R. S. is a 55-year-old moderately obese Hispanic woman (body mass index is 29). She was referred to you when her gynecologist noted glucose on a routine urinalysis. She subsequently has an FPG of 190 and 200 mg/dL on two separate occasions. She is thirstier than usual and has more frequent urination. She also complains of decreased energy over the last several months.

Family history: sister, mother, and maternal grandmother have diabetes

Social history: nonsmoker, drinks alcohol socially (1 drink about 3 times a month), and does not exercise

Review of systems: 20 lb weight gain over the past 2 years, has some blurred vision, has had two urinary tract infections in the past year and has frequent vaginal yeast infections

Physical exam: unremarkable except blood pressure of 150/90

Laboratory results: FPG 200 mg/dL, HbA 1c 10%, LDL 160 mg/dL, HDL 35 mg/dL, and triglycerides 266 mg/dL

DIAGNOSIS: TYPE 2 DIABETES MELLITUS

1. List specific goals for treatment for R. S.

2. What dietary and lifestyle changes would you recommend for R. S.?

3. What drug therapy would you prescribe? Why?

4. What is the goal for the FPG? Postprandial glucose? HbA1c?

5. Discuss specific education for R. S. based on the prescribed therapy.

6. List one or two adverse reactions for the therapy selected that would cause you to change the therapy.

7. If the HbA1c after 3 months on the prescribed therapy is 8.8%, what would be the next line of therapy?

8. What over-the-counter or herbal medicines might be appropriate for R. S.?

9. Describe one or two drug–drug or drug–food interactions for the selected agent.