Dear Class.

Below is the first assignment for you all to solve a case of DM. Since it is group based task, I will
hence request you to please take equal responsibility while discussing and writing up the report.

Moreover, please be honest with yourselves and solve Stem 1 before moving to Stem 2 and further.

Hope to see your responses in a compiled form soon (Friday 5pm, 19th Nov/21).

Best wishes.

Atif.
Stem 1
MF, a 32-year-old working class man visited a clinic with mild fever, productive cough and general
feeling of being unwell. He is 178 cm tall and weighs 134 kg. He has not been to the doctor in 5 years
and in today’s visit, he is diagnosed with upper respiratory tract infection. He visits the local free
clinic, and the following is discovered when labs and physical assessment are performed:

- Fasting glucose: 10.49 mmol/L

- BUN: 4.64 mmol/L
- Creatinine: 106 µmol/L
- Hemoglobin A1c: 11%
- BP (blood pressure): 167/98 mm Hg

1. What information is suggestive of diabetes?

2. What criteria must be met before a diagnosis of diabetes can be made?
3. What type of diabetes do you think MF has based on his clinical characteristics?
4. What challenges can you identify for optimal clinical outcomes through the initial
assessments for MF?
5. What additional information do you need to know before creating a treatment plan for this
patient?

Stem 2
MF comes back 1 week later for you to review the laboratory results with him and to determine if
medications are necessary. When you check his FBG level today, the result is 11.7 mmol/L. A
diagnosis of DM is made, but you have no other blood glucose records. His past medical history
states occasional sinus infections over the last several years and as per his last eye examination
about 6 years ago, he now believes he could use new glasses. His father had hypertension and
history of myocardial infarction while his mother has history of type 2 DM, hypertension, and
obesity. He usually prefers fast food, sweets and baked items, and carbonated drinks. He does not
has any notable physical activity routine but does walk around about 30 minutes a day.

1. What nonpharmacologic and pharmacologic approaches are available for MF?

2. What are your treatment goals for MF regarding blood glucose, blood pressure, and lipids?
3. Create a pharmaceutical care plan for MF’s DM including follow-up plan to evaluate whether
MF’s goals for therapy have been achieved and adverse effects avoided.
4. Are there any specialist care providers you would refer MF to?

Stem 3
Several years have passed since you have been following MF’s therapy. His weight is down to 104.6
kg, and he tries to maintain his diet and exercise. His recent HbA1c levels have increased up to 8.4%
from 7.2% despite combination therapy with sulfonylureas and metformin. The physician believes
that it is time to start insulin therapy for MF and asks you to initiate therapy and follow his regimen.

1. What insulin therapy would you choose for MF?

2. How would you transition MF to insulin?