Blood sugar and HbA1C are very high; how would you treat this patient's hyperglycemia?
Pete is a 55-year-old man who comes to you with complaints of increased thirst, a 10-lb weight loss, and fatigue. You last saw him 18 months ago, when you told him he had pre-diabetes. At that time, his HbA1c was 5.9l%; fasting blood sugar, 111 mg/dL; triglycerides, 187 mg/dL; and HDL, 38 mg/dL. You advised lifestyle changes.
Since his last visit, Pete gained 22 lb; he then began to lose weight. His “diet” lasted 3 weeks. His lab values at this visit are: HbA1c, 10.4%; random blood sugar, 455 mg.dL; total cholesterol,180 mg/dL; non-HDL, 149 mg/dL; LDL, 78 mg/dL; triglycerides, 355 mg/dL; HDL, 31 mg/dL.
Pete has no signs of cardiovascular disease, nephropathy, or other indicators of diabetes complications. He has reasonable insurance coverage, is literate, and has the other resources needed for adequate diabetes care.
How would you treat his hyperglycemia-other than with lifestyle changes?
What do you think about his lipids? Would you give him any medication for these lipid abnormalities? If so, with what agents?
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