Clinical Diabetes 21:190-192, 2003
© American Diabetes Association ®, Inc., 2003
Case Study: A 64-Year-Old Man With a 9-Year History of Type 2 Diabetes in Whom Insulin Therapy Led to Improved Control But No Weight Gain After 6 Months
Deborah Thomas-Dobersen, RD, MS, CDE
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Presentation
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L.T. is a 64-year-old white man with a 9-year history of type 2 diabetes. He suffered an inferior wall myocardial infarct 2 years ago. He also has a 7-year history of hypertriglyceridemia and hypercholesterolemia, as well as gout and abdominal obesity. He has no history of cigarette smoking.
At his initial visit to the endocrinology clinic, his weight was 242 lb., and he was 70 inches tall. Thus, his BMI was 35 kg/m2. His blood pressure was 130/78 mmHg, and his hemoglobin A1c (A1C) result was 9.0% (normal: 4.3–6.1%) on 2,000 mg/day of metformin and 10 mg/day of glyburide. A lipid panel revealed fasting serum triglycerides of 288 mg/dl, total cholesterol of 160 mg/dl, HDL cholesterol of 36 mg/dl, and LDL cholesterol of 66 mg/dl. His fasting blood glucose level was 331 mg/dl. In addition to metformin and glyburide, medications included simvastatin, 10 mg/day; niacin,750 mg twice daily; allopurinal, 300 mg/day; and aspirin, 325 mg/day.
L.T.’s primary care provider had been reluctant to start him on insulin, even though he was taking close-to-maximal doses of oral hypoglycemic agents without achieving acceptable diabetes control. The provider worried that, once L.T. started on insulin, he would regain the 20 lb. he had lost since his myocardial infarct and that the negative impact of this weight gain would outweigh the positive impact of enhanced diabetes control on his overall health. Taking these concerns into account, the endocrinologist started L.T. on 10 units/day of glargine at bedtime, to be taken in addition to his regimen of metformin and glyburide.
L.T. and his wife then scheduled an appointment for medical nutrition therapy (MNT) with a registered dietitian who was a certified diabetes educator. L.T.’s 3-day food record showed excessive calorie intake with > 90–120 g of carbohydrate per meal. The dietitian taught the . . . [Full Text of this Article]
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Copyright © 2003 by the American Diabetes Association.
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