A 61-year-old Malay female with type 2 diabetes, hypertension, and dyslipidemia presented with poor glycemic control and medication non-compliance. Her HbA1c was 8.0% and she had multiple lipid and blood pressure abnormalities. She was non-compliant with her insulin regimen and sometimes skipped meals or dosed incorrectly, resulting in hypoglycemia. The patient also had poor injection technique and used the same injection sites. She reported tingling in her feet and was advised to restart B vitamin supplements. The patient was also taking unregulated traditional medicines claiming to lower blood sugar.

1. Example Case Presentation
DMTAC
PREPARED BY MUHAMMAD ARIFF BIN MAHDZUB
DIPLOMA IN PHARMACY
UNIVERSITY TEKNOLOGY MARA (UITM)

2. Patient Profile
• Name : OJ
• Age: 61 years old
• Race : Malay
• Gender: Female
• Weight: 62kg

3. Past Medical History
• DM ( ~ 12years)
• HPT
• Dyslipidaemia

4. Laboratory Values
Laboratory Parameters Normal Value
FBS (mmol/L) 4.4 – 6.0 8.3
HbA1c (%) < 6.5 8.0
Blood Pressure (mmHg) < 130/80 140/80
Weight (kg) 62
Sr Creatinine (umol/L) 57-130 98
Total Cholesterol (mmol/L) 3.5 – 5.7 6.3
TGL (mmol/L) 0.6 – 1.6 1.8
LDL (mmol/L) <2.5 4.1
HDL (mmol/L) >1.5 1.62

5. Patient’s Medications
Medicine Dose Frequency
S/C Insulatard 8u on
S/C Actrapid 10u tds
T. Metformin 500mg bd
T. Felodipine 10mg bd
T. Perindopril 6mg od
T. Aspirin 150mg od
T. Simvastatin 40mg on
C. Gemfibrozil 300mg om

6. Compliance
• Modified Morisky Medication Adherence Scale :
Score 5 (non-compliant)
• Simvastatin :
– Sometimes forget so take the morning after
• S/C Actrapid:
– Sometimes inject less
– Sometimes missed afternoon dosage
– Usually injected by husband

7. Diet and Lifestyle
• Breakfast : Light meal, sometimes none
• Lunch : Bought at stall, protein + rice +
vegetables
• Dinner : Biscuits, sometimes none
• Regular caffeine intake
• Very limited physical activities

8. Pharmaceutical Care Issues
 Patient experienced hypoglycemia event before
but rarely ( ~ twice a month). Found that
patient injects 2 hours after meal, sometimes
no meal at all due to the lack of appetite
 Explain the cause of hypoglycemia
 Advise patient for regular meal intake
 Educate patient on how to treat hypoglycemia

9. Pharmaceutical Care Issues (2)
 Discovered that patient injected insulin at the
same abdominal area. Patient thought that by
‘different area’ just means not directly on the
previous spot.
 Explain to patient to inject roughly 1-2cm from
the previous injection site.
 To have a proper rotation for easier
memorization.
 Check injection technique

10. Pharmaceutical Care Issues (3)
 Patient complained of tingling sensation of
foot. Patient was prescribed with Vitamin B1,
B6, B12 before but was stopped due to non
compliant.
 Explain to patient that the tingling might be
due to insufficient amount of Vitamin B12 in
the body
 Suggest to restart Vitamin B1, B6, B12.

11. Pharmaceutical Care Issues (4)
 Patient admitted to take some traditional
medicines that claimed to reduce glucose level.
 Advise patient to stop taking or to space in
between meds if reluctant
 If patient still want to take, must consult with
doctor to avoid drugs interaction
 Educate patient regarding registered medicines
and to exercise caution when buying
supplements