01-11-2009, 06:42 AM
A 53-year-old African American male with medical history of type 2 diabetes mellitus (DM) for 5 years, hypertension for 7 years and a myocardial infarction 2 years ago, comes for a regular follow-up visit. His mother died of a heart attack at the age of 72 and his father died in a motor vehicle accident at the age of 42. He has no siblings. Patient is on glyburide, captopril, baby aspirin, and is compliant with his diet and medicines. Upon inquiring, he says that his blood sugars are running high lately and this morning his home glucometer recorded a reading of 200 mg/dl. His blood work done three days ago showed a blood urea nitrogen of 9 mg/dl and a creatinine of 1.1 mg/dl. What is the next step in managing this patient™s blood sugar?
A.Discontinue captopril as it is known to produce diabeticogenic state
B.Discontinue captopril since glyburide efficacy is reduced with simultaneous usage of captopril
C.Start the patient on human insulin 70/30
D.Add metformin to achieve better glycemic control
E.Ask the patient to be more compliant and come for the next regular follow up visit
A.Discontinue captopril as it is known to produce diabeticogenic state
B.Discontinue captopril since glyburide efficacy is reduced with simultaneous usage of captopril
C.Start the patient on human insulin 70/30
D.Add metformin to achieve better glycemic control
E.Ask the patient to be more compliant and come for the next regular follow up visit