University  |   Hospital  |   Pulse  |   JeffNet   |   RAP

Find People  |   JeffMail  |   WebMail  |   JeffCal  |   JeffShare

VOLUME 1 ISSUE 2 CASE WM	WM is a 55-year-old man with new onset diabetes.
CHIEF COMPLAINT WM complains of polydipsia, fatigue, and polyuria. LABORATORY VALUES »  Fasting glucose: 123 mg/dL »  Fasting C-peptide: 8 ng/dL (normal: <5) »  A1c: 8.3 % »  Blood pressure: 145/90 mm Hg »  Lipid profile   --  Total cholesterol: 194 mg/dL   --  Triglycerides: 220 mg/dL   --  High-density lipoprotein: 25 mg/dL   --  Calculated low-density lipoprotein: 125 mg/dL   --  Non-HDL cholesterol: 169 mg/dL PROBLEMS This patient displays several features typical of type 2 diabetes, including: 1. Uncontrolled hyperglycemia 2. Moderate hypertension 3. Dyslipidemia NAVIGATION »  Q1: What is your first step? »  Q2: What is your initial treatment plan to manage this patient’s hyperglycemia and dyslipidemia? »  Q3: How would you characterize WM’s cardiovascular risk based on this lipid profile? »  Q4: How could you further characterize WM’s lipid profile? »  Q5: What pharmacologic interventions can increase total HDL and HDL2? »  Q6: What are the expected results if a TZD and statin are used in combination? »  Q7: What other changes, if any, do you make in WM’s treatment plan? »  Q8: What are the advantages and disadvantages of adding a fibrate or niacin? »  Q9: You decide to add fenofibrate 54 mg/d to target triglycerides and HDL-C. What should you do if WM reports suggestive muscle symptoms?	Q: You decide to add fenofibrate 54 mg/d to target triglycerides and HDL-C. What should you do if WM reports suggestive muscle symptoms? A: If myositis is present or strongly suspected, the statin should be discontinued immediately. However, first rule out common causes such as exercise or strenuous work. Combination therapy (both the statin and niacin or fibrate) should be discontinued if a creatinine kinase (CK) greater than 10 times the upper limit of normal is encountered in a patient with muscle soreness, tenderness, or pain. If no CK elevation or moderate elevation (3 to 10 times the upper limit of normal) is shown in combination with muscle soreness, tenderness, or pain, CK levels and symptoms should be followed weekly until there is no longer a medical concern or until symptoms worsen to the point that therapy should be discontinued.11
	Questions? Contact 1-888-JEFF-CME (533-3263) or http://jeffline.tju.edu/jeffcme
The Thomas Jefferson University web site, its contents and programs, is provided for informational and educational purposes only and is not intended as medical advice nor is it intended to create any physician-patient relationship. Please remember that this information should not substitute for a visit or a consultation with a health care provider. The views or opinions expressed in the resources provided do not necessarily reflect those of Thomas Jefferson University, Thomas Jefferson University Hospital, or the Jefferson Health System or staff. Return to Thomas Jefferson University Home Page