Page 785 - Basic _ Clinical Pharmacology ( PDFDrive )

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C ASE STUD Y ANSWER

This patient had significant insulin resistance, taking about agonist, exenatide. The patient lost about 8 kg in weight over
125 units of insulin daily (approximately 1 unit per kilogram). the next 3 years and was able to stop his insulin. He had
He had had limited instruction on how to manage his dia- excellent control with an HbA1c of 6.5 % on a combination
betes. He had peripheral neuropathy, proteinuria, low HDL of metformin, exenatide, and glimepiride. His antihyperten-
cholesterol levels, and hypertension. The patient underwent sive therapy was optimized and his urine albumin excretion
multifactorial intervention targeting his weight, glucose declined to 1569 mg/g creatinine. This case illustrates the
levels, and blood pressure. He was advised to stop smoking. importance of weight loss in controlling glucose levels in the
He attended structured diabetes classes and received indi- obese patient with type 2 diabetes. It also shows that simply
vidualized instruction from a diabetes educator and a dieti- increasing the insulin dose is not always effective. Combin-
tian. Metformin therapy was reinitiated and his insulin doses ing metformin with other oral agents and non-insulin inject-
were reduced. The patient was then given the GLP1 receptor ables may be a better option.