Mrs.
S is a 45-yr. old woman who presents with a 2 month history of fatigue and
excessive thirst. She is a new patient to your practice, relevant history
includes possible borderline hypertension, obesity and two children whose
birth weights exceeded 9 lbs. She is a 1-2 pack a day smoker and family
history is significant for premature CAD, hypertension and diabetes. Her exam
is normal and BP is 135/82 mmHg. Fasting Glucose 138 mg/dl. Other results
include a total cholesterol 215, HDL-C 31 mg/dl. j
A week later Mrs. S returns and further
fasting glucose is 167 mg/dl. Subsequent HbA1c is 7.1% (normal range
3.6-6.4%). Mrs. S comes to the office to discuss her results. You tell
her she has diabetes and refer her for diabetes education and nutritional
counseling.
Mrs.
S follows up 1 year later for her annual diabetes evaluation, having lost 20
lbs in weight, adhering to her diet and exercise plan, home glucose monitoring
reveals fasting glucose readings in the 130-150mg/dl range and HbA1c of 7.2%.
Exam is normal, BP 128/75mmhg. You would now:
