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TM

NP Bridget

The member was recently discharged from the hospital following a bout with
pneumonia. She also came home with diagnoses of COPD and chronic respiratory
failure. She had seen her primary care provider since being discharged and just
completed her antibiotics and steroid therapy for pneumonia the day prior to
my visit.

She was sent home on a basal insulin as well as a sliding scale (for her high blood
glucose). The insulin was ordered for steroid-induced hyperglycemia. The day prior
to my visit, the member took her blood glucose level prior to dinner and the
reading called for short-acting insulin. She said that after taking the insulin and
eating a light meal, she did not feel well. She checked her blood glucose level and it
was 30 (100 140 would be more normal). She ate additional food, and she did not
take her basal insulin that evening.

Her blood glucose level the following morning was 78. I also discovered that she
had been on a proton pump inhibitor for several years. Current guidelines suggest
an alternative or trial discontinuation be considered.

I reported the findings to her primary care providers office and relayed back to the
member that a nurse would call back before the end of the day with instructions.

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