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Diabetes Quiz: How Would You Treat When Pre-diabetes Becomes Full Blown Diabetes?

By Edward Shahady, MD | July 25, 2012

Dr Shahady is Medical Director of the Diabetes Master Clinician Program, Florida Academy of Family Physicians.

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 HbA_1c 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: HbA_1c, 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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by steven pickert | August 05, 2012 2:00 PM EDT

This is a good example of a patient slipping through the cracks. He needed his HgA1c checked periodically in those 18 mo. I would start him on diet, exercise, and metformin, and see what that does, realizing that it is unlikely, though not impossible to reach goal. He will eventually need an ACEI and a statin, despite his LDL. I would wait to see what his trigs do with the initial treatment.