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Suggest Treatment For Dyslipidemia And Presence Of Microalbuminuria In Urine
Question: A 60 yo Caucasian woman presents to you for endocrine management after an initial visit recently where she was diagnosed with diabetes mellitus. Her PMHx is significant for dyslipidemia and HTN for which she is currently receiving metoprolol XL 100 mg daily and Lipitor 40 mg daily. She has also gained about 20 lbs in the past few years, is an occasional smoker and rarely exercises. Labs performed earlier in the week include SCr of 1.6 mg/dL, HA1C of 9%, BP 150/82, pulse 88. Urine dipstick shows presence of microalbuminuria. Last check of LFTs were WNL. A recent echo performed shows an EF of 35% and EKG was normal. What is your assessment of her current issues? What would be the pharmacological recommendations and why? What would be a good monitoring plan for efficacy and toxicity?
Brief Answer:
Microalbuminuria needs an early intervention in your case.
Detailed Answer:
Hi Mam.
I understand your concern.
As per her test results she seems to have uncontrolled diabetes mellitus which is evident in the form of raised Hb1ac.
For this she needs to be placed on antidiabetic drugs like Metformin.
Elevated body weight needs good control with regular physical exercise.
Both lipitor and metoprolol are absolutely safe drugs in your case.You require their continuation.
Echo and ECG are within normal limits.
Microalbuminuria needs correction through drugs like Ace inhibitors.
Microalbuminuria is a direct indicator of renal damage in diabetic individuals.
Metoprolol and Lipitor are relatively safe and are rarely toxic.
Microalbuminuria needs an early intervention in your case.
Post your further queries if any.
Thank you.
Microalbuminuria needs an early intervention in your case.
Detailed Answer:
Hi Mam.
I understand your concern.
As per her test results she seems to have uncontrolled diabetes mellitus which is evident in the form of raised Hb1ac.
For this she needs to be placed on antidiabetic drugs like Metformin.
Elevated body weight needs good control with regular physical exercise.
Both lipitor and metoprolol are absolutely safe drugs in your case.You require their continuation.
Echo and ECG are within normal limits.
Microalbuminuria needs correction through drugs like Ace inhibitors.
Microalbuminuria is a direct indicator of renal damage in diabetic individuals.
Metoprolol and Lipitor are relatively safe and are rarely toxic.
Microalbuminuria needs an early intervention in your case.
Post your further queries if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. :)
Would a drug like lisinopril be good to add along metoprolol or lisinopril by itself?
would the full regimen consist of
Metformin 250 MG bid
HCTZ 12.5 MG daily
metoprolol XL 100 MG daily
lipitor 40 MG daily
lisinopril??
Also, would she benefit from a sliding scale of regular insulin?
Please advise.
Thanks again!
Because of her creatinine clearance and low EF, would you not use the metformin? and just go with a sliding scale of insulin?
Would a drug like lisinopril be good to add along metoprolol or lisinopril by itself?
would the full regimen consist of
Metformin 250 MG bid
HCTZ 12.5 MG daily
metoprolol XL 100 MG daily
lipitor 40 MG daily
lisinopril??
Also, would she benefit from a sliding scale of regular insulin?
Please advise.
Thanks again!
Because of her creatinine clearance and low EF, would you not use the metformin? and just go with a sliding scale of insulin?
Brief Answer:
Insulin is preferred over Metformin in your case
Detailed Answer:
Hi Mam.
I understand your concern.
Your mentioned regimen should have following changes.
HCTZ has to be avoided in the elderly beyond 60 yrs of age.
Instead of lisinopril,Telma 40 mg can be given for effective control of blood pressure.
Lipitor 40 mg is okay
Metolar XL is better taken as 50 mg twice a day instead of single dose of 100 mg.
Metformin 250mg should be withheld only if sr creatinine is greater than 1.4mg in females.Hence it can be totally avoided in all such periods.
Overall sliding scale regimen of insulin is extremely safe and preferable in your case.
Post your further queries if any.
Thank you.
Insulin is preferred over Metformin in your case
Detailed Answer:
Hi Mam.
I understand your concern.
Your mentioned regimen should have following changes.
HCTZ has to be avoided in the elderly beyond 60 yrs of age.
Instead of lisinopril,Telma 40 mg can be given for effective control of blood pressure.
Lipitor 40 mg is okay
Metolar XL is better taken as 50 mg twice a day instead of single dose of 100 mg.
Metformin 250mg should be withheld only if sr creatinine is greater than 1.4mg in females.Hence it can be totally avoided in all such periods.
Overall sliding scale regimen of insulin is extremely safe and preferable in your case.
Post your further queries if any.
Thank you.
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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