work on her weight. She realized doing this can help her glucose levels and prevent other problems. To help, she chose to try the long-acting metformin and cut back on her glimeride. She would start by slowly increasing her metformin, and decreasing her glimperide to the 4mg prescribed. The patient returned in two weeks. The following assessment was made:
- Taking and tolerating 2,000mg long-acting metformin daily
- Decreased glimeride to 4mg day
- Less hungry
- Weight down 6 pounds
- Glucose levels in 100-140 range
- Ready to make another change. She really wanted to stop her glimiperide, but she understood this might mean another medication or higher glucose levels. She didn’t want another medication, so she asked about decreasing her carb intake. We agreed to this as long as she checked her glucose on a regular basis. She agreed to this.
The patient returned one month later. The following was assessed:
- Taking 2,000mg long-acting metformin daily
- Less hungry
- Weight loss of 12 pounds since first visit
- Glucose levels 100 to 120 fasting,
- Eating less carbs at each meal, and even making healthier food choices
- More active
- Feeling much better
- Take time to teach patients about their unique condition.
- Guide your patients to set their own goals. They know best what they can and will do. Be there to assess response and continue to help guide them back on the path if they should get off track.