ConsultantLive.com.

Diabetes Quiz: A 79-Year-Old With Elevated AlC Who Has Had a Stroke: How Would You Treat?

By Edward Shahady, MD | April 30, 2012

Sue Jones, 79-years-old, has had type 2 diabetes for 15 years. She is home-bound after a recent stroke and now requires assistance with most of her activities. She has a daytime sitter and a weekly visiting nurse; her family provides care in the evenings and on weekends. The family has moderate means and would like to keep her at home. Sue can communicate effectively: she recognizes all of her family members and you, as her physician.

Her most recent lab tests showed an HbA1c of 9.6; a random blood sugar of 450; triglycerides, 350 mg/dL; HDL, 40; LDL, 110 (calculated); total cholesterol, 220; and non-HDL,180.

Some of her medications were stopped when she was discharged from the hospital 3 weeks ago. She now only takes metformin(Drug information on metformin) (2000 mg/d) for her diabetes and no medications for her lipids.

Would you consider more aggressive treatment of her elevated HbA1c? If so, why—and with what medications? What goals would you have for her A1C? Would you do anything to treat her lipids?

Please add your comments below—including your agreements and disagreements.

Dr. Shahady he will respond to the comments made within the next 2 weeks.
Click here for Dr. Shahady’s discussion of options.

by Henry Izurieta | June 11, 2012 2:19 PM EDT

Insulin is definitely indicated: Lantus or Levemir, and close mon itoring of blood sugar

by Karen orozco | May 15, 2012 11:33 PM EDT

Given her age and frailty, start low go slow and do the best with the least amount of side effects. I agree to add 81 mg asa if stroke not hemorrhagic. Her lipid panel , especially triglycerides will improve with better blood sugar control. I would add levimir or lantus, starting with a very low dose. Because she is elderly, I would not seek to aggressively lower the Hga1c lower than 7. Low dose statin as well. Control bp (its not stated what it was) conservatively.

by Helen Ballestas | May 05, 2012 2:51 PM EDT

Forgot to add all labs checked q 3 months

by Helen Ballestas | May 05, 2012 2:50 PM EDT

Add sulfonerea, simvastatin and a low dose enteric coated aspirin. Check labs first. Consider adding an ACE like vasotec 5 mg for renal protection. Home aides to help with range of motion n teacahing fmily hazards of decreased mobility. Nutrion consult also necessary. Podiatrust n eye check as well.
Helen. Nurse Practitioner

by DIane Henzey | May 03, 2012 12:09 PM EDT

For her diabetes I would ask someone to check her blood sugar on a regular schedule to determine fasting and post prandial blood sugars. A long acting insulin would be added to titrate her FBS to upper end of goal. Most diabetics benefit from an ACEI for renal protection, and would add that at a dose determined by her BP. Considering she had a stroke, it is possible she also has HTN. Getting her blood sugar closer to goal would help her cholesterol, but I would also add 2 gms of omega 3 fatty acids to nudge her trigs down a little. Her elevation of non HDL cholesterol is mainly affected by her VLDL, not her LDL, so I would not add a statin. As long as her stroke was not hemmorrhagic, she might benefit from ASA 81 mgs, even though research has not confirmed the benefit for women. I would set an A1c goal for approximately 8, due to her age. She and the family would benefit from diabetes education to review general information, lifestyle, diet and activity as tolerated.

After 3 months I would recheck her A1c and lipids.

Article Comment Pages: 1 2 Next

More Diabetes Quizzes

Pre-Diabetes, Non-HDL Cholesterol, and Cardiovascular Risk