Problem:
Konane Pelekia, a 65-year-old female client (DOB: 12/1/1959), presents to the clinic for a follow-up appointment to review the results of lab work performed earlier in the week. The NP sent the client for routine lab work as part of her yearly physical. The lab work revealed that the client's kidney function, potassium, and cholesterol were normal, BNP was 110, fasting blood glucose was 155 mg/dL, and hemoglobin A1c was 8.1% with glycosuria present on urinalysis. A point of care (POC) blood glucose at the clinic is 205 mg/dL. An echocardiogram reveals that the client's ejection fraction is 55%. The client has no complaints at the clinic, and the physical exam performed by the NP is otherwise normal. The NP diagnoses the client with type 2 diabetes and considers what medications are appropriate given the client's comorbidities. Past Medical History: Hypertension, Stage C Diastolic (HFpEF) Heart Failure (NYHA Functional Class II) Allergies: None Medications: furosemide (Lasix) 20mg PO BID, lisinopril (Zestril) 10mg PO daily, metoprolol (Lopressor) 50mg PO BID, aspirin 81mg PO daily Social History: She quit smoking cigarettes 40 years ago and does not drink alcohol. Physical Exam: Height: 5 feet 7 inches Weight: 250 lbs Body Mass Index