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Problem
A 81-year-old with dementia. Has had DM for 10 years, CAD, NYHA class III congestive heart failure, afib, osteoporosis, emphysema. Brought to the clinic by her granddaughter for follow up. Poor mobility related to weakness and imbalance; however, she lives with 2 family members who are very supportive in her medical care and housework. She has been feeling depressed with complaints of fatigue during the day and poor sleep at night. She has fallen twice at home during the past 3 months. Her medications include warfarin, lisinopril, furosemide, nitroglycerin, simvastatin, aspirin, glyburide, calcium and vitamin D. Blood pressure is 142/78. Bibasilar rales; S3 gallop. 1+ lower extremity edema that has not changed since last visit. Decreased sensation in her feet by monofilament testing. A1c is 8%. 3-hour postprandial blood glucose is 224 mg/dl.
Hypoglycemia is rare.
1) What most worries you about this situation?2) What would you do?3) Any medication changes?4) Glucose goal? Get the instant assignment help.5) Discuss appropriate goals of care.
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