“I have had diabetes for about six months and would like to have my blood sugar tested. I think that my blood sugar is running low because I have a terrible headache.”

HPI

Sarah Martin is a 45-year-old white woman who comes to the pharmacy for a diabetes education class taught by the pharmacist. She would like for the pharmacist to check her blood sugar before the class begins. She was diagnosed with type 2 DM about 6 months ago. She had been attempting to control her disease with diet and exercise but had no success. Her physician started her on metformin 1000 mg twice daily with food about 3 months ago. She has gained 10 lb over the past year. She monitors her blood sugar once a day, and her results have ranged from 215 to 280 mg/dL. Her fasting blood sugars have averaged 200 mg/dL.

PMH

Type 2 DM × 6 months

HTN × 17 years

Bipolar disorder × 25 years

Dyslipidemia × 12 years

Morbid obesity × 20 years

FH

Father has a history of HTN, dyslipidemia, and bipolar disorder. Mother has a history of dyslipidemia and hypothyroidism. Brother has DM thought to be secondary to alcoholism.

SH

Has been married for 23 years. She has two children who are teenagers and one child in college. She works as a sales associate in the electronics department of a local mass

merchandiser. She denies any use of tobacco products after stopping smoking 10 years ago, but does drink alcohol occasionally (three beers or glasses of wine per week).

Meds

Metformin 1000 mg PO BID with food

Lisinopril 20 mg PO once daily

Olanzapine 5 mg PO QHS

Carbamazepine ER 200 mg PO BID

Lorazepam 1 mg PO TID PRN (takes once a month)

Fluoxetine 20 mg PO Q AM

Pravastatin 40 mg PO once daily

Labs

Na 138 mEq/L Ca 9.4 mg/dL Fasting lipid profile K 3.7 mEq/L Phos 3.3 mg/dL T. chol 244 mg/dL Cl 103 mEq/L AST 16 IU/L LDL 141 mg/dL CO2 31 mEq/L ALT 19 IU/L HDL 58 mg/dL BUN 16 mg/dL Alk phos 62 IU/L Trig 225 mg/dL SCr 0.9 mg/dL T. bili 0.4 mg/dL TC/HDL ratio 4.2 Glu (random) 243 mg/dL A1C 10.0%

Required

Create an individualized, patient-centered, team-based care plan to optimize medication therapy for this patient’s diabetes and other drug therapy problems. Include specific drugs, dosage forms, doses, schedules, and duration of therapy.