Test Your Knowledge #524: A Woman with Type 2 Diabetes and Hyperlipidemia, Part Two of Three

• She is married and the mother of 4.
  
• She stopped smoking 3 years ago when trying to conceive and gained a significant amount of weight.
• Both parents have Type 2 diabetes.
• She was diagnosed with Type 2 diabetes mellitus 2 years ago after delivering an infant that was large for gestational age.

When first diagnosed, she met with a dietitian for medical nutrition therapy.  She found this helpful -- after making diet changes and walking regularly with her children, she was able to lose 18 pounds in 6 months.  Her A1c at that time was 6.8% without antidiabetic medication.

Mrs. Carmend reports it has been more difficult to continue her nutrition regimen since returning to her full-time job 18 months ago as a receptionist in a business office. She often eats at a restaurant for lunch and then orders out or prepares convenience foods for dinner; finding time for regular exercise is also difficult. Since returning to work, she has gained 20 pounds. She self-monitors her fasting blood glucose levels occasionally, usually in the morning. 

Although Mrs. Carmend does not want more children, she has not been using a reliable method of birth control. She believes that it took so long to get pregnant with her last child 3 years ago, she is not likely to get pregnant again now that she is over 40.

Based on Mrs. Carmend’s initial presentation and laboratory values, what pharmacologic therapy would you recommend to treat her hyperglycemia and dyslipidemia?  (Please select the most appropriate response.)

A. Increase metformin to 1000 mg twice daily, stop lovastatin, and add simvastatin 20 mg daily.

B. Continue metformin 500 mg twice daily, add glipizide 10 mg once daily, and increase lovastatin to 20 mg daily.

C. Increase metformin to 1000 mg twice daily and lovastatin to 20 mg daily.

For the correct answer, please click here.