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Her Diabetes is Out of Control – Case Study

A primary provider approaches you to figure out why one of his patient’s diabetes is out of control.  Nothing seems to work.  The case:

A 59 year old female has a past medical history of:

  • COPD
  • Type 2 Diabetes
  • Hypertension
  • GERD
  • Chronic back pain

A1C= 10.2

Current meds include:

  • Lantus 30 units hs
  • Victoza 0.6 mg daily
  • Advair 100/50 twice daily
  • Spiriva daily
  • Bystolic 10 mg daily
  • Ramipril 5 mg daily
  • Aspirin 325 mg daily
  • Lidoderm patch as needed for back pain
  • Acetaminophen as needed
  • Combivent as needed
  1. My initial thought = $$$$$$$$$$$$$$!  Can this patient afford all the medications she is supposed to be taking.  This patient is on a ton of medications that are really expensive which could potentially be leading to a compliance problem.  I would assess the Bystolic and see if an easy switch to a different beta-blocker would be appropriate to save $.  (Always remember to look at the allergy list when recommending a switch or switching meds!!!) I would also assess Lidoderm use/need.  If the patient’s respiratory symptoms are under control it would be interesting to see if we could cut out the low dose Advair. Looking at Combivent use would help us assess this as well as inquiring about respiratory symptoms.
  2. If $$/adherence to medications is not an issue, we certainly have room to go up on the Victoza to get a better handle on the patient’s diabetes.  Accuchecks would be nice to know to help guide our therapy and assess if she gets really high at certain times of the day.

If you’d like to add any other comments, questions you’d like to investigate, feel free to do so below!  If you are new to the blog get my 30 medication mistakes for free!  Simply subscribing to the blog will get you access to my 6 page PDF based on real world clinical pharmacy experience!

Written By Eric Christianson

November 15, 2015

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