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Investigations and prescription
- 1. Examine the feet, assess: - discoloration - ulcers - sensitivity Estimate eGFR If between 45-60 ml/min/1,73m2 carry out fundus examination every two years or annually when there are signs of retinopathy assess Hb, potassium, calcium, phosphate, PTH, serum albumin and albuminuria. Additional investigations Asses lipids If LDL is >2,5 mmol/L or TC/LDL ratio is >8 Start simvastatin 40 mg/day 83 ml/min/ 1,73 m2* * not corrected for obesity (Salazar-Corcoran)
- 2. Step 4 Patient-specific choice: Metformin because it isn't max yet Hydrochlorothiazide is 1st line drug for hypertension in people with DM Step 3 Non- pharmaceutical: - Lifestyle changes - Like exercising - And losing weight Pharmaceutical: Increase metformin Start hydrochlorothiazide Step 2 Intent of therapy: Prevention (of CVA's) Step 1 The diagnosis and/or problems: - Hypertension - Diabetes II - Obesity Evaluation current treatment: Metformin should be increased Hypertension not treated 6 steps Step 5 Practical: Discuss lifestyle changes If patients is motivated perhaps referral to dietician or other relevant health professional Prescription on the next slide Inform about side-effects: Orthostatic hypotension Nausea Loss of appetite Headache
- 3. 6 steps Step 6 Follow-up: Assess renal function 10-14 days after initiating diuretic How: creatinine, eGFR, potassium Assess compliance Assess effectiveness S van Jole Bloemstraat 28 020-34 56 78 06-02-2015 Rx hydrochlorothiazide 12,5 mg tablet 28 tablets S. 1 tablet in the morning Swallow tablet without chewing Signature: S Mr. D. Mellitus Keienplantsoen 33 3479 XC Groningen Date of birth: 04-05-1959