Lenore is 76 years old and has had type 2 diabetes mellitus (T2DM) for 25 years. She lives alone, but her daughter lives close to her and has brought her to see you today. The daughter is a patient of yours and her mother would like you to become her new primary care doctor.
Lenore’s current medications are metformin(Drug information on metformin) 850 mg twice daily; glipizide(Drug information on glipizide) XL 2.5 mg daily; and lisinopril(Drug information on lisinopril) 10 mg daily. Her weight is 193 lb; BMI, 30; blood pressure, 142/85 mm Hg. Laboratory tests reveal the following results: GFR, 40 mL/min per 1.73m2; creatinine, 1.3 mg/mL; HbA1c, 7.7%. Lipid values are LDL, 130 mg/dL; HDL, 35 mg/dL; and, triglycerides, 350 mg/dL.
Her daughter reports that she has recently experienced 3 episodes of dizziness and shaking. Her blood sugar level was 55 to 60 mg/dL when this happened. The symptoms stopped after she drank 2 glasses of orange juice.
What medication(s) would you choose to treat this patient's T2DM? What would be your goal for HbA1C? Would you consider initiating any other treatment at this time?
Please leave your comments below; then see the next page for Dr Shahady's discussion of treatment options.